Sunday, October 08, 2006

Answering services should not make it hard to talk to physician

A recent article in the September/October issue of the Journal of the American Board of Family Practice by David Hildebrandt called attention to an issue with some answering services techniques that serve to prevent patients from contacting their physicians. By simply being asked "Is this an emergency?", many contacts with the physician are eliminated. Patients often call their doctor because they do not know if the issue is serious enough to be considered an emergency or not. This "filtering" technique does not serve the interests of the patient.Procedural barriers limiting contact with doctors cannot be in the physicians' s best interests either.

The survey admittedly was small, only 35 physicians offices were contacted and of those 14 used answering services and 9 of those asked the patients to decide if their call should be fowarded to the doctor. The small sample size precludes robust conclusions about how widespread the practice might be. An larger earlier study by the same lead author involved 91 primary care offices and in 55 the answering services "forced" the patients to decide if it was an emergency requiring a call back from the physician. Clearly ,this is not a good practice but I have encountered worse. I have attempted to contact physicians after hours, and sometimes on Friday afternoon and been unable to contact them at all or anyone providing coverage. The answering machine-not even a human- informs the caller what the office hours are and that if they have an emergency they should go to the nearest emergency room.

Another approach is the nurse telephone triage. While this is better I have some uneasy feeling about this as well. When you get old and cranky you tend to think if things are not done like you did them they are off base. When I was in private practice all calls were referred by the answering service to either the patient's physician or the on call doctor.

Dr. Bruce Bagley,the medical director for quality at the American Academy of Family Physicians, is quoted in the American Medical News story about the article:

"You want the highest level clinical person determining what's an emergency, not a person at an answering service who knows nothing from nothing."

6 comments:

Anonymous said...

Doctors can make the rules clear to their answering services; I'd say, in other words, it's up to the doc to see that it's not the service that's deciding. If someone called for me, I got the call. The only thing the service did was collect a little basic info so I'd know whether to drop everything and return the call or if I had time to finish what I was doing. The problem with answering services is that they regularly get confused (it's a hard job, typically too few people handling too many calls) about who's on call, which docs had what instructions. My problem, for the most part, was that they DIDN"T call me, forgetting I wanted to be informed no matter who was on call

james gaulte said...

Thanks for the comment.The way I had written the post seemed to imply the answering services were the villians.Of course, the doctors are the ones who should be giving the instructions to the service.In my group IM practice a physician called every patient back after being notified by the service.

Carol said...

In college I worked at an answering service. Our favorite doctors were the ones who gave instructions like this:

Tell the patients I check in for calls ever hour or so. Ask them if they can wait until then, or if you need to page me urgently.

The patients liked not being pressured to choose emergency or not. The patients rarely even chose urgent because they knew they WOULD get a call from the doctor, and the doctor got to respond to urgent needs while still being able to have supper or read to his/her kid. The key was...the doctor had to remember to check in!

The Independent Urologist said...

I am in solo practice urology and have established absolutely no barriers after hours between existing patients, prospective patients, or referring doctors and me. And I am rarely, if ever called! I found, as others have, that when you, the physician, makes it clear that you are available, patients are respectful.
Richard A Schoor MD FACS
www.theindependenturologist.com

Doctor Answering Service said...

The prime objective of a physician answering service is to help patients to get in touch with their doctor in case of an emergency, but both, doctors as well as patients misuse this service. Doctors try to filter the calls for their convenience and patients keep on bothering their doctor for less important queries. Their should be a balance in the approach.

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