Doctor Access – How Much Is Too Much?

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
Mountain View Medical &
Surgical Associates,
Madras, Oregon

How easy should it be for patients to contact their physician? I had to ask myself this question recently after receiving a phone call from a patient. After performing a partial toe amputation for osteomyelitis about six months ago this particular patient to whom I had given my pager called me the other day to discuss a billing issue. Unfortunately for me this phone call was only one of many I have received over the months following her procedure. The phone calls varied from small questions about her toe to more problematic concerns when she would fail to attend her regularly scheduled appointments and suffer some complication. Of course, each phone call — regardless of the complexity — lasted much longer than necessary, often infringing on my personal time.

My personal policy regarding my pager is as follows. I give my pager to every patient in which I perform an operating room procedure. I do not provide my pager for patients who’ve received in-office procedures. I would rather have my patients call me directly with concerns rather than receive a call from the emergency room or, worse, hear later they were seen in the ER. I tell my patients they are to call me at any time day or night if necessary while providing a specific postoperative instruction form to cover general issues.

One might ask the question about patient volume; does a higher volume make this unrealistic? I would argue not. Currently, my practice volume is low at an average of 15 patients/day (we’ll chock this off to a new practice in a rural area) so it’s easy for me to respond to a comparatively low surgical volume. On the other hand, when I was in practice in Michigan and my practice was much busier (plus covering for another very busy doctor) I had no difficulties maintaining this open access policy.

In most cases I don’t receive phone calls, everything goes according to plan, and my personal time is not infringed upon unnecessarily. I some cases a patient will call with a concern that is easily taken care of via telephone. Rarely, a complication will occur that will require my direct intervention in which case I’ll make a home call, see them at my office after hours, or examine them in the emergency room. Universally my patients appreciate this open access; I’ve never had a surgical patient complain that they’ve had a hard time contacting me. Additionally, this is simply better patient care, eliminating a small problem before it becomes a significant complication.

In some cases I regret giving my number to patients. I have a very high maintenance patient, for instance, who calls me much too often for small problems and concerns that may easily be handled during office hours. Especially exhausting are those patients who think I’m the billing company or the front office staff. Superfluous phone calls such as these – always seeming to come during dinner – are inappropriate to say the least. In cases such as these I’ll politely ask these patients to call the appropriate office number in the morning and extricate myself from the phone as quickly as possible (always asking if there’s something else I can do for them).

I consider this one of those parts of the job that come with the territory, and I have every plan to continue providing my pager to my surgical patients (even the crazy ones). Here’s my question to the podiatric community: how do you deal with patient access? What advantages and disadvantages do you find with your communication methods? Do you have a special protocol that balances your privacy with good patient care or is this just wishful thinking? Write in and be part of the community.

How do you deal with patient access?

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Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]