My nurse regularly receives at least 50 voicemail messages each day, many saying “please call me back”.

I have a patient who frequently tests the patience of our clinic staff by calling multiple times for the same thing. It is the most dramatic example of what appears to be a widely held 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’re often hampered by busy signals, phone tag, or “unconfigured voicemail.” Email is not a panacea, as patients may not know what it takes to answer their questions correctly and effectively on the first contact.

Pharmacies, too, create duplicate demands that slow down our workdays. In my EMR, if an electronic recharge request is not answered on the day it arrives, the “system” sends out a new request every day until it is completed. This is one of the reasons I seem to be more behind on “tasks” than I really am. To top it off, each recharge request generated by the “system” is accompanied by a red exclamation mark. This happens even when a patient has just picked up their last 90-day refill – a case where I should theoretically have 89 days to respond. During this time, my system has no way of reporting really urgent recharge requests. This “fatigue alarmIs common in EMRs today.

The business model in healthcare today is that reimbursable activities (seeing patients in person or via telemedicine) are scheduled consecutively, throughout the day. There is a universal assumption that this will always provide enough headroom to process prescription refills, phone calls, incoming reports, and subsequent patient orders and comments resulting from it. 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.

Providers, as salaried employees, are universally expected to do their jobs in their free time (jokingly called “pajama time”). This creates varying degrees of stress and burnout. But nurses and medical assistants have a different stress. As hourly employees, they are theoretically entitled to overtime pay if they cannot complete their work during their normal working hours. But it is expensive for health organizations and is often discouraged or prohibited.

In Sweden, known for its somewhat cumbersome bureaucracy, clinics almost universally have ‘telefontid’, a part of the day when patients can call, or when staff do not see patients but answer calls – details may vary. It might not be ideal customer service, but it at least recognizes that multitasking in healthcare isn’t always necessary and certainly not healthy.

A growing trend in this country, mysterious to me and causing frustration for patients and stress for employees, is that despite all of our expensive computers and phone systems – or maybe because of them – most clinics, even large organizations, cannot afford to ask someone to answer the phone.

St Joseph’s Hospital in Bangor usually answers the first ring and the main operator (I know her voice well) is efficient and helpful. My mother worked as an operator for a large hotel and also at one point for the telephone company. I remember how effective it was at plugging in those little cables to transfer callers to the right department. Most clinics and hospitals tell you to hang up and call 911 if you have any problems and make you ‘listen carefully’ to all the options, threatening that they ‘may have changed’ and that you will end up. find someone’s voicemail.

When everyone is talking about patient orientation, customer experience and the like, why isn’t it obvious that inbound calls and other types of requests should be prioritized as they come in and not just thrown, unsorted, into someone’s voicemail or inbox?

Organizations seem paranoid about being held accountable if non-clinicians are put in a position to “sort” incoming calls. But it’s not rocket science – everyone does it at home, with their kids, pets, and themselves. I think it can be an even bigger responsibility to have an automated phone system that people get lost in or get stuck in.

Here are two slides of a staff education speech I gave up 10 years ago on common sense telephone triage.

The telephone was a powerful tool, connecting people with businesses, departments and with each other. It doesn’t work like it used to because no one is responding.

Hans Duvefelt is a rural family physician born in Sweden in Maine. This article originally appeared on his blog, A Country Doctor Writes, here.

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