PHYSICIANS' RECIPROCAL INSURERS
Risk Management Department
Loss Prevention Technique © 1996

January - March 1996
(Volume IX Number 1)

It is well-recognized that the telephone is an important "tool" in medical practice. As with any other tool, its appropriate use requires adequate training and the use of appropriate guidelines.

The purpose of this pamphlet is to address certain of the more general issues related to the telephone in the medical practice. A subsequent pamphlet will provide information on the development of telephone guidelines for use in the medical office.

It is very important that all medical office personnel responsible for telephone contacts with patients understand that patients call not only regarding routine matters, but may also call with what are sometimes urgent or emergency complaints. Therefore, every call has to be considered important.

Adequacy of phones and phone coverage
The physician must ensure that the number of telephone lines in the practice is adequate to handle the volume of calls received and that there are adequate numbers of staff to answer these calls. Staff should also be reminded that it is not prudent to place patients' calls on hold, without first ascertaining if the patient's situation is an emergency.

Electronic Answering Systems
In an effort to handle incoming calls more efficiently, many practices are installing electronic telephone answering systems which provide the caller with various options, depending upon their reason for calling. In setting up such a system, the practice should ensure that patients are able to get a "live" operator immediately, if they believe that they have an urgent or emergent problem. To reduce patient confusion and frustration these answering systems should be as simple as possible.

Where a practice utilizes an answering machine during the hours that the office is closed, the practice must ensure that it delivers a clear and concise message to callers. The telephone number at which the doctor may be contacted in the event that the call is an emergency, should be clearly stated at the beginning of the message. The message should also notify patients early on, as to whether the machine accepts messages, so that the patient doesn't spend time unnecessarily waiting to leave a message. The taped message should also indicate when the office will reopen.

Requests for Medical Advice
Many calls to the physician's office involve clinical issues, however, not every staff person who answers the phone is qualified to provide patients with advice. The physician should determine who in the practice may give medical advice and the scope of that advice. Unless this issue is addressed specifically, unauthorized staff members may provide incorrect information to patients, which may adversely affect their health. This also creates liability for the physician, since (s)he is responsible for the information provided by his/her employees.

In those cases where the patient must speak with the physician but (s)he is not immediately available and, therefore, will return the call, the staff should provide the caller with an estimate of the time within which the doctor will call.

Triage Appointments
The medical office staff should also have guidelines to help them prioritize patients who call for appointments. This will help to ensure that patients are seen in a timely way, relative to their complaints.

These guidelines will vary, not only with the physician's specialty but also with the individual office. Therefore, each staff member who is responsible for making appointments should be aware of them.

Emergency Situations
Staff should understand very clearly the types of complaints that require emergency handling. The practice should institute guidelines that define exactly what the response should be (e.g. call 911; go to the nearest hospital emergency department). Since there should be no delay in responding to such calls, staff must be knowledgeable regarding the complaints which should evoke this response.

Below is a list of our Loss-Prevention Techniques:

Telephone Matters | Patient Relations | Test Results and Follow-up Monitoring Patients | Patient Follow-up
Guidelines for Comprehensive Office Chart
Emergency Prepardness | Developing Telephone Protocols
Medical Office Personnel | Medication Matters
Issues in Physician Coverage
Discounting the Doctor/Patient Relationship