My client Alfred called this week to describe the issues he was continuing to have following cataract surgery two months ago. We had attended numerous specialist appointments together in the past and he’d learned how to create an agenda and have thorough conversations with his physicians. He now felt confident that he did not need me to attend his follow-up appointments.
However, although he’d described these issues on two different occasions to his physician – and was following every recommendation she made – he was still feeling some discomfort. He just knew that these symptoms arose following his surgery and yet when he saw his doctor in person, he felt he was still not being heard. He was afraid she would think he was just a complainer and he asked if I would call her.
Despite all our work together about being politely assertive in the healthcare system to get one’s needs met, this experience reinforced how difficult it sometimes is for healthcare consumers to challenge the patriarchal culture they grew up with. For many, asking to speak directly with a physician on the phone is one of the most intimidating tasks.
I admit, I really dislike calling a physician’s office. Not because I myself am intimidated, but because the process can be long, tedious and inefficient. In this case, it took two tries with an inadvertent disconnection included to get to the actual assistant who works directly with this doctor. In the context of all the calls I make to physician’s offices, this one wasn’t so bad!!
Here’s what I said to the Ophthalmologist’s assistant:
“Hi, I’m Dianne Savastano, a private healthcare advisor to Albert ______ who is a patient of Dr. Smith. A release form has been placed in his medical record and I have permission to speak with you on his behalf. Dr. Smith performed a cataract extraction on Albert on 3/5/16 and he’s been having some problems ever since. He discussed these issues with Dr. Smith on 4/29/16 and has been carrying though on all of her suggestions, but the problem persists. I’m calling to request a phone conversation with Dr. Smith so that she and I can confer and problem solve together. Here are some good times for her to call me back.”
I’m happy to report that the physician’s assistant (who was lovely) listened intently and honored my request to speak directly to Dr. Smith. I received a call back within half an hour and had a comprehensive conversation in which I could do the following:
- Relay data
- Give my own impressions
- Answer the physician’s questions as she thought through the situation
- React to her recommendations
- Come up with a plan of action
I don’t think the same outcome could have been achieved via email. Why not? Here are a few things a live phone call offers that email does not:
- The ability to promptly and efficiently have a dialogue
- The opportunity to respond to questions and comments on the spot
- The chance to ask spontaneous questions that arise from the conversation
- The opportunity to problem-solve together
Don’t get me wrong. I’m a big fan of patient portals. Email is fine (and often better) for many things including appointment requests, data sharing and keeping your physician up-to-date on visits with other specialists, to name just a few examples.
How do you know which communications tool is best in which situation? I say, if your gut tells you that you need (or want) to have a direct conversation with the doctor, make it happen.
And when you do, here are two suggestions for promoting an efficient and successful interaction:
- Set the stage early. Even before the need for a call arises, make sure you’ve put the topic of “Communication Methods” on your agenda to discuss with your doctor. Ask what the different vehicles are and what the preferred method is. And then ask: “When I have a need to speak directly with you by phone, how do we make that happen?”
- Prepare for the phone call. Write out a script for yourself. State who you are; what your relationship is to the patient (if it’s not you); exactly why you’d like to speak with the doctor; and when a good time is to reach you.
Why resistance may persist
The chief way most physicians produce revenue, especially primary care doctors, is by billing for patient visits. This is called direct work. Telephone conversations, email correspondence, a review of test results, etc., on the other hand, are most often considered “indirect work” and are not billable. And so it makes sense that physician’s offices attempt to promote revenue-generating activities by having others perform the indirect work, thus keeping the physician directly seeing patients.
Although I appreciate this challenge, this is a scenario when business practices are created to meet the need of the physician/practice and not necessarily the healthcare consumer. So until “indirect work” is compensated – and I think it should be – we are forced to “Challenge the Process” once again to meet our needs.
Your relationship with your physician plays a pivotal role in creating healthy experiences within the healthcare system. Identifying appropriate means of communication is important. Sometimes, and despite all the new, digital options available to us, there is nothing better than an in-person meeting or a direct telephone conversation.
So don’t be afraid to make this happen for yourself. You will have taken control over a situation that you have some control over, and be a more satisfied healthcare consumer as a result!