American College of Physicians: Internal Medicine — Doctors for Adults ®

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.

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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

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David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

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Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

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Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

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Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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