RE: WHAT SHOULD 24/7 ACCESS REALLY MEAN??

[Guest guest]

a , my wife wants to put together an office brochure. Could you drop a copy in the mail so see can get some ideas. Thanks D. Egly, M.D. 11 E Pleasant Ave Sandwich, IL 60548Mintek wrote: Our home phone is listed in the local phonebook and our answering machine, outside of office hours, gives Rian's cell phone number. On the inside of the brochure, that we give to all new patients, is our home phone and Rian's cell phone listed under a short paragraph titled Unfettered Access (thanks to Gordon's idea several years ago). It says that Rian may be reached at

that cell 24/7. As I hand patients the brochure and I open it and point that section out, I say to them "Here's how to reach Dr. Mintek outside of our office hours when you have any kind of urgent medical concern....keep an extra brochure in your glove compartment so that when you are traveling you can reach him as well." Patients are simply amazed. No one has offered this kind of access before. After 23 years of practice and sharing call with a group much of that time we were afraid that in his new practice he'd be bombarded outside clinic hours, but it is amazing. Patients are very respectful of his free time. I think when you show them you are able to be reached easily, it pleases them and your relationship with them strengthens but so does their respect for you and your free time. Patients rarely call him. He maybe averages one call a weekend and we very rarely get calls on weeknights. However, there HAVE been several occasions (over 2 1/2 yrs) where Rian was VERY glad that a patient DID call him (usually urged to do so by a spouse) - where, for example, a patient was vastly understating an important symptom and also was not planning to go to an ER but did wonder what he thought. In those instances Rian was very glad they called him and glad that he could urge them to be seen in the ER. Some of those situations would have turned out very poorly if they had "toughed it out at home" and also not bothered any physician. Perhaps the reluctance to "bother" someone is more common in a small midwestern town like ours (ala Garrison Keillor's Minnesota characters who don't like to complain and who understate the illnesses, diseases, and traumas that come their way) When we lived in Philly, I thought people were a lot more aggressive and pushy so maybe everyone's 24/7 policy has

to be designed with their regional, cultural style in mind. Still and all, you may want to give a really "unfettered" approach a try. When you are only taking call for yourself and your patients really respect what you are trying to do, you may be surprised at how few bother you in your free time. a Mintek office manager Dowtown Allegan Family Practice Allegan, Michigan Re: PRACTICE TRANSFORMATION by> ACTIVATING patients>>>> Kathy, I will attach the handout below. Regarding your specific issues> I would like to make a few comments.>>>> 1) If you start giving free advice (telephone medicine) you will never> get off the phone and your income will plummet. You will also start to> get irritated. You are a professional and you should charge for your> services as all professionals do. A simple answer on the phone will be> tempting in cases but folks always seem to have follow up questions and> you will set the stage to be doing all your 99212 & 99213s by phone.> Your patients will learn that they can call and not come in.--> a> counterproductive behavior (female

codependence?)>>>> 2) Activated patients come to visits prepared and do not need to make> stray phone calls between appointments. We give them our attention for> as long as they need during the office visit and they should be prepared> to discuss refills, FU intervals, disease management at that time.> Enforce this.>>>> 3) Patients should never ever bother you on your cell phone unless they> are on their way to the ED/UC. If they are worried enough that they> will consider disrupting THEIR plans to get in the car and be seen> urgently/emergently then I want to know. Otherwise, if they are not so> concerned that they plan NOT to interrupt their plans but can still> interrupt YOUR PLANS with an unnecessary phone call then something is> wrong with the picture. ---> Do not train your patients to abuse you.> My phone message on my

machine says you may notify Dr. Wible on her cell> phone at 968-8510 if you are ON YOUR WAY TO THE ED/UC. Very clear and> it is upheld by all patients even my traumatic brain injury patients in> the middle of the night when they call in a total panic/frenzy about not> being able to find their car keys or their boyfriend walked out on them.> Even with their brain injury and impulse control issues they understand> what my cell phone is for. Uphold the sanctity of your personal space.>>>> 4) A practice with well trained activated patients will have an office> phone that primarily rings for scheduling office visits.>>>> 5) Dysfunctional behavior attracts others with dysfunctional behavior.> Clean up your act and set firm boundaries and the patients will be> respectful or...they leave and find another kindred dysfunctional soul> at ANOTHER

office.>>>> You can make your office life whatever you want. You can be supportive,> empathetic and firm!>> Keep a running list of ANYTHING or ANYONE that gets under your skin and> problem solve your list weekly. Soon you will have nothing to put on> your list!>>>>>>>>

