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| Medical Information: A Call to the Doctor Can Cause Static |
| Nicholas V. Costrini, M.D. Medical Director Georgia Gastroenterology Group, PC |
| I have evolved in my communication skills. Considering that I began with the Italian Intercom I may not be saying very much. In this form of communication, you need only to crane your neck and look in the direction of the person with whom you wish to communicate , clear your throat and yell, Hey Tony, what do you want to do tonight. When I tried to do that with my patients in the early years of private practice, it seemed to fall short of expected professional standards. I would stick my head out of the examination room and yell, I need a nurse and a blood-drawing set up right now. Some of my staff and patients would seem startled, babies would cry, and the waiting room would empty faster than the CDC cafeteria. I began evolving in my distance communications by returning phone calls to patients at the end of the day. I would call patients home phone numbers and most of the time I would get an answering machine. So as not to appear to ignore the patients call, I would leave a message. Hello, Mrs. Smith, this is Dr. C, I am returning your call. If you are at work, I presume your crushing chest pain is gone. If you are dead, I guess your pain was not heartburn. Leaving a message on a machine left a great deal to be desired. (I could hear the trial attorney in my nightmares, Dr C. is that your voice on the machine? Perhaps you called too late.) Later, in order to improve the speed of returning the fifty to seventy calls that would come in each day, I hired a full-time nurse whose only task is to return calls promptly. Still, we would have trouble reaching patients in a reasonable time. Patients have busy lives and it is most clearly evidenced by the following message on a patients answering machine the names have been changed to protect the stressed Hi, you have reached the Smith residence. If you want Bill, call his office, the boat, the workshop out back, or his cell phone (numbers supplied). If you want Angela, call her at her office or at home after 4pm, (except on Wednesdays when she drives the Billy, Jr. to soccer camp.) If this is an emergency, call Angelas cell phone. Billy, Jr. can be reached at his number only before 9:00 pm. please. My nurse left a brief message, Mrs. Smith, your polyp was benign. You will need a repeat colonoscopy in five years. Of course, the patient will likely have additional questions. She is too busy to come to the office or cannot get an appointment until the third Tuesday in December. Communicating with patients is a mess. The evolution process is continuing but now the issues of privacy and the law become serious. Doctors all over the planet are beginning to communicate with patients, offices, and hospitals with cell phones and e-mail. We are doing this because the Italian Intercom and routine telephone communication methods have become obsolete and out of sync with patients real lives. The problem is that we can never be sure that some health information is not leaked accidentally or otherwise to parties other than the patients. Patients are of no help. Last week, my nurse gave me a message from a patient requesting that I call him right away on his cell phone. I did. Dr. C. I am on my way to the airport. Can you call in a refill for my Viagra and my codeine? As an old physician once said, An urgent phone call is not always an emergency. The patient could have thought ahead (i.e. weeks) in this matter. Also, it is not proper or appropriate for a physician to discuss very specific matters on a cell phone, but the patient had put all this in motion. I guess he really wanted his med. It is further not safe for the patient to use the cell phone while driving. Cell phone communications with patients are becoming too commonplace. It is not safe, secure, private, or consistent with best medical practice. The e-mail medical communication is also very common. If we could be sure it is secure, it may have merit. Doctors have no way of knowing who is reading your e-mail. Neither do you. It is not likely to please a patient if a co-worker reads an e-mail discussing your most recent rash, malady, pregnancy, etc. As we evolve in this mad world of communications-run-amok, patients should consider the following issues. If you call for information, state your specific questions to the nurse. Most can be handled on the spot by the nurse. If you need a prescription, give the name of the pharmacy and the number to the nurse. Have the number at hand when you call. Dont ask the doctor to call a cell phone number. Make a reasonable effort to separate truly urgent problems from your urgent desire for an answer to a less than urgent matter. In the future, security and legal issues will be resolved so that mobile phone and e-mail medical communications will be ideal means of linking you with your doctor. Until then, if I cant find you at home, I will try the office, the work shed, or the boat. Better yet, I will open an office at the soccer field and I can use the Italian Intercom again. It is the surest way to get the message.
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