When the doctor is. . . inaccessibile

Her experience with a hard-to-reach doctor prompted the author to ask her patients about physician accessibility. She got an earful.

By Judith A. Paley, MD
Internist/Denver

I can be as hard to reach as the next doctor. My front office has been known to form an offensive line of Super Bowl caliber to protect me from patients who want forms filled out for nothing, plus free advice. I'm always looking for that elusive balance between accessibility, which is good medicine, and efficiency, which is good business.

A recent personal experience on the other side of the receptionist's desk suggests that I'm not the only one who struggles, at times unsuccessfully, to find a workable solution. My ordeal was sobering and instructive because my mother was the patient, and her doctor was never in.

It took multiple calls, and finally professional privilege, to score a timely visit with Mom's cardiologist, a kind and competent clinician whom I've used as a consultant for years. "If your mom's short of breath," his front desk said on my first try, "take her to the ER." After the appointment I finally managed to secure was canceled, by them, another staffer explained it away: "The doctor has a lot of patients." If I, a sophisticated insider, could scarcely connect, how does a layperson break through?

With eyes newly opened to the view from a waiting room chair, I polled my patients and the readers of my e-mail newsletter—who are scattered all over the country—regarding their attempts to reach physicians. Many felt neglected and angry; several had been so annoyed that they'd changed doctors. More than a few, however, praised their providers, citing inventive ways that these docs stayed in touch. The bottom line? Accessibility is both good medicine and good business. Here's why.

The doctor is incommunicado

How do patients feel when doctors are hard to reach? Mary, a working mother of two, summed up the sentiment of many frustrated patients: "I like my mother's physician and I have confidence in him. But I can ill afford time spent waiting for return calls or delayed appointments." She now places easy access alongside clinical competence in the list of qualities she seeks in a physician, and she's willing to jump practices to find a provider with both.

This "love my doctor, hate that office" refrain was a common theme. I found, to my chagrin, that I wasn't exempt. Dorsey set me straight: "Honey or vinegar? With your office, I generally try friendly first, then stubborn, adding an edge the longer I wait. I've always felt that if I can just get past the office staff, you'll connect with me."

Another patient was less diplomatic: "I don't know if you are seeing too many patients, or if your help is just useless." Apparently, when charged by me to "get my back," my staff creates an impenetrable wall. Dr. Inaccessible, the cardiologist, was similarly taken aback by the intensity of his front-desk efforts. "I had no idea," he apologized when finally we met. "I shudder to think of all the situations like your mother's that I never even hear about."

Many patients who answered my query mentioned that their doctors were "four-plus" overbooked. Deb of Denver complained, "When I called to schedule an annual exam with my primary care physician, I was offered a 10-minute appointment three months down the road. I no longer go to this doctor and I've made sure that my friends don't, either."

Things were no better across the country in Pennsylvania, where Pamela called her physician in early October for an annual exam, and took the first available slot—in late January. "Needless to say," she concluded, "I'm looking for another doctor. The sad thing is I like this doctor because she listens."

A Denver nurse wasn't surprised at my difficulties in getting through to my mom's cardiologist. "The trick is to talk to the nurse rather than the front desk," she advised. "This works for me—maybe because I'm a nurse." In fact, I did finally pull out a professional trick of my own. "Dr. Paley calling" scored a prompt callback from Dr. Inaccessible's emergency coverage early one morning, and the long-awaited appointment materialized that day.

Noninsiders usually aren't so lucky—unless they can get a physician to intervene on their behalf. Lois of Washington, DC, was told that a local orthopedist couldn't tend to her dislocated hip for six weeks. One call from her referring doctor, however, and she was offered an appointment for the following day.

Jane from Denver recalled her frustration when her daughter, who'd had a tooth extracted, developed a dry socket after returning to college. "The oral surgeon told me, through his nurse, to find emergency care for Susan in St. Louis." A call from her regular dentist elicited a prompt return call from the surgeon.

The doctor is in touch

Fortunately, not all doctors view the phone as a loathsome addition to the day's workload. After Mark of Brooklyn, NY, was diagnosed with a serious illness, his internist provided a home phone number and told him to call any time, day or night. I, too, have given my home phone number to patients after delivering bad medical news, and have never had anyone use it in excess. The patients are grateful for a chance to talk with me when the shock wears off and the questions begin.

If you call Denver psychiatrist Alan Levine over the lunch hour, you may find him at his desk, answering by the third ring! "This is a service industry; people deserve that," he says. "And a lunch call answered is one less call to return." As an added benefit to his solo practice, he's able to fill an empty appointment slot or two if he promptly picks up the Sunday night cancellations.

My informal survey suggests that timely callbacks, coupled with rapid-access appointments, would garner patient loyalty from coast to coast. Laura, a working mom, writes that her Indiana GP has "a longer office waiting time than I like, but we're able to handle so many things over the phone that it's not a big issue." She adds, "I drive 30 minutes to take my kids there, even though there are plenty of choices closer to home."

A busy Oregon professional endorses service as well: "I stopped seeing a physician a few years ago because every minute is precious to me, and I was extremely annoyed at having to take time off from work to sit in her waiting room for 45 minutes."

No more victims in Framingham, MA, either: "I recently switched doctors because, after struggling to get an appointment, I would sit in the waiting room for as long as an hour. My new internist is great! I can call and get in the same day."

The doctor is innovative

Janice is unhappy that her orthopedist doesn't use voice mail. "I want to leave a detailed message," she explains, "but I don't want to tell it all to his receptionist." Her doctor, in turn, is likely no more interested in having his staff tied up listening to her message than she is to leave it. Many of my correspondents would agree with me that Janice and her orthopedist should sign on immediately to MDhub ( www.mdhub.com ).

MDhub's online messaging service, one respondent wrote, "is a very efficient way of contacting my physician. Nothing can compete with such easy access." This service is free, and all physicians have a secured center on the site identified by their 10-digit phone number. Patients send their requests, questions, or follow-up information via the Internet; the correspondence arrives via fax or the physician's online inbox.

The convenience of e-mail, which I also offer to my patients, placates even Dorsey, the patient who is happy with my care but can't always get past my front desk. "I love having e-mail access to you," she says. "Phone calls are okay, but too often the return call comes when I'm taking the trash out." From my perspective, the convenience of reviewing patient questions afterhours, without playing telephone tag, is a wonderful timesaver.

Marilyn, another caretaker of an aging parent, enthused, "Mom's doctor and I usually communicate by e-mail. He responds the next day, or, if it's urgent, within a half-hour. I consider myself very fortunate." When I spoke with this Denver internist by phone, however, he was skeptical about the prospects of continuing e-mail communication with his patients now that HIPAA has hopped in. Incidentally, MDhub notes on its Web site that this secured service is HIPAA-compliant.

I'm going to be perfectly straight here. There are frantic days when a stack of messages from MDhub looks no better than a pile of prescription refills, phone messages, or referral requests, and patient e-mails are no more welcome than spam. While practice consultants may call me a successful multitasker, I sometimes think that's just a euphemism for being pulled to pieces.

But as my mother's health care advocate, I've learned a useful lesson about life as a patient. At the very least, these days, I'm trying to be kind to those folks on the phone. That call on hold may be somebody's mother.

 

Judith Paley. When the doctor is in(accessible). Medical Economics Jun. 20, 2003;80:47.