[Guest guest]

, I'd be happy to mail a brochure and if anyone else wants to see our basic brochure, wrangled together using simple Publisher software, just let me know through our email mintek@....

I neglected to say to everyone, re the 24/7 thread, that we do not accept Medicaid and I'm sure that makes a difference in how often patients call Rian outside of office hours. We do accept Medicare - about 1/3 of our practice. Also we have lots of low income patients, and patients without insurance. Michigan's economy is currently one of the worst in the nation - plants continue to close in our county. There are very few well-to-do in our area.

a Mintek

Re: PRACTICE TRANSFORMATION by> ACTIVATING patients>>>> Kathy, I will attach the handout below. Regarding your specific issues> I would like to make a few comments.>>>> 1) If you start giving free advice (telephone medicine) you will never> get off the phone and your income will plummet. You will also start to> get irritated. You are a professional and you should charge for your> services as all professionals do. A simple answer on the phone will be> tempting in cases but folks always seem to have follow up questions and> you will set the stage to be doing all your 99212 & 99213s by phone.> Your patients will learn that they can call and not come in.--> a> counterproductive behavior (female codependence?)>>>> 2) Activated patients come to visits prepared and do not need to make> stray phone calls between appointments. We give them our attention for> as long as they need during the office visit and they should be prepared> to discuss refills, FU intervals, disease management at that time.> Enforce this.>>>> 3) Patients should never ever bother you on your cell phone unless they> are on their way to the ED/UC. If they are worried enough that they> will consider disrupting THEIR plans to get in the car and be seen> urgently/emergently then I want to know. Otherwise, if they are not so> concerned that they plan NOT to interrupt their plans but can still> interrupt YOUR PLANS with an unnecessary phone call then something is> wrong with the picture. ---> Do not train your patients to abuse you.> My phone mess! age on my machine says you may notify Dr. Wible on her cell> phone at 968-8510 if you are ON YOUR WAY TO THE ED/UC. Very clear and> it is upheld by all patients even my traumatic brain injury patients in> the middle of the night when they call in a total panic/frenzy about not> being able to find their car keys or their boyfriend walked out on them.> Even with their brain injury and impulse control issues they understand> what my cell phone is for. Uphold the sanctity of your personal space.>>>> 4) A practice with well trained activated patients will have an office> phone that primarily rings for scheduling office visits.>>>> 5) Dysfunctional behavior attracts others with dysfunctional behavior.> Clean up your act and set firm boundaries and the patients will be> respectful or...they leave and find another kindred dysfunctional soul> at ANOTHER office.>>>> You can make your office life whatever you want. You can be supportive,> empathetic and firm!>> Keep a running list of ANYTHING or ANYONE that gets under your skin and> problem solve your list weekly. Soon you will have nothing to put on> your list!>>>>>>>>

[Guest guest]

I have to agree with (although we don’t

forward our phone because many of our patient leave a message asking for an

appointment). Our answering machine gives Elise’s cell phone number

for urgent medical issues. Most of our patients just leave a message for

an appointment the next day. She gets maybe 3 calls a week. She has

never been woken up by a patient. (She has been by nurses at the

hospital, but that is another story.) No one has abused it. It

seems like it works well. Last night she got a call by a mother who’s

two year old might have diabetes. She is trying hard, but not

sophisticated. She called because he was having slow capillary refill on

his feet and had a family member who has neuropathy. She did not know the

difference. If Elise had not answered the call, she would have visited

the ER and Medicaid HMO would have footed an ER bill of a minimum of $496.

