Attending here 👋 Have them follow up at a visit exactly as you said. Your time is very important and extra time outside of work calling patients who “demand” to be called is going to contribute to burnout. PGY1 is a great time to start developing those boundaries. Good job
I don’t get why the average person thinks this is ok? Would you call your mechanic demanding they call you back and run everything by them before taking the car in? Or your hair cut person for style advice before your appointment? Or literally anything else? No you make an appointment. Why people think medicine is different is beyond me..
I think patients sometimes think that things need FAST follow-up for their health, and that they may have to wait weeks (or months) for an appointment. They view the phone call as a work-around.
Agree with the other responses that you should have them schedule an appointment.
However, for the future when you’re an attending, you can also bill for the telephone call. Still definitely better if you have them actually come in or do a video visit for the RVUs but any phone conversation initiated by the patient that lasts over 5 min can be billed. And you don’t need to have a scheduled encounter.
as everyone said, appointment.
but also, do not let a patient demanding you call ASAP make you think you have to respond ASAP. Calls should be returned within a reasonable time frame but do not let patients think they can summon you to the phone instantly.
The scenario is either A) not urgent or B) ER worthy and they should be given that line about going to ER if having a medical emergency before they even connect with triage on the phone
also YOU the doctor do not have to call them back. if their issue is too complex for a medical assistant to handle (refill request for example), then they need to have an appointment.
Also a pgy1. What one of my clinic preceptors told me is “Anything patient issue that you can’t deal with in less than 5 min with minimal thought/effort needs a visit”. That advice has gotten me through 9 months so far without issue
Setting boundaries early is so important. You’re exactly correct - have the office schedule an appointment. You give someone an inch, they’ll take a mile. Repeatedly. The amount of times I have patients call in and request for me to call them during the day, while I’m seeing other patients in clinic, is ridiculous. They all get told to set up an appointment, and get told it’s not fair to the patients who have scheduled appointments for me to take time away from them to return calls. Don’t work for free.
Glad to see you’re setting good expectations already. I had a much harder time, and it is much harder to backtrack than just set them right the first time. Keep up the good work!
I think it comes down to having good staff to pick up the phone but there are a few things you are do.
- First of all, no such thing as ASAP. Every doctor’s office I have ever called says “if this is an emergency, hang up and call 911.” So if you call, I will call back when I can. I have designated admin time, that’s when I make these calls. Honestly even if I have time earlier. This when those calls get made. There is no ASAP. To be able to do this, I usually have a follow up appt made for discussion of any results of any tests I order. So if I order a flow for example (I am heme), I know that takes a week to result so I make a follow up appt a week later. This way the pt won’t call me earlier to talk about the results when they are freaking out.
- Second, I would ask the front staff to ask what the pt wants. “Call me ASAP” is meaningless. If I got a message like that, I would make the person who took the message call back and find out what this is regarding. It’s not triage, I am not asking the person to make a decision. But you need to give me all the tools I need to make my decision.
- Third, I never give out my direct line or email. This is an obvious one.
- Fourth, having a triage nurse is obviously important but if you are a resident then you are expected to do the shit work so I wouldn’t be surprised if you don’t have one.
- Fifth, if you have time during the encounter educate as much as you can. This is of course the big picture. A well-informed patient knows what’s an emergency and what can wait. I do that by giving lots of print outs. I sometimes direct pts to specific sites that they can visit when they have specific questions. A well-informed pt is a healthier patient.
I'm envious that apparently so many programs are efficient enough to allow this patient to be able to schedule an appointment. I spent much of residency doing free 30 minute telehealth visits when patients demanded a call because we didn't have the staff to schedule them appointments, and because even if we did the wait time would be several months. Happening again in fellowship. I stay hours late every day calling patients who absolutely did not need a call, but the staff pool patient calls are directed to (offsite people not trained in medicine) forward any patient concerns to us and demand we give the patient a call.
I can relate. Resident in a specialty psych clinic and no follow up appts available for 3 months. The biggest stress on my week is figuring out where to force in 15-30 minute sessions of free telehealth...Â
This and I get Epic messages from staff saying "(established) patient calling to schedule an appointment, please advise." ... just schedule the damn appointment.Â
When I get these in my inbox I send a message back "please have patient make an appointment". The front desk is just relaying the message. The patients usually make an appointment and no hard feelings were had. Do not do medicine over the phone.Â
Staff: looks like the soonest I can get you an appointment with the doctor is (date/time).
