Haven't seen this topic recently...let's talk about phone calls to patients!

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    I just have to say that phone calls to patients are both a pleasure of mine AND a major time suck. I would love to hear other NPs policies on awkward phone calls with patients. Here are a few of my thoughts:

    If a patient has an expensive, worrisome scan (CT,MRI) that I ordered I try to honor that with a phone call back promptly when I get the report. I want to immediately alleviate their worries and let them know the results. However, this can go bad quickly because as we all know, some of these scan bring up a gazillion "incidentelomas" that are just impossible to explain and plan for over the phone. In those cases I have learned to say "your scan was negative for X and nothing *life threatening* is going on right now, but we need to review your scan IN person IN office to plan and follow up for other things found on your scan.

    For follow-up labs I have learned to FLAT OUT tell people when they are in the office: if all if your lab work is perfect and nothing needs to be changed or added, I will have the office nurse call you. If your labs are out of range and a med needs to be tweaked or added, you must come in...it's just too much to go over on the phone. I did that for awhile (calling the patient and explaining on the phone) and just got sucked into long painful phone calls about side effects, risks, benefits, etc. I just don't feel it can and should be done on the phone.

    It quite honestly took me at least a year of practice to figure out how to do phone calls the correct way to avoid a situation where the patient doesn't understand what is going on and then also to avoid a situation where I am quite literally caught on the phone for 20 minutes of completely unbillable time! Communication with patients was not adequately covered in school.

    Other situations...I'm still learning how to find the balance of not getting sucked in over the phone but also being able to communicate somehow with the patient. Yes, we have an office LVN but let's face it, sometimes that's just not an effective way either.

    I would LOVE to hear from those of you who feel they have this balanced all out and never get caught for those long conversations "while I have you on the phone...let me ask you about this....." Do you bill for phone calls? What is your office policy?

    Oh, and we are a super small family practice so we are not quite yet moved to EMR although that is coming.
    Joe V likes this.
  2. 6 Comments so far...

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    I round on dialysis pts and while I am supposed to only manage dialysis, and HTN, frequently I'm ordering other things too. I do phone calls from my car by using star67 so they don't have my cell number. My cell phone is partially reimbursed by my very large practice. I keep my phone calls to:

    Hi there Mrs Smith. I got the results of your recent shoulder MRI and you will need follow up with an orthopedic surgeon. I made the referral and the staff from the clinic will be calling you. If you have not heard back in two weeks please let me know.

    Hi Mrs Smith. Your labs are....and then I tell them the normal results and if any require f/u I tell them what that will consist of.

    I keep the calls very short and sweet. I keep a small yellow steno pad with me at all times so I can jot down who I talked to in order to chart later.
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    And so what do you say when they say 'so what exactly does my MRI show is wrong? " and "do you think I will need surgery?" and so on and so on and so on.
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    I shut them down when I preface this with, "just a quick call to let you know I looked over your test results. Your results require a referral to a specialist, ortho MD, derm provider, etc.".

    "I can't answer the question about surgery but that is a good question to ask when you go for your appt. I ordered this test just to get the ball rolling"

    "Your MRI shows you have a rotator cuff tear. There are several ways to treat this and the ortho provider that I'm referring you will be able to answer your questions"
    platinum likes this.
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    Those are good responses, Trauma and I use similar quotes a lot. I think a distinction here is we are a small family practice and are surrounded by OTHER family practices so competition is definitely there. They have a choice and we want them to keep returning to our practice. So it's a fine line between being available and informative vs. letting patients have a free appointment on the phone!
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    I currently work as a Case manager which includes calling pt's with results. I do know your frustrations but I have learnt to tell them it's nothing to worry about (if it isnt) and if it is I tell them the provider will call them back (at least I have been able to get all their questions and talk to the provider before he calls them back). And there are those you just have to tell them, there is nothing to worry about and that's it; Some patients try to gauge your tone on the phone and how much they can push.
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    I don't make phone calls to patients or accept phone calls from patients. All phone calls go through either the triage nurse, or through my MA.

    I have the MA call and deliver the message I provide: "Blue Devil said your CT was negative. There is no evidence of ________(whatever we were looking for)." Or "Blue Devil said your TSH was WNL, no changes to your medications." If they have questions, they need an appointment. If their test demonstrated worrisome findings, the MA calls and says "I'm Jane from ABC Health, we'd like to schedule your follow-up visit to go over your test results..." Or, "Blue Devil said your TSH is off and requires a medication consult, when would you like to schedule that?" She is very crisp, very professional. I have heard her on the phone countless times and I like the way she handles it. She is very good at screening things, can anticipate most answers (she knows I'm almost always going to say no to whatever they are asking for, lol) and knows what information to get from the patient to pass along a complete report to me about a situation. We do all of the communiction electronically so it is part of the patient's medical record, which is nice, and it saves everyone a lot of time.

    I also don't do paperwork without a visit, even if it means they just come sit in a chair and watch me fill it out! Anything that requires me to "certify" anything = a visit, and anything that requires more than simply a signature = a visit. People get po'd about that, as if I'm supposed to spend 30 minutes filling out their forms for the government, schools, camps, FMLA, etc in the evenings at home on my own time. Um, no. You want something from me, you will pay me for my time, just like I pay my lawyer for his time. I do my pro bono work in another venue, not from my office!

    There is talk that we are going to start doing phone consults and bill for them, but I don't know how that is going to work.
    midwestFNP likes this.


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