THE TELEPHONE IN YOUR PRACTICE – GOOD PATIENT RELATIONS RESULTS IN GOOD RISK MANAGEMENT

Telephone calls are a vibrant part of your office practice. Patients call for many reasons – to make appointments, to ask questions about their bills, and to inquire about health matters. Practices need to recognize that there is both great opportunity and high risk in how those calls are managed. Good telephone etiquette and internal procedures for handling calls is a must. Many allegations of malpractice can be thwarted by accurate documentation of patient phone calls. Likewise, sloppy or nonexistence phone records can hurt your chances of providing a quick defense to an untoward allegation.

Telephone Etiquette

Consider the telephone to be one of your office’s first public relations tools. Calls that are answered promptly, with a cheery and helpful approach will help your office appear professional, caring, and responsive. Poor phone systems may show your office as uncaring, unprofessional, and unresponsive, which can lead to allegations of professional negligence.

The following are some suggestions on how to make patients’ phone contacts with your office high-level.

Good telephone technique dictates that the doctor’s office be identified as well as the person answering the call.  This is helpful to patients who may be transferred around and then cannot remember who was to help them.  Everyone in the practice should answer the call, even transfer calls, with their name.

People hate being put on hold.  They especially hate being put on hold before they have even been able to describe the reason for the phone call. Most telephone calls can be diverted to someone else in the practice within a few seconds.  It is more time-efficient and considerate to try to handle each call first, then putting it on hold for a short time if necessary.  If this is a constant situation in your practice, you should consider getting more help for the telephone, especially during the peak telephone times and busy days like Mondays and Fridays.

A number of physicians like to call their own office to see how their calls are handled. This can give you great insights into how your office sounds to patients.

Cam you can “hear a smile” over the phone? Of course a smile can be heard.  Hopefully, the people answering the phone in your office enjoy the job and smile to their patients, even on the phone.  The people on the phone should be told how important their job is and how much their efforts to take care of the patient are appreciated by everyone. Telephone work is very demanding and it should not be considered as the bottom rung in your medical office ladder.

There should be a protocol for handling abusive callers.  No one in your office should be subjected to verbal abuse.  Whether it be finding a nice way to hang up on the patient, to calm the patient down, or to transfer the patient to a higher authority in the office, some protocol should be established.

Whenever possible, you or your staff should speak directly to the patient.  The further removed the physician is from the patient, the more difficult it is to get an accurate picture of the situation.  When family members relay information, it is not as accurate as when speaking directly to the patient.  Also, the more people involved in relaying a message, the more possibility of a garbled message.  Remember the children’s game, “Telephone?”

Some patients do not call their doctor’s office for fear that the call is trivial and they are causing an inconvenience.  You need to encourage your patients to call so that they feel their needs are being met.  “Thank you for calling” is a wonderful way to make the patient feel important.

The entire staff needs to be trained in how to avoid giving confidential information. They need to be warned of common ploys people use to try to get information about their spouses, children, employees, and others, when it is not their right to have this information. Offices have been sued for breach of patient confidentiality.  This happens especially easily over the phone.

Patients love to listen and see everything that goes on in your office.  If they are able to overhear telephone calls, then patient confidentiality is certainly compromised.  It might also hinder them from making calls to your office when they know that other people can easily overhear.

Many times patients who call to speak to the doctor are told that the doctor will call them back.  However, if the patient does not know when to expect the call, the doctor and the patient might miss one another. This can be a serious problem. If your staff knows that you return morning calls between 12:00 and 1:00 p.m. and afternoon calls between 5:00 and 6:00 p.m., for example, they should tell the patient to expect the call then. They should further ask the patient at what number they can be reached during that period of time.

Many patients insist on speaking only to the doctor.  Most busy practices these days do not afford the physician the luxury of taking patient calls when they come in.  However, patients should not be browbeaten into telling others what their concerns are. They can be asked if they would like to speak to the nurse or office manager.  If they still resist, then the doctor should make every effort to speak directly with the patient.

It is helpful for all people answering the phone to know what calls go immediately to the doctor.  This list should be updated as necessary and given to new employees also.

Phone Call Documentation

A pertinent medical telephone call which is not documented in the record is no proof of what was said by you or by the patient.  In a court of law, it would be your word against the patient’s.  It is recommended that the telephone slip, including all the pertinent data, be put directly into the patient’s medical chart along with the follow-up information; specifically, the time and date of the call, who returned the call, and what instructions were given to the patient.  If your office is using EMRs, the information should be written into the chart immediately. Night calls should be handled in the same manner.  You might consider dictating your evening and weekend calls or writing them down and getting them into the chart in a timely manner.

The telephone note should be permanently attached in the record, or a clearly dictated note regarding the telephone call, its time, and date should be put into the chart.

Telephone calls in the evening and on weekends need to be documented as well as those in the daytime.

You should review the nurses’ hospital notes against your telephone orders in the hospital chart to make sure the information is as you recall giving it.  If it is not, you should then make the necessary alterations in the chart in the acceptable ways.

Research shows that psychotropic drugs are more likely to be prescribed over the phone than in person.  You do not need to prescribe such drugs to people, especially those who are not your patients, no matter what their reason.  In resort towns where there are many visitors, it can be tempting to provide such drugs over the phone.  However, this should not be done without first seeing the patient.

Whoever is responsible for calling for laboratory reports in your office should be advised to clearly write down the following information:  the name of the technician who called, his or her shift, the date and time of the call, verify the patient’s name, and clearly read back the values.  Please make sure that when the written lab report comes in that it is checked against the oral report taken.

In summary, the telephone in your practice is an active source of communication between you and your patients. Make sure that these interchanges are polite, helpful, caring, and professional. Make sure to document all medical phone calls to keep an accurate, on-going record of the important information given and received.

IND offers three risk management programs per year, two in Las Vegas and one in Reno.  In addition, tailored programs are also held for nurses, administrators, and medical office staff.  Information regarding these programs can be found here:  http://www.ind-insurance.com/risk-management.  Please contact Idora Silver, IND Director of Risk Management, at (775) 829-0606 if you have any specific risk management questions or would like to consult with her on customizing a program specific to your needs.