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Follow up – or maybe rant part 2

Follow up on the previous post about the rude woman:

It occurs to me that I rant a lot about people whose behavior makes me mad, and very little about those whose behavior is perfectly reasonable. Which leaves my friends convinced that it’s always evil to call the doctor!

So I thought I’d comment about some of the factors that influence whether I’m irritated by a phone call or not.

One of the biggest – could you have made this request at a more convenient time for me?  For example, last night’s example had three days of knowing about the problem, where she could have let us know the problem that needed solving, but instead she decided to call after-hours.  Another example from yesterday – a fellow who had been having headaches for two weeks, and contacts us with demands for a stat workup to be completed before he goes on vacation in two days. If you take a routine medication and your bottle is getting empty, don’t wait until you’ve used up your last pill on Saturday morning and then expect the doc to get you a refill by Saturday dinner.  If you develop the chest pain Saturday morning, call me Saturday daytime, don’t wait until 2 AM. And so on. 

And likewise I’m most friendly if you’ve used the method of communication that is easiest for me.  So if it requires immediate action from me, schedule an appointment with me so that I have time blocked off to give you that action. If it could wait a few days, send me a letter or a secure email (we have a website set up for people to do that) or a fax or leave a message on the clinic answering machine. This is far more likely to get you service with a smile.

Another big one is how life-threatening is the disease?  I understand insomnia sucks.  I got less than 3 hours of sleep last night, due to handling that situation with the 92-year-old whose blood glucose was over 500. As a result I anticipate a crappy day.  I get that you’d like to avoid that. I’m all for treating chronic insomnia.  But, one more night of poor sleep isn’t going to kill you, so wait and come see me in the daytime to start that treatment. On the other hand, when you slip and fall and hit your head and now you’re not sure if you should be going to the ER or if it’s OK to just have your family keep an eye on you for a few hours…. call me any time. I wouldn’t want you to die of the intracranial bleeding while you wait for my office to open. Sometimes its a matter of personal situation:  I want the severe asthmatic with bronchitis to call me for refills of the inhaler over the weekend; the ordinary healthy person with that same bronchitis should take some Robitussen and come see me in the office.

A third biggie – is this your fault?  Because if the reason you can’t get a prescription is a screwup at the pharmacy, I’m gonna be pleasant to you and then call and be mean to the pharmacy. If I failed to give you the correct number of refills to get you through to your next recommended appointment, or failed to explain to you that your diagnosis could cause this symptom, or confused you in any way – then you’ll get my quick response along with an apology.

How about this one:  should I be getting paid for the service you’re asking of me?  If it’s a routine transfer of a current prescription to a different pharmacy, where I don’t have to make any clinical decisions, then by all means call me during office hours.  If you lost your bottle of antibiotics and need me to call in a repeat prescription for the exact same thing, then calling is fine and you probably need to catch me on the weekend so you don’t miss a dose. If you want me to re-evaluate your condition and suggest different therapy:  THIS IS WHAT I DO FOR A LIVING.  I don’t want to do it for free over the phone during my dinner or sleeping hours instead.  If you need refills of the medicine that you haven’t discussed with me since I last refilled it a year ago, come in to see me – I’m not interested in guessing about whether the treatment is still appropriate.

And finally, there’s the question of what sort of person you are.  Are you one of the people who is always friendly when you come in? Have you shared your life and your family stories and your interests with me? If I was delayed in clinic with someone else’s emergency, were you pleasant to my staff and forgiving of the wait? Have you had a history of showing up on time, not missing appointments, and addressing problems in a reasonable and courteous manner in the past? Are you experiencing unusual life stresses right now – illness, divorce, bereavement, job change, etc – that might explain why you’re not thinking clearly about other peoples’ needs?  Are you demented or mentally ill? Are you mobility-impaired so that getting to the clinic is very difficult?

Now, there’s another side to this, which is:  What are my responsibilities, such that I can expect you to treat me so courteously? Here are some that come to mind:
– Make sure that I’m actually available to help you take care of problems a reasonable number of hours every week, and make sure those hours are clearly publicized.
– Offer you a number of reasonable alternatives for communicating with me and for getting the care you need.
– Being sure to listen to what you have to say, so that I don’t unwittingly cut off someone who actually had a legitimate reason to be making demands on me.
– Have competent staff and workflows so that when something needs doing, it gets done.

What else?

OK, enough rambling.  Perhaps should try to get some caffeine to counter the 5 hours of sleep I wanted and didn’t get…


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