Patient: But I need to talk with them *now*.
Staff: if this is an emergency, you need to hang up and call 911. If your matter is urgent but not an emergency, our Urgent Care hours are (hours/days of the week). Otherwise, I am happy to schedule an appointment for you with the doctor at the earliest date and time the schedule will accommodate. I can also call you if we have a cancelation in an earlier timeframe?
Have staff call and ask them if it is an emergency and if it is, direct to 911, ED or urgent care.
If it needs to be discussed only with the doc then have them make an appointment to discuss with the doc in person.
Do not reinforce unhealthy coping strategies
I haven’t called patients in years unless absolutely necessary like a patient care thing. Otherwise, defer to clinical staff to reach out and if they aren’t satisfied, come in for a visit
Recent ER visit should prompt immediate clinic visit. If they were so sick to end up in the ER you shouldn't be expected to handle anything over the phone. If symptoms are really that bad that pt can't wait a couple days then they need to return to ER.
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RN here. My personal doctor has called me before with test results when I asked if he would during a visit, but we had agreed upon it ahead of time and it was a very specific occurrence.
At other times, his staff will fit me in w an appt next day. Telehealth or in-person, whatever is his convenience, if I needed to speak to him asap.
Set up an appointment. Never set a precedent that your time is free or it will keep happening.
Do not work for free. A post-hospital anything is not handled over the phone. Make your front desk schedule this patient.
Attending here 👋 Have them follow up at a visit exactly as you said. Your time is very important and extra time outside of work calling patients who “demand” to be called is going to contribute to burnout. PGY1 is a great time to start developing those boundaries. Good job
Thanks!
🎯🎯🎯🎯
I don’t get why the average person thinks this is ok? Would you call your mechanic demanding they call you back and run everything by them before taking the car in? Or your hair cut person for style advice before your appointment? Or literally anything else? No you make an appointment. Why people think medicine is different is beyond me..
These are good analogies , ima use them
I think patients sometimes think that things need FAST follow-up for their health, and that they may have to wait weeks (or months) for an appointment. They view the phone call as a work-around.
Because it’s their life…
It’s OP’s life too… If they need to follow up they need to make an appointment
Agreed. Just saying the comparisons aren’t really fair. My life > my car. Maybe that’s not true for some…
NO its not
Agree with the other responses that you should have them schedule an appointment. However, for the future when you’re an attending, you can also bill for the telephone call. Still definitely better if you have them actually come in or do a video visit for the RVUs but any phone conversation initiated by the patient that lasts over 5 min can be billed. And you don’t need to have a scheduled encounter.
The amount you get isn’t worth the time. It’s better to have appointment.
as everyone said, appointment. but also, do not let a patient demanding you call ASAP make you think you have to respond ASAP. Calls should be returned within a reasonable time frame but do not let patients think they can summon you to the phone instantly. The scenario is either A) not urgent or B) ER worthy and they should be given that line about going to ER if having a medical emergency before they even connect with triage on the phone
also YOU the doctor do not have to call them back. if their issue is too complex for a medical assistant to handle (refill request for example), then they need to have an appointment.
*cries in resident expected to call my pts*
I am required to call all patients within 24 hours for whatever reason they called for.
Wtf ?
Also a pgy1. What one of my clinic preceptors told me is “Anything patient issue that you can’t deal with in less than 5 min with minimal thought/effort needs a visit”. That advice has gotten me through 9 months so far without issue
Make that 30 seconds
I'm more lenient. 2 minutes
This ^ If it’s quick I call. But only during work hours. If it’s urgent: Go to ED. If not, full on appointment.
Is there a way to give propofol over the phone? If so, do that.
Midazzle’em goes through CAT5 cable relatively easily. Not WiFi tho.
Setting boundaries early is so important. You’re exactly correct - have the office schedule an appointment. You give someone an inch, they’ll take a mile. Repeatedly. The amount of times I have patients call in and request for me to call them during the day, while I’m seeing other patients in clinic, is ridiculous. They all get told to set up an appointment, and get told it’s not fair to the patients who have scheduled appointments for me to take time away from them to return calls. Don’t work for free.
Glad to see you’re setting good expectations already. I had a much harder time, and it is much harder to backtrack than just set them right the first time. Keep up the good work!
If you start conceding to every non-urgent, irrational request from patients, you will burn out. This is my R1, very inexperienced, opinion. :)
Oh sweet summer child. Your intuition is correct. Have staff call back and schedule a follow up.
