I work in a fantastic place. About 14 years ago, I transferred away from primary care to dermatology and have never looked back. I’m now seeing more patients per day than I’ve ever done, and I no longer stay hours behind after the office is closed. For once, I leave the office as scheduled. One difference in the practices repeatedly rises above others to explain why that might be. The big difference is that we answer our phones. Immediately, in person, and without fail.
I’m quite sure there’s no need to detail why primary care has become an unbearable area of medicine, but I do have a bone to pick with one of the solutions to the overburdened and underpaid PCPs have chosen to alleviate their stress: It is now the norm, not the exception, to shut the phones down in the middle of the day. The excuse is lunch, but we all know it is to allow the staff to catch up with work. It is that hour or so in the middle of the day when you can do your work without constant interruptions. It doesn’t seem to make any difference what kind of a practice you call, whether huge hospital systems or small private offices. The phones are off for lunch.
The two aspects of medicine appear, to some degree, to be in constant conflict with each other. We train for years to help people. Our brains thrive on solving medical mysteries, the quest for constant learning, and the ability to sort through a barrage of information in nanoseconds to choose the right intervention on the spot. But we also run a for-profit business. We provide a huge chunk of the overall economy to our communities. The business is constantly battling to keep the patients and insurance companies happy, staff content, and bank accounts solvent. Doing a better job with patients is in no way a guarantee for a promise of a more successful business. The relationship is actually more inverse: The more time you spend, the less you’re paid. And, if you bill for your extra time, be prepared to pay your billing department to challenge the denied charges.
But even under the constant need for more time to do the work, I can’t see how closing your business in the middle of the day is good for you. As a private person, the only time I can make appointments for myself is during lunch. It is the same for the vast majority of all of us, isn’t it? This is exactly when the phones are now turned off. But I’ve also started to notice phones being off at any time of the day. I have several experiences with trying to schedule an urgent follow-up for a patient still in my office, only to get a recorded message from the specialist asking for a number to call back “as soon as possible.” Just recently, one of my colleagues was trying to update an oncologist over the phone about a patient’s adverse reaction to the new chemo. Four days and repeated messages later, she’s still waiting for that call-back. Our surgical coordinator spent 20 minutes on hold today, waiting for a PCP to just answer the phone after I asked her to get an urgent referral for the treatment of numerous invasive cancers. She finally sent a fax because no one answered. Just like the patient had warned us.
Phones are the lifeline to the success of your practice. It is the primary contact for patients. This is where the new patients reach out to you. It is also the primary contact for managing your own schedule. You do prefer knowing about the cancellations, don’t you? Missed calls wreck your schedule, and create administrative bottlenecks for the remainder of the day. Phone calls are the primary mode for collaboration with other disciplines. It is the avenue for urgent updates, as well as side notes for helping with the care of a complex patient. I have had staff call an ambulance to a patient’s address while I’ve been on the phone with her on another line, so telling anybody to call 911 in case of an emergency is also rather pointless. If people know it is an emergency, they will call 911. They just don’t always know that, and they’ve been told to “ask your doctor.”
In short, answering our phones all day continues to raise our service head above others in patient satisfaction. Everybody, even the tiny babies, now carry that convenient little communicator on them 24/7. We have no recorded messages to call 911. If the lines get too busy, we have a support service off-site who are our employees rather than an answering service. Ask your IT manager: They very likely already know of services that work for them off-hours. With VOIP, it is easy to set up alternate locations, and with chat engines and online scheduling, they help us more than just answering the phones. We promise our patients that all calls are returned the same day. Our schedules remain flexible when patients know they can make a 20-second phone call to cancel an appointment, even at the last moment. Or call from the road to notify of an unexpected delay. The phone is our lifeline, not our enemy. It is yours too; you just have to answer it!
Marianna Helin is a nurse practitioner.
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