It took her sixty seconds.

Ernie

From: [mailto: ] On Behalf Of Brady, MD

Sent: Thursday, March 02, 2006

12:12 PM

To:

Subject: RE:

WHAT SHOULD 24/7 ACCESS REALLY MEAN??

I am available 24/7 as well. What that

means to me is that after I leave the office, I forward the phone to my cell

phone and keep that with me at all times. Although I understand your

“tough love” kind of stance, I don’t necessarily agree with

its premise. The problem is what is urgent or emergent to me may or may not be

urgent or emergent to you and is certainly not clear to a patient with little

medical knowledge. I believe you are right in activating your patients, but I

think discouraging patients from calling when they think they need your

services (even if you don’t) is potentially dangerous. Ex. What if a

patient is having diarrhea? They are encouraged not to call. What if the

diarrhea is black and tarry? They still are encouraged not to call because they

probably don’t know the nuances of treatment algorithms for diarrhea. In

my office, I would be mad if they did not call.

So do I get inundated with calls after hours. No. Why? I always have same day

appointments (so most people know they can get in the next am) which eliminates

many calls. I also get all the work done before I leave the office, which

eliminates even more. Also, those that call after hours for appointments get a

reminder from me that they can schedule an appointment on my website or call at

8am the next morning (thus

activating them at the time of the error). Those that call for rx refills get

told that I don’t do those except when I am at the office (again

activating them when necessary). Yes, I still have some that abuse the system

to some degree, but in general, my patients are very considerate of my time and

very appreciative that I am able to assist (even if only over the phone) when

they are in need.

By the way, I have about 1200 patients

(maybe 1000 active) and average one call on weeknights and probably 3-4 on a

weekend (during the winter). I have had only 3 calls wake me up in the middle

of the night (that I remember) since I opened the office 3 years ago.

Re:

PRACTICE TRANSFORMATION by ACTIVATING patients

Kathy, I will attach the handout below. Regarding your

specific issues I would like to make a few comments.

1) If you start giving free advice (telephone medicine) you will never

get off the phone and your income will plummet. You will also start to get

irritated. You are a professional and you should charge for your services as

all professionals do. A simple answer on the phone will be tempting in

cases but folks always seem to have follow up questions and you will set the

stage to be doing all your 99212 & 99213s by phone. Your patients will

learn that they can call and not come in.--> a counterproductive behavior

(female codependence?)

2) Activated patients come to visits prepared and do not need to make

stray phone calls between appointments. We give them our attention for as

long as they need during the office visit and they should be prepared to

discuss refills, FU intervals, disease management at that time. Enforce

this.

3) Patients should never ever bother you on your cell phone unless they

are on their way to the ED/UC. If they are worried enough that they will

consider disrupting THEIR plans to get in the car and be seen

urgently/emergently then I want to know. Otherwise, if they are not so

concerned that they plan NOT to interrupt their plans but can still interrupt

YOUR PLANS with an unnecessary phone call then something is wrong with the

picture. ---> Do not train your patients to abuse you. My phone

message on my machine says you may notify Dr. Wible on her cell phone at

968-8510 if you are ON YOUR WAY TO THE ED/UC. Very clear and it is upheld

by all patients even my traumatic brain injury patients in the middle of the

night when they call in a total panic/frenzy about not being able to find their

car keys or their boyfriend walked out on them. Even with their brain

injury and impulse control issues they understand what my cell phone is for.

Uphold the sanctity of your personal space.

4) A practice with well trained activated patients will have an office

phone that primarily rings for scheduling office visits.

5) Dysfunctional behavior attracts others with dysfunctional

behavior. Clean up your act and set firm boundaries and the patients will

be respectful or...they leave and find another kindred dysfunctional soul at

ANOTHER office.

You can make your office life whatever you want. You can be supportive,

empathetic and firm!

Keep a running list of ANYTHING or ANYONE that gets under your skin and

problem solve your list weekly. Soon you will have nothing to put on your list!