(To view the case of the original post, go to Case 1.)

One of Susan’s problems was that she wasn’t getting the home nursing visits she needed nor the physical therapy treatments.  After calling the home health agency, she learned that they hadn’t received the order from the physician.  When she tried to speak with physician she seemed to get nowhere and was waiting for a callback.  This raises the third issue – a practice that seems unresponsive.  You’ll notice I didn’t say a doctor who is unresponsive.  From the information we have, we don’t know that yet.  From my experience, patients often don’t know how to convey the most important information to enable the office receptionist to make the best decision.  The message sometimes lacks important information to convey the appropriate priority.  If Susan just said, “Hello, I’m Susan, Dr. Smith’s patient and I need to speak with him.  Please have him call me at XXX-XXXX,” that probably won’t rise to the top of the priority list. 

Let me give you a little background about how physician practices are run.  First of all the clinical training of the receptionist varies from practice to practice.  Usually it’s not a nurse who answers the phone, so in most instances their medical knowledge is limited.  In many practices there is a nurse who works with one or more of the physicians.  One of the responsibilities of this nurse is to handle many of her doctor’s patients’ issues.  This is the person you want to make sure gets an accurate message.  The receptionist who answers the phone will usually relay the information you have given to that nurse or the doctor. Sometimes the nurse can take care of some issues without the doctor having to call the patient back.  For instance, if Susan relayed all the necessary information, the nurse could have gotten her physician to complete the required paper work and forwarded it to the home health agency without the doctor calling Susan.  It’s critical that you communicate effectively.  Here are some suggestions:

1. When calling ask to speak to the doctor’s nurse.  The nurse will have a better clinical understanding of the importance of your clinical issues.  If there is no nurse, the next steps are even more important.
2. Tell them specifically what the issue is and why it’s important; not just that you want to be called back.  Be clear and direct.  If you need the doctor to make sure to sign orders with the home health company so you can get the care necessary for your recovery, say so.  Also state that you want to be notified once he has done that.  (You’ll see below why that’s important.)
3. If you can’t speak with the nurse or doctor then, always get an estimate of the time when the physician or nurse will call you back.
4. In Susan’s case, where she needs her doctor to authorize her visiting nurse visits, she has another option if her physician fails to help her.  But first she needs to call her doctor one more time to determine what, if anything, they have done.  (Sometimes the practice takes care of this kind of thing but doesn’t let the patient know.  In this way the doctor doesn’t even need to call the patient back.  But unless someone calls the patient, they are waiting for a call that may never come.)  If it hasn’t been taken care of yet, I would let the practice know that since I need the services, I’ll be calling my insurance to see what they recommend.  This may move your issue up in priority and get it resolved.  Otherwise, go ahead and call the Customer Service department of your health insurance to enlist their help.  They have a whole team of staff who work with physician practices who should be able to resolve this.  If you have to take this route, you probably need to find another more responsive practice, so see my last recommendation.
5. If your experience trying to reach your doctor is disappointing, the next time you see him or her, ask how you can make sure you get a more desirable response in the future.  Most physicians take pride in being accessible to their patients.  Gauge your physician’s reply to your concern.  If it is unsatisfactory, you may want to consider my next suggestion without waiting for a recurrence.
6. Consider changing physicians if you continue to have difficulty getting through to your doctor.  If your health plan requires you to use an in-network physician, call the Member Services number on the back of your health insurance card for help in identifying other suitable, in-network physicians in your area.  You may also want to mention to them your reason for changing doctors.

Have you had difficulties with accessibility to your doctors?  Please share some of your experiences.

On the next post I’ll talk about Susan’s transportation problems.

For Your Health – Dr. Bob