A few weeks ago, I woke up with a miserably clogged ear — the kind of clogged where, despite my best efforts, no amount of sound reached my eardrum. After a few semi-soundless days, Q-tipping and ear-dropping only seemed to make the problem worse. I called my primary care doctor to see if she could remedy the clog herself or refer me to a specialist for treatment. The kind receptionist said she’d check with the doc and call me back with an answer that day. Two days went by with no response. Annoyed, I went to urgent care and dropped $150 on a standard earwax-clearing procedure, where a healthcare professional sprays a warm water solution into your ear to clear the clog. At my primary care doctor, I only would have owed a copay.
It’s likely my doctor never even got my message, says Linda Beck, a board certified patient advocate who founded Square One Elder and Health Advocacy. In fact, this sort of communication breakdown happens all the time: “A lot of healthcare providers are incredibly pressed for time and don’t find a way to squeeze these messages into their day.” The complicated phone automation systems used in many healthcare offices don’t always help matters, Beck adds. As a result, it’s not unusual for patient messages to go unanswered.
In extreme cases, a doctor’s failure to respond can constitute patient abandonment, such as when a patient makes several unsuccessful attempts to reach their doctor and incurs an injury as a result. A Louisiana judge ruled that a doctor could be found legally liable for medical complications suffered by a patient following an unreturned call.
In a lot of cases — when ears need declogging or birth control refills run out — not hearing back from a doctor is more irritating than life-threatening. Still, patients deserve better. Here’s what you can do when it feels like calling your doc is the equivalent of screaming into the void.
Establish communication protocol
To lower your chances of dealing with an unresponsive doctor, take the preventive step of asking a new healthcare provider about their preferred methods of communication, says David J. Zetter, founder and lead consultant with Zetter HealthCare Management Consultants. Does the physician want all communication to take place through the patient portal? Are scheduling calls the only telephone communication the practice accepts? “I’ve got clients that will not accept any patient calls for script refills, medical record requests and even in some cases, they have to request an appointment through the portal,” Zetter says. “That’s just an example of how things some things may be changing and patients aren’t aware.”
While making a phone call might seem like the fastest and most efficient way to acknowledge a medical query, practices are often busy and understaffed, says Julia Pinckney, a patient advocate and CEO of AmbassaCare. Doctors might not receive all their messages if their schedules are packed or notes get lost in the shuffle. “They’re not going to return the call if they are buried,” she says.
Beck, Zetter and Pinckney are proponents of the patient portal. If the practice has one, utilize it, as it creates a written record of patient needs and requests. “Phone calls are very inefficient, not only for the patient but for the practice,” Zetter says. “Answers can be done much quicker through patient portals. They can get back to people right away.”
Of course, the impetus is on the healthcare professional to emphasize this as the preferred course of patient communication, Beck says.
If you don’t hear back from your healthcare provider within two working days, Beck suggests calling or emailing again. In her experience, reaching out to someone else in the practice, such as another doctor, a physician’s assistant or the practice manager, will expedite the response time.
Recently, after a number of voicemails to her primary care physician went unanswered, Beck wrote a letter explaining her reason for calling — she needed a specialist referral — and dropped it off at the office. She received a call back two hours later. “It got into the doctor’s hands,” Beck says. “You don’t need to belabor the point. I stated what I needed, which is a referral to a specialist, and it was a very clear thing he could hold in his hand.”
Know who you need to talk to
In order to get a call back, it’s important to reach out to the right person (or people). Leaving a voicemail for your physician regarding a prescription refill is not always the most effective course of action, Zetter says. “It should be going through their nurse or the medical assistant,” he says. “They’re the ones that should be handling that, otherwise you’re never going to get a call from that doctor.”
For a clogged ear-level health concern, a prescription request, an insurance coverage question or any other nonemergency situation, Pinckney suggests asking for the nurse. “The nurse can reach out [to the insurance company] and they’re going to have a quicker return time than perhaps you might,” Pinckney says. If a day goes by and you haven’t heard back, don’t hesitate to call the practice manager, who’s responsible for resolving communication issues.
If you have a question about a medication you’re taking, Beck likes communicating directly with pharmacists. They’re well-versed in side effects, dosing guidelines and any potential conflicts with other medications, and they can contact your healthcare provider on your behalf. A call from a pharmacist might be more likely to reach a busy doctor.
When you finally do get face-time (or phone time), it’s appropriate to voice your communication concerns. Whether speaking to your healthcare provider or the practice manager, Pinckney says to share what went wrong. In my case, which ended with an urgent care visit, she suggests saying something like: “This is an unfortunate sequence of events, and ultimately it led to me seeing a physician who does not know me, who does not have a history with me.”
Beck agrees: Be upfront with communication gripes. “They can’t make improvements if they don’t know what the problem is,” she says. “Ultimately, it’s the practice manager who should be overseeing the communication links to make sure everybody is getting the patient communications that they need — and that the patients are getting good care, which includes good, timely communication with your healthcare provider.”
Don’t ditch your primary care physician
I jumped ship to an urgent care facility without so much as a second call to my primary care physician. Don’t follow my lead. Pinckney’s a proponent of keeping primary care physicians as the central hub of your healthcare. “Always coordinate through your primary care physician,” she says. “For the most part, there are specialty care providers that will always require you to go to the primary care physician first.” Plus, a primary care provider has a more comprehensive record of your health history at large, something the ER urgent care does not, and is better suited to provide care simply because they have more information.
At the end of the day, if you’re still getting silence after reaching out multiple times, it might be time for a new doctor. “If you’re not getting good bedside or chair-side service or if the practitioner or practice is rude,” Zetter says, “the patient’s going to go somewhere else.” And they should.