I believe that, in the world of practice management, a doctor is only as good as his worst employee. This is especially true for those employees who meet and greet the public on behalf of and in the name of the physician (eg, employees who answer the phone, staff the registration desk, or make appointments). And we as physicians should not only consider the performance of the human staff working for us, but also the electronic or automatic systems.

The answering system
In the eyes of the public, you are only as good as your answering system. First encounters are extremely important. Unfortunately, all too often, patients hear one of the following greetings:

• Please hold ... click.
• We appreciate your call.
• All of our operators are currently busy.
• Please stay on the line; your approximate wait time is 18 minutes.
• Please listen carefully, as our list of options has recently changed.
• Please select from the list of options 1 through 9; if at any time you are not sure, press 0 and the list of options will be repeated.
• If you know your party’s extension, please dial it now.

I’m having so much fun writing these impersonal greetings that I don’t know where to stop, so here are just a few more:

• If this is a medical emergency, go to your nearest emergency room.
• If this is a life-threatening emergency, hang up and call 911.
• If you are still alive, press 1 or call back later.
• Thank you for holding. Now what was your name again? Before we get started, give your ‘social’ and answer a few questions: male or female, over or under 65…

Perhaps the one I like best is “Please leave a message and your call will receive the attention it merits.”

Making appointments
The second area for problems is the appointment desk or appointment line. What must a patient think when he or she hears the following:

• I’m sorry, Dr. Jones doesn’t see knees, hands, feet, trauma, or Worker’s Comp.
• I’m sorry, Dr. Jones doesn’t see low backs or high backs, much less Worker’s Comp backs.
• Dr. Jones is not taking any new patients for the next 6 months.
• Dr. Jones can see you on Christmas Eve at 4:30 p.m.—take it or leave it.
• So, you are a ‘knee’ that needs an appointment?
• Have you tried your local chiropractor or, if that fails, what about the City Hospital?
• I’m sorry, but I am away from my desk or on another line. Please leave your number and I will call you back in 4 days.
• Dr. Jones doesn’t have an opening for 4 months, but Dr. Canale can see you today; he doesn’t have any new patients.

I just can’t stop! The list goes on and on! Just a few more ... please let me indulge:

• Have you had an MRI yet? No point in making an appointment without an MRI.
• We don’t take that insurance plan. Have you tried the City Hospital?
• You only have Medicare? Are you kidding me?

So what can be done about this? As I said, I have tried for years to improve our system and about the time we get someone trained, he or she moves on to another, better-paying, less stressful job.

That is part of the problem. The image of you and your practice is many times left in the hands of the “first responder,” who may be your lowest-paid employee. I’m not sure better pay is the only answer (possibly less stress), but certainly better training is part of the answer.

There is some hope on the horizon with innovative new techniques, which is the thrust of this editorial.

Trunks and tracking
I would be the first to admit that I know nothing about “trunk” lines and whether you have enough lines to meet your answering and appointment needs. Also, I know there are pros and cons of both centralized and decentralized systems, dedicated lines for referring physicians, and even dedicated lines for Worker’s Comp case
appointments.

I am not “Terry the Phone Guy,” and I don’t know which system might be useful to you. But consultants are available to help you determine your needs for all or any of the above. Automated options are not as good as a personal voice, but if you do use automated options, according to the experts, three options are best, with a maximum of five.

One innovative technique that has recently become available is “tracking” technology, which measures how many calls and what type of calls your office receives per hour and per day. Typically, Mondays and the days after holidays are high volume. Staff assignments can be adjusted based on the hour and the day to anticipate the load.

“Hold time” also can be tracked—how long are patients waiting (on hold) to make an appointment. The longest hold time per day can again be handled by adjusting staffing levels. Hold time also can be shortened by simplifying the “appointment rules” and information needed to make scheduling easier and quicker.

Tracking “abandon” rates is important—how many potential patients just give up and hang up. When callers hang up, available technology allows you to track the numbers and call them back. And ask why they hung up!

Recently, some medical offices have instituted call-recording systems. “For quality assurance, this call may be recorded.” At first I thought this was just plain snooping, Big Brother listening in, a phone tap, but maybe it is important to record calls for customer service training and scheduling accuracy.

Recorded calls can also be used to verify a complaint about what was really said on the call, for the sake of both the employee and the patient. Recorded calls can be forwarded to office managers so that they can evaluate “customer service points” (greeting with name, identification of patient’s problem, and closing reminder of appointment date, time, location, and physician). “Trust in God and trust in your fellow man, but put a tap on your appointment desk phone line.”

Indicative of the frustration of people who deal with automated systems, several websites (e.g., www.gethuman.com) can actually tell you the wait time and how to get a human on the line in the shortest amount of time for many large national companies. According to this website, for a major company, the longest wait time, regardless of the gimmicks and advice on how to get a human voice is—48 minutes. Wow!

“On-line” appointment scheduling is a popular option that may be the wave of the future, but it’s still pretty impersonal.

Training schedulers and operators—not only in medical terminology, but in communication techniques—is important for customer (patient) service. Staff and physicians need to remember to “smile with your voice” when speaking to a patient on the phone.

Finally, the second most beautiful words a patient can hear: “Hi, I’m Dr. Canale’s nurse.” The MOST beautiful words are, “Hi, I’m Dr. Canale. How may I help you today?”