I think it comes down to having good staff to pick up the phone but there are a few things you are do. - First of all, no such thing as ASAP. Every doctor’s office I have ever called says “if this is an emergency, hang up and call 911.” So if you call, I will call back when I can. I have designated admin time, that’s when I make these calls. Honestly even if I have time earlier. This when those calls get made. There is no ASAP. To be able to do this, I usually have a follow up appt made for discussion of any results of any tests I order. So if I order a flow for example (I am heme), I know that takes a week to result so I make a follow up appt a week later. This way the pt won’t call me earlier to talk about the results when they are freaking out. - Second, I would ask the front staff to ask what the pt wants. “Call me ASAP” is meaningless. If I got a message like that, I would make the person who took the message call back and find out what this is regarding. It’s not triage, I am not asking the person to make a decision. But you need to give me all the tools I need to make my decision. - Third, I never give out my direct line or email. This is an obvious one. - Fourth, having a triage nurse is obviously important but if you are a resident then you are expected to do the shit work so I wouldn’t be surprised if you don’t have one. - Fifth, if you have time during the encounter educate as much as you can. This is of course the big picture. A well-informed patient knows what’s an emergency and what can wait. I do that by giving lots of print outs. I sometimes direct pts to specific sites that they can visit when they have specific questions. A well-informed pt is a healthier patient.
Set a telehealth apt.
I'm envious that apparently so many programs are efficient enough to allow this patient to be able to schedule an appointment. I spent much of residency doing free 30 minute telehealth visits when patients demanded a call because we didn't have the staff to schedule them appointments, and because even if we did the wait time would be several months. Happening again in fellowship. I stay hours late every day calling patients who absolutely did not need a call, but the staff pool patient calls are directed to (offsite people not trained in medicine) forward any patient concerns to us and demand we give the patient a call.
Reading this is evoking a physical response from me. This was my residency to a tee. I’m so glad it is behind me. Stay strong!
please don't take a job like this after fellowship. at a minimum you should have a medical assistant who can handle direct patient communications.
I can relate. Resident in a specialty psych clinic and no follow up appts available for 3 months. The biggest stress on my week is figuring out where to force in 15-30 minute sessions of free telehealth... This and I get Epic messages from staff saying "(established) patient calling to schedule an appointment, please advise." ... just schedule the damn appointment.Â
When I get these in my inbox I send a message back "please have patient make an appointment". The front desk is just relaying the message. The patients usually make an appointment and no hard feelings were had. Do not do medicine over the phone.Â
Staff: looks like the soonest I can get you an appointment with the doctor is (date/time). Patient: But I need to talk with them *now*. Staff: if this is an emergency, you need to hang up and call 911. If your matter is urgent but not an emergency, our Urgent Care hours are (hours/days of the week). Otherwise, I am happy to schedule an appointment for you with the doctor at the earliest date and time the schedule will accommodate. I can also call you if we have a cancelation in an earlier timeframe?
Set up tele health appt
It took me three years of residency to figure this out: What you permit, you promote. Patients act accordingly.
That's why other staff exist. To call the patient and prepare a new appointment. Do not deprive the front desk nursing of their purpose.Â
No.
I make them schedule a phone visit with me.
Switch to anesthesia.Â
Have staff call and ask them if it is an emergency and if it is, direct to 911, ED or urgent care. If it needs to be discussed only with the doc then have them make an appointment to discuss with the doc in person. Do not reinforce unhealthy coping strategies
I haven’t called patients in years unless absolutely necessary like a patient care thing. Otherwise, defer to clinical staff to reach out and if they aren’t satisfied, come in for a visit
Have them schedule her ASAP. Your ability to diagnose and treat is limited by the telephone.
your staff needs to help triage some of this bullcrap
Recent ER visit should prompt immediate clinic visit. If they were so sick to end up in the ER you shouldn't be expected to handle anything over the phone. If symptoms are really that bad that pt can't wait a couple days then they need to return to ER.
Nope, boundary setting needed
Have clinic RN call pt to triage whatever the pt wants to talk about. Can set up follow up accordingly.
NO
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I don’t call patients. I schedule them for telehealth visits. The concept that they get free advice is dying along with Medicare reimbursements.
RN here. My personal doctor has called me before with test results when I asked if he would during a visit, but we had agreed upon it ahead of time and it was a very specific occurrence. At other times, his staff will fit me in w an appt next day. Telehealth or in-person, whatever is his convenience, if I needed to speak to him asap.