Medical Voice Mail Etiquette

Some of us older* medical students can remember a day without answering machines. If you weren't home or didn't run to the phone in time, whatever the caller on the other end had to say would have to wait. These days, the only reason not to have an answering machine is if you don't have a land line. Furthermore, cell phones record caller identity, the second the incoming message was recorded and the return number. Call me old fashioned, but I still would like you to leave your name, number, time and reason for the call. At least callers still have to wait for the beep...

Leaving a concise phone message is a lost art. This presents a problem for the fledgling medical care provider. What is the best way to communicate with a patient or family member when you have one minute for a message? Leaving a phone message is dangerous territory. On the one hand, you want the patient to know that it is important to call you as soon as possible, but you do not want to unduly alarm them. And leaving a message for a family member can provide more information than the patient would like. I tend to leave overly detailed (read rambling) messages, so am at serious risk for providing too much information. The one minute cutoff some voice mail services enforce in their message recordings is a blessing in disguise. It's a hint that the care provider should leave a short and direct message.

Consider the following situation that happened to me. During the second year of medical school, I volunteered to be a normal healthy subject for a new nasogastric (NG) tube monitoring device. The idea was that an electrical conductance probe just at the lower esophageal sphincter (a muscle that separates the stomach from the esophagus) could better predict gastro-esophageal reflux disease (GERD or heartburn) than other techniques. So this required me to wear an NG tube and a monitoring device for a day. If you know anything about the first two years of medical school, you know that someone with an NG tube will be noticed. I was fine with that - I was getting $200, after all. Anyway, a few weeks after the study, I came home to a message on my answering machine: "Hello this is Dr. NoThink from the GI clinic. We would like you to come in for some more tests. We are really concerned about the results from our study, and think you might have GERD."

Excuse me?!!!?? What went wrong here? Let me count the ways:

1. Delivering a diagnosis this way is like breaking up over the phone. It's just not cool.
2. Coming to a decision about a condition that can lead to cancer based on an untested diagnostic procedure is, well, unscientific.
   
3. Dr. NoThink has no idea who has access to this answering machine. Some options include my medical student roommate, family, my health insurance company. Okay, maybe not the health insurance company...
4. By leaving confidential patient information in an uncontrolled location (including data recordings), Dr. NoThink has broken the law (HIPAA) and opened his hospital to the potential of bad things.

Honestly, Dr. NoThink probably just wasn't thinking. This is a mistake we care providers need to avoid. As such, when making a phone call, here are some tips that can help you comply with HIPAA and avoid embarrassing or ticking off your patient.

1. When you call, expect to leave a message. Be prepared to leave a short and direct statement.
2. Speak in a measured rate and a flat or friendly tone.
   
3. Say your name.
4. Indicate your hospital.
5. Do not say your clinic or specialty. (Unexpected calls from oncology or psychiatry will raise flags for anyone!)
6. Do not leave any information about tests or results.
   
7. Leave your phone number or pager.
8. Ask that the patient contact you as soon as he or she can.
9. Hang up.

If you are ready to leave this information, you can do it for a machine, you can provide it to anyone other than the patient who picks up, and you can introduce yourself to the patient if she or he answers. This seems so straight-forward, it's a wonder that it's so hard to do! As with everything else on the wards, it will take practice. 15 or 20 seconds for this information is my goal. Save the details for a live conversation.

*Interesting... in my most previous post, I argued that I am young for a scientist.