Thursday, July 24, 2008

Letter to My Family Practice Physician

Re: Your Office Staff
Dear Dr. D:
I love that you’re my family practice physician. You’re a wonderful, sympathetic, and intelligent practitioner. You listen carefully. You give good advice. You make me glad I choose to confide in you, and as an added bonus, you have a great sense of humor. You’re like the big sister I wish I had.

Your office staff, on the other hand, is a completely different matter. Let me paint a picture for you.

Your patient wakes up at 5AM with an incipient medical problem. The kind that needs antibiotics before it gets out of hand. She tries to contact your after-hours triage line, but despite punching all the necessary buttons and interminable waiting, no one ever picks up. Finally, the call is disconnected and she remembers the last time she tried to use the after-hours triage line—when she swelled up with hives from a penicillin allergy—it didn’t work for her that time either. So she limps back to bed and counts the minutes until the office opens at 8AM.

When your office staff finally starts picking up the phone at 8:10AM (your patient is counting every minute here) she identifies herself, explains her medical problem, and asks whether an antibiotic can be called in or whether she needs to come in to see you. But . . . there’s only silence. Your patient is worried she’s been disconnected after ten minutes of trying to get someone to answer the phone. “Hello?” she asks after a few moments. “Hold on I’m writing this down,” a voice says tersely. Then, “Name?” She gives it again. “Date of birth?” She gives her date of birth. “Pharmacy?” She gives that, too. “Pharmacy number?” Your patient doesn’t know that, and she’s not sure it’s relevant at this point. She asks if the pharmacy number could be looked up later, but the woman on the phone says in an unmistakably exasperated tone, “Patients need to provide the pharmacy number.” Your patient starts downstairs for her phone book. On the way, she asks again whether she needs to come in or whether an antibiotic can be called in. The unsympathetic voice on the other end says flatly, “It’ll be after 1PM before anyone can get back to you.” At this, your patient panics. By 1PM, her medical problem could be out of hand. She protests, “I think I really need to come in this morning--have you ever had one of these things?” looking for empathy, “They get harder to treat the longer you wait.” “There’s no reason to talk to me that way,” the office worker snaps. What way? Like someone in a physician’s office might care? Your patient protests again, “Dr. D is such a kind and sympathetic person. I can’t imagine she would want her patients to go untreated for this.” At this point the woman answering the phone apparently loses all patience because she snaps, “You can talk to my office manager,” and puts your patient on hold.

When the office manager gets on, your patient takes a deep breath and tries to seem reasonable. She’s seen what happened to Elaine on Seinfeld—she doesn’t want to be labeled a problem patient. She explains again in a rational and measured tone, who she is, that she has a medical problem, that she can’t wait until 1PM because the symptoms will continue to worsen until she starts taking antibiotics, when the office manager rudely interrupts to say, “I know that. I’ve worked here for 12 years.” Your patient digs deep for what’s left of her patience and continues to explain calmly that she would like to either have the office call in a prescription or come in to the office. She says again she really can’t wait until 1PM. The office manager is unmoved. Your patient then explains that she would expect a physician’s office to show a bit more concern when a patient is scared and worried. She points out that a physician’s office isn’t a place to order magazines or widgets, after all, it’s a place where people are supposed to be concerned about patient health. The office manager is dismissive—the staff has too many people to keep happy on the phones, she says. Plus, she adds, the woman answering the phone is pregnant (as if this excuses her from civility).

Your patient then starts down the path of giving identifying information again. She gets to the pharmacy phone number that she still doesn’t have even though her entire family is by now frantically running through the house searching for the phone book. “Is it possible,” your patient pleads, “that you have a phone book there? To look up the number?” “No,” the office manager says, “we don’t look up phone numbers. We expect the patients to provide them. How would we know we were calling the right pharmacy?”

It’s at this point your patient realizes your office staff is a serious problem.

Your patient’s husband finally finds the phone book. She gives the office manager the pharmacy number. She gives her a number where the nurse can reach her. She then politely explains to the office manager that the after-hours triage line doesn’t seem to be working. The office manager chalks it up to your patient’s error. Completely possible, your patient says, but maybe it should be checked. No, the office manager replies, we just checked it recently. Your patient says goodbye and hangs up, wondering why she is treated like an aggravation instead of a customer.

When a nurse calls back (promptly!), your patient wrangles again and this time it is decided she needs to come in. At 11:45AM. “It can wait until then,” the nurse patronizingly explains. It’s not until your patient asks for a referral to an urgent care clinic that an earlier slot magically appears in her physician’s day. And by 10AM she has a prescription clutched in hand and heads for the nearest drugstore.

Here’s the thing, Dr. D, I work with so many wonderful human beings in the health care industry. I value their strong sense of altruism. They want to help, in any way they can. You, Dr. D (and your job share partner, for that matter), are wonderful and competent people, but you’re surrounded by . . . jerks. In a world full of “the customer is right,” these office workers stand out like a sore thumb. I get better care at Starbucks. And I’m concerned that if I get seriously ill—cancer or a heart condition— I’m going to be sparring with these same people just to see you. A major illness is a big enough obstacle without running a gauntlet of office workers who plainly don’t care how I feel. Honestly, your office staff is making me think about choosing another doctor.

So, I’m writing this, Dr. D, just so you know, your staff—particularly the people answering the phone and your office manager—aren’t anything like you. They may tell you I’m pushy and demanding, and they may mark my medical record as “PROBLEM PATIENT,” but given who it’s coming from, take it with a grain of salt.

And maybe, if you have any power to do so, you might let someone more like you handle the important job of answering the telephone.

Your patient,

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