Have you ever tried getting a doctor on the phone?
And tried and tried and failed? I have.
Or been answered -- unsatisfactorily -- only by a nurse or secretary? A doctor's staff must handle many calls, but sometimes you need to hear the doctor's voice and opinion, with a chance to ask some more questions.
And sometimes, pleasingly, the doctor calls back as soon as possible.
Of all the ways we relate to our doctors, relations on the phone can be among the most frustrating.
I happen to have a doctor who phones back as soon as he can, when needed. But at times I've been referred to doctors who don't. Blast 'em.
These villains aside, we ourselves may have a lot to do with whether or not the doctor gets back to us and how soon.
We may not find ourselves at the top of the call-back list if we habitually call at 11 p.m. about trivial or nonurgent matters -- "Doctor, do you think I should be taking vitamin C?" (such late-night calls aren't unknown) -- or habitually demand a phone call instead of making an appointment, or if we again and again wait until late hours or the weekend to phone.
When our children were young, their mother and I had a wonderful pediatrician who always phoned back -- or showed up at our home -- when we phoned to say that a child seemed sick. Yet one of our friends complained that he did just the opposite. We knew why. She called two, three times a week, every time a kid looked cross-eyed.
Still, many doctors -- such as Dr. Raymond Scalettar, a Washington internist, recently elected a trustee of the American Medical Association -- say: "I'd rather have you err on the side of calling more often. I'd rather you not assume that the burning discomfort in your chest is heartburn. It may be a heart attack."
Dr. Ray Coleman, Silver Spring-Rockville pediatrician, says: "I'd hesitate to tell people, 'Don't call except in an emergency.' Something that's an emergency to me may not seem one to them.
"We tell our patients, 'If you can, wait till our calling hour,' " a regular 8 a.m. to 9 a.m. for Coleman and his father, Dr. Allan Coleman. "But if you feel you need to call at some other hour, don't be bashful. I'm not sure I want people to feel anxious about when they should call."
Yet even doctors like this may get turned off by the patient who calls every Monday, Wednesday and Friday. Both patient and physician have responsibilities.
What should doctors do to make the phone work for doctor and patient?
"Office-based physicians in solo practices generally receive between 40 and 80 calls a day," reports the American Society for Internal Medicine. The calls are from hospitals, other doctors, health insurors and pharmacists -- and patients about appointments, tests, bills, vitamin C, symptoms and worries.
"I never want to miss anything serious," one doctor told me. "But I can't possibly tell everyone with a pain, 'Come in.' I have to play the odds. I've been wrong. I'm trying not to be again."
Duane Johnson, PhD in psychology, heads Practice Productivity Inc. of Atlanta, consultants to doctors. He views the doctor-patient telephone relationship as "two people trying" to communicate, yet far too often reaping only "misunderstanding" and "irritation."
In an interview and in his column in Internal Medicine News and other medical newspapers, he says:
*Doctors should have written policies telling their staffs just how to handle calls about symptoms, fees, bills and so on, including emergency calls when the doctor isn't there.
*Doctors should intensively train some staff members as "patient-flow technicians," able to decide when they can handle a matter, when to schedule a phone conversation with the doctor and when to interrupt or find the doctor immediately or send the patient to an emergency room. "The doctor should usually not be interrupted while seeing a patient," Johnson says. "That patient deserves undivided attention. But the staff also has to recognize the exceptions, the red flags, the typical emergencies."
*When they don't take the call immediately, doctors should either call back within a short time or have the staff let the patient know about when to expect a call.
Many doctors, especially pediatricians like the Drs. Coleman, establish regular phone hours when "any of our patients can call with any question at all," Ray Coleman explains. Many also have regular "call-back hours," a practice Johnson calls a "must," though others manage to sandwich calls between patients.
Whatever the doctor's method, most of us appreciate the difference between waiting all day for the phone to ring, and more sensibly being told: "The doctor will get back to you between 11 and 12. Do try to keep the phone open." Doctors tell of sometimes trying to phone but getting a repeated busy signal or no answer.
*Doctors obviously should help educate patients about the phone, and give them, too, written phone policies and calling times.
*Doctors and staffs should try to make phoners feel welcome, not like intruders. Johnson advises "smiling on the phone . . . you may never get a chance to correct an unfavorable impression."
We patients know no one can smile all the time, but we don't appreciate being snapped at.
Scalettar summed up his feelings about all this by saying: "A physician should be available. And have an appropriate answering service. One thing that bothers the hell out of me is when a physician goes out of town and has no service or substitute coverage. If a doctor leaves town and makes no such arrangement, I'd report it to the local medical society."
Should a doctor treat over the phone?
At times it's inevitable, many doctors say, adding explanations such as: "If you know a patient well, if you know the usual problems and what works, you can safely give some advice often or even call in a prescription that has a high degree of safety."
Johnson says: "Unless it's something very routine, treatment over the phone is something doctors should avoid like the plague, especially in this day of malpractice suits. If something is serious enough to require a prescription, the patient should generally be seen. Besides, patients' descriptions of symptoms can be very unreliable. One patient may have a pinprick in his thumb and say it's an emergency. Another may be dying and say, 'I'm okay, doc.' "
Next Week: Should a doctor charge for telephone advice?