Why Not Call? (Exhaustion and Economics of Phone Calls)

A reader writes:

Why do I have to take time off of work and make an appointment for my doctor to explain test results? Wouldn't it be much easier to do over the telephone?

It would be easier to discuss this over the phone, and cheaper. Your doctor isn't paid for talking to you over the phone. Getting info over the phone is always a win for patients and a loss for doctors.

Primary Care Doctors (like Doctor D) for whom much of the job is educating you about your health are making a less and less every year (we're the green line) and we started out as the lowest paid physicians. Primary Care clinics are just barely scraping by, so when it comes to discussing your labs they can either do it over the phone for free, taking time away from seeing patients, or bring you in and get paid by your insurance to have the same discussion. The economic solution usually beats the common sense solution.

Now, I don't want this to sound like one of those Happy Hospitalist I-don't-get-reimbursed-for-all-I-do posts. Primary Care is still a good job and Doctor D doesn't have to worry about keeping food on the table.

But when Doctor D worked at Crayzee Clinic he spent many hours every day getting patients results, refills, and forms without pay. He did his best to call patients when he could, but if he knew it was going to be a long talk he usually had you come to the office. Doctor D had to keep some work during office hours—as it was he barely saw his wife or son while working primary care. Of course, some docs avoid phone calls because of greed, but most in primary care are just exhausted having to see more patients faster and faster while doing more paperwork in the evenings. An appointment to follow up tests was usually pleasant and easy, and didn't keep Doctor D in the office later at night after office hours.

But for the patient, it sucks! You have to get off work and drive to the doctor's office, just to get information you could have gotten over the phone. You can and should ask if your doc can call you the results without an appointment. Your heathcare is already too costly without extra visits. But please realize that this is harder on you doc, so don't abuse it. If you are the sort that needs to ask lots of follow up questions please schedule a visit instead of tying up your doc on the phone for 20 minutes!

Okay, after a long blog post about money and reimbursement Doctor D feels dirty and must go bathe the Happyishness off of himself.

This is one of those annoying situations that forces either you or your doc into a financially frustrating situation. The solution proposed on most doctor blogs is billing for phone calls.

What do you think? Would you be comfortable being billed for phone calls? It would save you costlier office visits. Or do you want to keep phone contact free?

How To Call A Doctor

A question from WarmSocks:

When my family gets sick I assume that we'll get better in a few days. When in doubt, I phone my doctor's office to ask if something is serious enough to be seen. I am always told to bring the kids in that same day. My doctor is very busy, but he work us in when what I'd really like is assurance that it's okay to wait a few more days. Are there guidelines for when to call the doctor or not?

Your body will sometimes do quirky things that don't require a doctor's visit. The tricky part is figuring out what needs a doctor and what doesn't. It's nice to have advice from a medical professional on which symptoms merit an exam. For this you call them on the phone.

Although the telephone was patented in 1876, we doctors still haven't quite figured out how to use the thing in medical care. Talk is cheap, and this can be a very good thing. In fact it's free. Doctors aren't paid one red cent for talking to you on the phone. Unfortunately if Doctor D tells you over the phone it sounds like a viral cold and you get pneumonia lawyers won't take it easy on Doctor D because the advice he gave was free. Extra risks with no pay makes a lot of doctors avoid phone questions like the plague. You call with a question and the receptionist tells you to make an appointment. This sucks because you often pay for care you didn't need.

So if your doc will talk to you on the phone realize this is a really nice service. Doctor's are always nervous about phone advice. You really don't want to be that guy that causes your doc to say "Screw it, no more phone questions! Just make an appointment for everybody who calls."

Tips on Calling Your Doctor:

• If you feel you simply must be examined don't call and ask. If your doctor saying your symptoms don't warrant a visit will upset you, then just go a head and make your appointment. Patients that get an answer they don't want will either show up angry wanting an appointment anyway or stay home angry. Neither is good.

• Have a specific question or concern when you call. Doctors have very short phone attention spans. People sometimes call Doctor D with long stories about how Little Johnny never did have a strong stomach. After several minutes of this Doctor D has to stop this very interesting story to figure out what the heck you are calling about.
  

• Let your doctor know your expectations. There are a lot of things that might result from a call: reassurance, a prescription, a referral, advice, moving up the date of your appointment, or being asked to come in right away. You probably have expectations of what you think should happen. If you simply call, list your symptoms, and listen to your doctor's response, you often feel frustrated afterward because your doc didn't address your real concern. The best doctor in the world can't read minds. You should politely let the doctor know what you are expecting. Even if your doctor doesn't agree they can respond to your concern.

• Don't try to solve all your problems over the phone. Remember the phone calls are free, and doc has to keep seeing patients in person to keep the lights on. If you want to discuss your entire medical history or every odd symptom you've had in the last year consider an appointment. Your doc just doesn't have the time to cover all that on the phone.

• Accept that different patients get different phone care. If Doctor D has known a patient for years he is very familiar with that patient's body and mind. He is much more comfortable treating that person over the phone than somebody he only met once or twice.

• Acknowledge the uncertain nature of the situation. Medical work involves examining the body. We can't do that over the phone. This makes us less certain. Sometimes that uncertainty (coupled with fear of lawyers) leads us to ask you to come for an expensive checkup when our gut tells us it's really nothing serious. Just saying "I know you can't be certain over the phone, doc, but what is your best guess?" could save you hundreds of dollars.