Telephone etiquette, key to a successful practice

January 2006

Eugenia Marcus, MD, educated us all in October with her excellent, informative article about electronic medical records. Although it’s never enviable to follow a great performance, here comes another article on technology.

What low-tech device is ubiquitous, serves multiple functions, costs physicians money, yet helps make money and is indispensable?

The telephone, of course!

The first contact most patients have with their physician’s office is through the telephone. This contact may occur when a patient who has not met you calls the office to discuss an urgent issue or to schedule a first visit. The manner in which the phone is answered gives an important first impression of your office. If your office gives a negative impression, it may be the last time that patient calls you.

Anyone can answer the phone as long as she is well informed and has a good-working knowledge of how the office functions. For example, if someone is unable to answer the patient’s question(s), she must know who in the office can answer the questions or where to direct the call; connecting a patient to multiple people without securing an answer is frustrating.

Equally frustrating, especially to a frightened patient or a patient in pain, is a call that is answered by a voice messaging system, listing a menu of choices, none of which are the option desired. Although a human voice is more expensive, it is also more personal.

First contact

How to answer the phone is equally important. The call should be answered this way: “Hello, Dr. Lander’s office (or your group name). Barbara speaking, may I help you?” This way, the person who answers the phone identifies the name of your office and herself. The latter is important because if any misinformation is given or there is any problem reported by the patient, you can easily identify the source.

When Barbara answers the call and puts the patient on hold, she must add, “Will you hold please?” Wait for a reply, rather then hitting the hold button immediately. Imagine calling your physician with an emergency and being placed on hold. It should not surprise the administrator when she returns to the line to find an angry patient.

How many phones necessary?

It’s not easy to decide the number of telephone lines an office needs to run efficiently.

Adding an additional line is easy; it only costs money. But will you now have more patients on hold or will it necessitate hiring additional personnel? More personnel means more wages, more employees on the office health plan and additional monies contributed to the pension plan.

Other businesses monitor the individual response time to a call and the dropped call rate (ie, how many times the person calling hangs up before the operator can actually talk with them). Perhaps physicians should monitor these things as well. Often in our office, staff members make 10- to 20-minute phone calls when dealing with managed care representatives. Imagine the dropped call rate during these periods!

Toward this end, we have started to make the families more responsible for their health care: We have them make many of these calls. It is important to cut down the time a patient is on hold. A prolonged wait is all the justification a patient needs to become an ex-patient.

Many phone companies can, in a given time, measure the percentage of time your phone lines are busy. If it’s a significant percentage of time, add an additional line, making sure that you have the personnel to support it.

Calls to patients

It is imperative to triage the medical questions that are asked over the phone, which can be handled in several ways. There are published phone triage protocols that you can purchase to help with this issue. In some offices, a nurse handles phone triage. Some offices train their secretarial staff to ask specific questions. This information is given to the physicians who then provide the answers.

Of course, with this approach, the patient must be given the opportunity to speak directly with a physician if they are uncomfortable talking with an intermediary.

Other than emergency calls that require the immediate attention of a physician, the physicians in our office call patients back at lunch or at the end of the workday. When patients have to be called back, we ask for the phone number where they can be reached. We do not accept an office number, a home number and a cell phone number, unless specific times, indicating when and where a patient is available, are included with each number. Physicians should not have to call more than one number to return a call.

Having physician phone hours can be a practice builder. In our office, a physician answers the phone personally from 8:30 a.m. to 9:00 a.m. Many times, we are simply triaging the patients who were sick during the night and determining which patients should come for a visit. At other times, we are dispensing quick advice about medicine dosages or feeding questions or toilet training issues. If a question requires more than a quick answer, the patient is given an appointment for a consultation.

Reaching the physician

In a pediatric practice, patients must be able to reach a physician after hours. There are several methods for handling after-hours calls. Some physicians sign up with call centers to handle their after-hours calls. Other physicians use 900 numbers that require that patients pay up front with a credit card. And other physicians employ an answering service.

Our office, however, did away with an answering service more than 10 years ago, and it has saved us $30,000 to $40,000.

When our patients call after hours, they receive a recorded message that tells them several things: First, we provide our names. Next, we state that if this is a medical emergency, the patients should hang up and call 911. Our recording lists our lunchtime hours and when the office is closed.

We provide a second phone number to call if this is a truly urgent matter. The second number is our beeper number, which allows the patient to page the physician on call directly.

We also instruct the patient to hit *87 on her keypad to remove caller ID block, so we can call them back. Our physicians always hit *67 on their keypad when returning pages after hours to block our home or cell phone number. Some physicians have a dedicated cell phone or land line at their home and have patients call them directly.

Having patients call us directly rather than employing an answering service had an unintended bonus. It has made patients stop and think, “Do I really need to speak with my physician?” Consequently, our call volume dropped tremendously with this system.

To be complete, any discussion about the use of phones in a physician’s office must include the fax machine.

It is wonderful when a physician needs to quickly obtain a copy of a lab report.

Faxes become problematic, however, when a patient wants a form filled out immediately. Our office does not accept faxes from patients. (And, we don’t give patients our fax number.) For the most part, we do not fax anything to patients. As a rule, we unplug our fax machine to stop the waste of paper on incoming faxes from people trying to sell us things that we don’t want!

The low-tech device can help to increase your bottom line. The telephone allows you to call a patient who owes you money and has ignored your mailed statements (which, costs you about $4.00 each mailing) and have them settle her account with a credit card.

It is important to encourage patients to come in for their yearly checkups. Mailing cards or having a computer program call patients to remind them to make an appointment works. However, it lacks both the personal touch and the immediacy of talking to a human being, which gives patients an opportunity to schedule an appointment during the phone call. Stop and think how much revenue is lost when patients don’t come in for their yearly well visits.

An effective use of the telephone is a follow-up call to patients after their visit to a specialist or after a procedure. What a wonderful way to show your patients that you care about them. I’m sure it’s old fashioned, but I prefer a phone call to an e-mail or a computer-generated note.

And guess what? In the not-too-distant future, thanks to the ongoing work of the AAP, we should be able to use a CPT code for telephone care and get paid for them!

Money is definitely there to be made using the telephone.