Blog | Monday, June 24, 2013

Medical telephone etiquette (and lack thereof)


This post may be in the nature of a rant. It may not even be entirely a medical topic, but it touches on my medical practice and one of its constant frustrations: communication between us physicians and between us and our patients, and the tools we use. In this case, I mean the telephone.

It's a shame we still need to use telephones. Using the phone used to be easy, but now it's more of an inconvenience and a frustration for all concerned. The days of a simple phone call to the doctor being promptly and courteously answered by a receptionist and a simple message taken are bygone. Now we are usually greeted by the "automated attendant." What an abominable excuse for communication that has become. The patients think the process has become frustrating and sometimes infuriating, but it has become that way for me as a physician as well.

Here are just a few irritants I would like to know who devised so I can post their names on the Internet.

1. "Your call is very important to us." A doubtful proposition to begin with when it's the same greeting everyone receives while waiting. But can they really expect us to be even more convinced of our importance after hearing it repeated for the fourth time?

2. "If this is a true medical emergency, hang up and call 911 immediately." Only a moron or someone living in a cave the past 30 years would wait to listen to that advice from a recorded menu while they or their loved one is gasping for breath!

3. "Please listen carefully to the following options." Of course I am listening to the options carefully! You had me at "You have reached the office of ..." God forbid I choose the wrong one and wind up in automated limbo. But do you need nine different options? I might listen patiently to three, but can I be forgiven if my attention wanders after #8? And just in case you think you already know the options, you may be told that "our menu has changed." I sometimes wonder what item on the menu is the special of the day!

4. A human being answers, and the first words out of (usually) her mouth are, "Dr. Smith's office, please hold." followed by hold music. And don't get me started about hold music consisting of advertisements for whoever you are holding for. My hospital is a notable offender there.

5. The person answering actually gives me what would seem to be an option: "Can you hold?" If I am in a good mood and my hands otherwise occupied, I say "Certainly, I'm very good at it." If the matter is more pressing I say, "No, I can't. This is Dr. Sack and I need to speak with Dr. X right away." Amazing how quickly I get results. If I am in a foul mood, I am sorely tempted to answer "Can you hold?" with "Hold what?"

6. I get a human being but one who was never taught old-fashioned telephone etiquette. The person answering the phone doesn't identify himself/herself. Sometimes it doesn't matter. But often it helps to know who took the message and if they are someone I can expect knows who I am. I called the ICU last week and the person at the desk answered "Hello?" I said "This is Dr. Sack. Who is this?" She replied "the ICU". To which I responded, "I know that. I called you!"(I am thinking, "You ninny!"). What's so hard about answering "ICU, Betty."?

7. The interminable human recitation. This corporate "professional greeting" is infecting more and more doctor's offices now that more and more of my colleagues are working for Big Brother. (Did I say that? I mean The Hospital.) I used to get "Surgical Specialists, Jasmine speaking." Now I am greeted with "Big Hospital Surgical Specialists, an affiliate of Big Hospital Medical Group, with affiliates in Gotham and Podunk, Jasmine speaking. How may I assist you?" And the poor receptionist has to repeat this oration several dozen times a day! It's a wonder she has time to do anything else!

8. And my personal bugaboo: the emergency room page. I receive a summons on my pager (actually a text to my phone from my service) to call the ER. The secretary answers and says, "Yes, Dr. Jones needs to speak with you about a GI bleeder. I'll get him." Then 3 minutes go by. Now I am tethered to the line. I wonder if I should just pitch a tent. Then someone picks up and asks who I am holding for. Then, apologies. Or after several minutes I get tired of waiting, hang up and call again. "Oh, he didn't pick up? I'll try again." Sometimes I get paged as I am putting on clothes in the morning. Have you ever tried buttoning a shirt with a phone in your hand? Thank goodness for the speaker phone!

9. The patient whose phone line is busy when you return their call. Sometimes it is because they are summoning the ambulance. Most of the time it's just thoughtlessness.

10. My receptionist buzzes me: "Dr. Sack, doctor so-and-so is on line 4." My receptionist sometimes fails to mention that it isn't "doctor so-and-so"; it's her secretary. There's little that makes me feel as foolish as having offered an enthusiastic greeting to my colleague only to hear, "Just a minute, I'll put her on." I suppose my staff probably perpetrate the same thing on other doctors when I call them. But lately they have been learning to tell me, "It's Dr. Jones' office on the phone. Pick up on 4, they are getting him."

All these nuisances and inconveniences are the reason why I think we doctors are entering a new era. The landline has been obsolete among the youth of our nation for over a decade. Soon it will be a thing of the past for us doctors as well. Now if I want to call my friend Doctor X, and I have his cell phone number, I dial that myself. It's amazing how well that works and how much it frees up our receptionists for more important tasks, like answering the patient calls and actually speaking with them immediately!

David M. Sack, MD, is a Fellow of the American College of Physicians. He attended Harvard and Johns Hopkins Medical School. He completed his residency at Lenox Hill Hospital in New York City and a gastroenterology fellowship at Beth Israel-Deaconess, which he completed in 1983. Since then he has practiced general gastroenterology at a small community hospital in Connecticut. This post originally appeared at his blog, Prescriptions, a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.