By HANS DUVEFELT

My nurse regularly gets at least 50 voicemails every day, many saying “please call me back”.

I have one patient who frequently tests the patience of our clinic staff by calling multiple times for the same thing. He is the most dramatic example of what seems to be a widely held belief that physicians, nurses and medical assistants sit at their desks and answer phone calls all or most of their time. But when we do, we are often hampered by busy signals, phone tag or “voice mail not set up”. Electronic messaging isn’t a panacea, because patients don’t necessarily know what we need to know in order to answer their questions correctly and efficiently at first contact.

Pharmacies, too, create duplicate requests that bog down our workdays. In my EMR, if an electronic refill request doesn’t get a response the day it comes in, the “system” sends a repeat request every day until it gets done. This is one reason I look like I am further behind on “tasks” than I really am. To top it off, every single refill request generated by the “system” comes with a red exclamation point next to it. This happens even when a patient has just picked up their last 90 day refill – a case where I theoretically should have 89 days to respond. Meanwhile, my system has no way of flagging truly urgent refill requests. This “alarm fatigue” is common in EMRs today.

The business model in today’s healthcare is that reimbursable activities (seeing patients in person or via telemedicine) are scheduled back to back, all day long. There is a universal assumption that this will still provide enough slack to deal with prescription refills, phone calls, incoming reports and the further ordering and feedback to patients prompted by them. And did I mention EMR documentation? Multitasking, or rather, constantly switching between different kinds of tasks, is not a sane or efficient way to work.

Providers, as salaried employees, are universally expected to get their work done on their own time (jokingly called “pajama time”). This creates varying degrees of stress and burnout. But nurses and medical assistants have a different stress. As hourly employees, they are theoretically entitled to overtime pay if they can’t finish their work during their normal working hours. But that is expensive for healthcare organizations and often discouraged or forbidden.

In Sweden, known for its somewhat stodgy bureaucracy, clinics almost universally have “telefontid”, a portion of the day when patients can call, or when staff are not seeing patients but returning calls – the details can vary. This may not be ideal customer service, but it at least acknowledges that multitasking in healthcare isn’t always necessary and certainly not healthy.

A growing trend in this country, mysterious to me and a generator of patient frustration and employee stress, is that in spite of all our expensive computers and phone systems – or perhaps because of them – most clinics, even large organizations, can’t afford to have someone answer the telephone.

St Joseph Hospital in Bangor usually answers on the first ring, and the main operator (I know her voice well) is efficient and helpful. My mother worked as an operator for a big hotel and also at one point the phone company. I remember watching her efficiency plugging in those little cables to transfer callers to the right department. Most clinics and hospitals tell you to hang up and call 911 if you’re in trouble and make you “listen carefully” to all the options, threatening that they “may have changed” and eventually you end up in somebody’s voicemail.

When everybody is talking about patient centeredness, customer experience and such things, why isn’t it obvious that incoming calls and other types of requests need to be prioritized as they arrive and not just dumped, unsorted, in someone’s voicemail or inbox?

Organizations appear to be paranoid about being held responsible if non-clinicians are put in a position to “triage” incoming calls. But it isn’t rocket science – everybody does it at home, with their kids, pets and themselves. I believe it may be an even greater liability to have an automated telephone system people get lost or stuck in.

Here are two slides from a staff education talk I gave 10 years ago about common sense telephone triage.

The telephone used to be a powerful tool, connecting people with businesses, services and each other. It no longer works like it used to, because nobody’s answering.

Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.