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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Monday, March 21, 2011

When Your Doctor Doesn’t Return Your Call…

Maybe my expectations are too high, since I do return phone calls to my patients. However, unless it is a true emergency, I do not make scheduled patients wait in the room in order to return calls. I will return non-urgent calls when there is a lull in my schedule. I called my own doctor in the morning. It has been over 24 hours, and I did not get a call-back. It is now the weekend, so I suspect I will not.

There may be several scenarios:

1. She had an emergency; either at home (she has a new baby) or in the office (chaotic).

2. She never got the message on her email, never looked at her emails, or lost a paper message on her desk.

3. She got the message but didn’t have time to call me.

4. She got the message, saw it was from me, and ignored it (I hope that wasn’t the case).

5. She had so many messages, that mine never made it to the top of her personal “triage”.

6. She told someone else to call me back to make an appointment, but they did not do it.

7. The front desk gave her the wrong phone number.

8. Hell opened up and sucked in all of the urologists.

Being on both ends of this issue, I suspect there may be other factors. The bottom line: She didn’t call me.  Not that I expect a different level of response because we are both medical providers in the same group, but we are supposed to take care of each other. I was disappointed; especially after I got a bill for $444 for my initial office visit (this did not include lab and x-rays). She was a lot better than my last urologist, who never even touched me or made a note on my chart (this is not an exaggeration). He no longer works in the group.

Our patients can now email us, if they sign up for this free service. Email responses are typically faster and better than playing phone-tag. I tried to email my doctor, but again, no response. My primary care doctor, on the other hand, calls or emails me back surprisingly fast — every efficient.

I have patients that will call and give me a narrow window to call them back. It ain’t going to happen. When I am in the office, I am not sitting around waiting for calls. I am actively seeing patients. Non-urgent phone calls go on the back burner until lunch time, or after my scheduled patients have been seen. More urgent calls go to may email, printed out, and placed in big, red file folder right in front of my computer screen. Many times, what a patient considers to be urgent (they need an immediate call since they have to board a plane), I do not share.

My patients have learned to expect and tolerate some chewing in the background when I return calls. I work 12-13 hour shifts, so many patients get a call back at 9 PM. I make it a point to acknowledge the response delay right away (to defuse any possible anger), apologize, and quickly get to their question. Many will feel sorry from me, working so late. A few will be angry about the delay, but I can handle those, too.

I instruct the message-takers in my office to tell my patients that I may not call back until late this evening; that I am seeing patients and my schedule is full (always true). I instruct the message-taker to double-check the phone numbers (doesn’t always happen), but I still get a lot of wrong numbers, home numbers when they are at work, work numbers when they are at home, and cell numbers that have been “disconnected or changed”. There is nothing more frustrating in a busy day, than to try to call someone, and not be able to connect. I make a chart indication with the time of each of my attempts, in case someone claims that I never called them back. This is the real issue with phone medicine.

I call. The line is busy. If there is an answering machine, I leave a message. However, patients cannot return calls after the office has closed. After a few dozen rings, they will get a lengthy message to call “9-1-1″ if this is an emergency, perhaps some pointless advertising, an old announcement about the H1N1 influenza vaccine (that we are really not giving now), followed by some very disagreeable music-on-hold. Eventually, the phantom answering service will pick-up, play stupid and then inform the patient that the office has closed. Daaaah! It is 9 PM; of course we are closed. They will then take a detailed message and promise to get it to me. Several days later, I may or may not get it.  If I really want a patient that I have been playing phone-tag with all day to get through this crap, I tell the patient to inform the answering service that they are returning my call; I am in the office and to just ring through. This works most of the time.

My contractor, “Dr. Zeiszler”, gets through to me quite easily. He informs the front desk that “Dr. Zieszler is returning his call.” Since Front Desk people are inherently afraid of doctors, they will knock on my exam room door to inform me. If I have sterile gloves on and up to my elbows is stuff that you don’t want to know about, I will call him back, relatively quickly, to discuss the new sink or whatever. Dr. Zeiszler loves doing this. Since his hourly rate is higher than mine, I call him back as quickly as I can.

Phone messages that I answer later:

  • “Patient would like to discuss her son’s constipation.”
  • “Doesn’t want to come in. Just wants you to call in an antibiotic.”
  • “Has been sick for over two weeks. Needs to be seen right away. Your schedule is full.”
  • “Hasn’t been seen for over a year. Will you refill her medications?”
  • “Would like to start birth control pills….today. Please call on cell phone.”
  • “Missed work (or school) all week. Just needs you to fax a note.”

Messages that I try to answer immediately:

  • “Child fell and has facial laceration that needs stitches.”
  • “Patient has right-lower quadrant abdominal pain. Suspect appendicitis.”
  • “I think my husband had a stroke.”
  • “Patient is waiting in the pharmacy (or lab) and you forgot to send in the order/prescription.”
  • “Your wife (or daughter or son) is on the phone.”
  • “Dr. Zeiszler is returning your call.”

It is the next day and my own doctor has still not responded, so I am on my own. If you have read any of my past blog posts, you know that I have been passing kidney stones like a human Pez dispenser. Kidney stones have this annoying habit of taking their sweet ‘ol, painful time transiting the tiny ureters — a pain that has been described as equivalent to having a baby (a comparison that I can never truly make). I really know how to treat myself if I must, but it would be nice to have some input from a specialist from time to time. With the exception of not having an IV set-up and a CT scanner at home, I am well-prepared. I have done this before.

My wife is a PA and (usually) does any injections that I may need. But lately she has been upset at me since I complained about her technique (which was wrong, incidentally) and that she was too slow. Not only did she stick me in the wrong gluteal spot, she denied it, left the needle in for a painful five seconds, and then pulled it out without even injecting the medicine! My leg is now tingling, but I know better than to bring this up. Of course, my yelling did not help. When in pain, a patient is not on their best behavior. I really hope that she didn’t hurt me on purpose.

The last injection, I had to give to myself.

Posted by: Rod Moser, PA, PhD at 8:03 am

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