Yes HANS DUVEFELT
My nurse regularly receives at least 50 voice messages every day, many say “please call me.”
I have a patient who often tests the patience of our clinic staff by calling several times for the same thing. It’s the most dramatic example of what appears to be a widespread belief that doctors, nurses and medical assistants sit at their desks and answer phone calls all or most of their time. But when we do, we are often hampered by busy signals, phone tags or “voice mail not installed”. Email is not a panacea, because patients do not necessarily know what they need to know to answer their questions correctly and effectively at the first contact.
Pharmacies also create duplicate questions that clutter our working days. In my EMR, if an electronic top-up request does not receive a response the next day, the “system” sends a repeated request each day until it is done. This is one of the reasons why I seem more behind the “activities” of what I really am. To complete, each single recharge request generated by the “system” comes with a red exclamation point next to it. This also happens when a patient has just collected the last 90-day recharge – a case where theoretically I should have 89 days to respond. Meanwhile, my system has no way to mark really urgent recharge requests. This “alarm fatigue”It’s common in EMR today.
The business model in today’s healthcare is that reimbursable activities (see patients in person or via telemedicine) are planned over and over again, throughout the day. There is a universal assumption that this always provides enough calm to deal with prescription relapses, phone calls, incoming reports and further ordering and feedback to patients ordered by them. And did I mention the EMR documentation? Multitasking, or rather, constantly switching between different types of tasks is not a healthy or efficient way to work.
Suppliers, as salaried employees, are universally expected to do their job on time (jokingly calling it “pajama time”). This creates varying degrees of stress and burnout. But nurses and medical assistants have different stress. As hourly employees, they are theoretically entitled to overtime pay if they are unable to finish their work during their normal working hours. But this is expensive for healthcare organizations and often discouraged or banned.
In Sweden, known for its somewhat robust bureaucracy, clinics have almost universal “telefontid,” a part of the day when patients can call, or when staff don’t see patients but come back to call – details can varies. This may not be the ideal customer service, but it recognizes at least that versatility in healthcare is not always necessary and certainly not healthy.
A growing trend in this country, mysterious to me and a generator of patient frustration and employee stress, is that despite all our expensive computers and phone systems – or perhaps because of them – most of them clinics, even large organizations, cannot afford to have anyone answering the phone.
St. Joseph’s Hospital in Bangor usually responds on the first ring, and the main operator (so his voice sounds good) is efficient and helpful. My mother worked as an operator for a large hotel and also at some point the telephone company. I remember looking at his efficiency plugging those little cables to transfer the calls to the right department. Most clinics and hospitals tell you to hang up and call 911 if you’re in trouble and make you “listen carefully” to all the action, threatening that they “might change” and finally , you end up in someone’s voice.
When everyone talks about patient focus, customer experience and things like that, it’s not obvious that incoming calls and other types of requests should be prioritized while they arrive and not just dumped, unsorted, in the voicemail. or someone’s inbox?
Organizations seem paranoid about being held accountable if non-clinicians are put in a position to “triage” incoming calls. But it’s not a science of breeds – everyone does it at home, with their children, pets and themselves. I think it can be an even bigger responsibility to have an automated phone system where people get lost or stop.
Here are two slides from a talk about staff training I gave it 10 years ago about common sense triage.
The telephone was a powerful tool, connecting people with business, services and others. It doesn’t work as well as before, so no one responds.
Hans Duvefelt is a Swedish-born rural family physician in Maine. This post initially appeared on his blog, A Country Doctor Writes, here.