A lesson in serving patients

Some people say voice mail is unfriendly, even rude. Maybe they're right. But since I can't be in the office every day, I recently purchased a digital answering machine with voice mailboxes that allows me to retrieve my messages from home (or wherever) and respond to patients as needed. From what I can tell, patients seem to like the voice-mail option, but I'm not sure I do.

A message I received last week gave me a start. An irate patient chided me for not getting back to her with her test results. I vaguely remembered her, a new patient, an elderly woman with microscopic hematuria whom I had sent for a renal ultrasound. I had planned to give her the results this week when she returned for her follow-up visit. I don't put ultrasounds in the same class as tissue biopsies in terms of the need for immediate follow-up with patients, and I had obviously underrated its importance to this woman. “Doctor, I haven't been able to sleep in three nights. I thought you would have called me by now,” was the end of her message.

I called her back immediately, apologized and offered the lame excuse that I hadn't yet received the written report from radiology and that, since radiology hadn't called me, it was probably normal. I then phoned radiology, confirmed my hunch and called her back to reassure her. It was too late. Today, I received a request from another doctor for her medical records.

I felt foolish and insensitive and would have liked to shrug it off as a disgruntled patient, not my problem. But instead I've asked Isabel to keep a log of every test and procedure we do or refer patients for. We'll review the log daily, we'll call for reports much more often, and we'll let patients know when we will call them with their results, if they don't want to wait for the follow-up appointment.

We are a “service” profession, are we not?

Computer fix

The computer I use for patient education has been on the fritz recently, so I called Merlin Tinker, FSM (“fixer of sewing machines”), as he calls himself, for a consultation. Merlin can fix almost any appliance (although I've learned he will not work on toasters or vacuum cleaners), but he mostly builds and services computers. We've been trading services for years. I keep him healthy; he keeps my computers healthy.

Merlin told me I needed to rebuild: a larger hard disk, a 3.5-inch floppy drive, a newer CD-ROM and a faster modem. A 17-inch monitor would make for better viewing besides. For what it would cost to fix my old one, I told him to make me a new machine — oh, and could he throw in some voice recognition software, too?

Today he appeared with it in tow, and what a pleasure it is. I can hook up to the Internet with blinding speed, retrieve my e-mail quickly and use all my patient education CDs with ease. I immediately put it to use. My first patient today, Thelma, has an extremely recalcitrant case of post-herpetic neuralgia that has defied the usual treatments. I did a quick online search and found information about a new laser therapy that is having some success. Dean, the very next patient, has severe osteoarthritis and has tried everything; he seems close to summoning Dr. Kevorkian at times. I recalled reading about a new drug for his condition but couldn't remember the name or manufacturer. So I jumped onto the Internet and, one minute later, came up with Celebrex by Monsanto. Both patients went away with printouts and some vestige of hope. It sure beats saying you wish there was something more you could do — when there very well might be.

Mystery diagnosis

Today I received a voice-mail message from Susan, one of my patients, who said she had finally been diagnosed by another provider and I could call her if I wanted to know what the diagnosis was. Hers had been a frustrating case. Several weeks earlier, I had done a complete workup on her for atypical chest pain, coming up with nothing — except a large bill. I had reassured her that she was OK, but she insisted she wasn't. I then referred her to a pulmonary specialist, Dr. Gude, who, I assumed from her phone call, had taken one look at her and told her exactly what the problem was, making me feel superfluous and irrelevant. With some trepidation, I returned the call.

“Hello,” I said. “Are you feeling better?” “Oh, yes. Much,” she said.

“So what did Dr. Gude say you have?” I asked.

“Oh,” she said, “I didn't see Dr. Gude. I went to an acupuncturist, who said I had a floating rib and sent me to a chiropractor, who put it back in.”

In addition to being made aware that complementary health practitioners also refer, I was relieved. I hadn't blown it after all. Rather than turn defensive and tell her that “floating rib” wasn't in the allopathic repertoire of diagnoses, I supported her alternative approach and shared her enthusiasm. After all, she was feeling better. She reminded me to consider floating ribs in other patients with chest pain, and I assured her that I would.