Patient access

[air bud]

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So what type of access do you give patients? I am very fortunated, I have incredibly nice, respectful compliant patients. Seriously. Not one elective case has anyone walked on early and screwed anything up (not saying they haven't walked early....).

I give all (95 percent) of my patients my personal cell phone after surgery. I used google voice instead of a burner phone, so if something goes wrong, easy to get a new number. Not one patient has every abused it. I text them intra-op photos (I take a ton if doing things like arthrodesis, tendon repair, cyst excision). Yeah, OR staff gets annoyed with me when I tell the rep to get a pic, move the lights, maybe grab a towel so a cleaner backdrop. But people love seeing how messed up their stuff was - it helps them justify why they had the pain (hey look there is no cartilage in here!) and also they love showing friends. I tell them after surgery, "if you are having pain the medication or loosening the bandage won't fix, get the dressing wet, or accidently fall, please call/text me. It doesn't matter the time of day or night, please get a hold of me (95 percent texts). If you just need to reschedule an appt or something like that, please just call my office." Again, nobody has ever abused it, 80 percent of the messages are relevant. It only makes patients like me more. Especially when you have complications, again patients just want to know that you care and are accessible. Only a handful of times have I had a patient text me after they were dishcarged from care, and even then was still legit texts.

What do you guys do?

 

[Pronation]

With a large patient load, I would lose my mind if I was getting an influx of texts on my cell phone. I communicate with patients through the patient portal.

 

[PeaJay]

Calls go to my clinic nurse for triage from 8-4. After hours calls go to a nurse line where the patient is triaged. Standard protocols are utilized and if they meet criteria are connected to a provider on call.

 

[air bud]

With a large patient load, I would lose my mind if I was getting an influx of texts on my cell phone. I communicate with patients through the patient portal.

i did 170 cases in last 9 months. Although I guess I should clarify I don't give my number to infection cases....so lets say 100 elective cases in last 9 months

 

[air bud]

I guess I should clarify - Its just me. No partners (well ortho but they have their own stuff). Just MA's, no real medical knowledge. If there is a problem I am ultimately getting called, so cut out the middleman and just get stuff answered and fixed asap. Again, I am in a small community, 12kish where I live and another 15kish in another town 30 mins away. I see these people at the grocery store, kids schools, the gym etc.

 

[wakaflocka88]

I do the same above as AirBud and agreed - only 1 patient has semi abused it but otherwise nothing. They even tell me at appts they feel bad if they bothered me on my cell. Patients really appreciate this and to me, makes a big difference in them spreading good word about you around town.

 

[air bud]

I do the same above as AirBud and agreed - only 1 patient has semi abused it but otherwise nothing. They even tell me at appts they feel bad if they bothered me on my cell. Patients really appreciate this and to me, makes a big difference in them spreading good word about you around town.

100 percent - the first words out of any phone call are - "I am so sorry to bother you" - to which I reply not at all, this is why I give you my number.

 

[dtrack22]

I worked for a podiatrist where the call number listed on the practice’s after hour recorded greeting (clinic telephone number) was a google voice number that went to my cell. Which means anyone who called after hours were basically given direct access to my cell phone. Most of the calls were not from my patients, but surprisingly I did not get regular calls or texts.

Currently my patients essentially have to go to the emergency department if it’s something not on their surgical paperwork and if it’s outside of clinic hours. There is no after hours call line/nursing line for any of our surgical specialty clinics. I’m actually tempted to set up a google voice and start giving it to my elective surgical patients because I’ve had a time or two when it would have been beneficial for the patient to be able to get a hold of me on a Friday, during the day, when our office is closed. But currently patients have basically no after hours access to me specifically. Unless they show up to UC or ED and then those providers can reach me because they all have my cell.

 

[Scrantonicity]

Patient portal on my EMR. I probably get 2 or 3 questions a month, and I see a high volume. It might be because I don't advertise it--I just let them figure it out on their own if they get the emails the EMR sends...otherwise they call the office (or go to Urgent Care/ER). I give my cellphone number only to the patients I deem much higher risk for complications, which is rare. Maybe I should re-think and give better access, but so far I haven't had too many problems in 10 years.

 

[DYK343]

I call the night before and the morning after surgery to check in. Usually thats a Saturday as my main OR day is Friday. They are on their own Sunday until Monday morning but we do have a semi worthless call center/triage. They just send a message to me via EHR which I dont see until Monday anyways.

When I first started here I fixed a pretty nasty fx. I knew he would be in a lot of pain so I gave him my cell number. To this day he still texts me on all major holidays with a holiday meme and at random times to ask if symptoms XYZ is normal.

Never again.

 

[heybrother]

I give out my cell phone number to surgery patients. I intermittently give it out to high risk diabetics that I like (none have ever called) and sometimes to nail surgeries around Christmas. I had some requests for scheduling appointments during regular business hours on the cell so I started to make clear to people that during regular business hours it is much faster to call the office. Patients are in general very appreciative. I would say I haven't been burned yet. Got sent a few too many toe amp pictures by one patient. Received a very polite text asking for gout medication on Christmas once.

My outpatient surgery center asks for data on all complications - ED visits, inpatient, complications etc so I like the idea of intercepting unnecessary ED stuff that would make me look bad. Shibuya has an article on VA patients using the ED like its your clinic. In general I prefer to manage my own complications.

Beats the hell out of my residency experience.

 

[streetsweeper]

My office recently adopted RingCentral (kind of pricey) for all our phone/fax needs. It's internet based. There is an app on my phone that I turn on after-hours so patients or whoever can still reach me. The caller ID on the patient's phone will always show our business name - never our personal info. Patients will always get a robo prompt/operator when they dial the number so it has a professional appearance 24/7 without a need for a call center. During business hours, I turn the app off so calls can be directed back to the office phones instead. The system doesn't get abused. My personal cell phone information never gets compromised. I highly recommend for small operations/clinic. Although I'm sure there are cheaper alternatives out there.

 

[air bud]

My office recently adopted RingCentral (kind of pricey) for all our phone/fax needs. It's internet based. There is an app on my phone that I turn on after-hours so patients or whoever can still reach me. The caller ID on the patient's phone will always show our business name - never our personal info. Patients will always get a robo prompt/operator when they dial the number so it has a professional appearance 24/7 without a need for a call center. During business hours, I turn the app off so calls can be directed back to the office phones instead. The system doesn't get abused. My personal cell phone information never gets compromised. I highly recommend for small operations/clinic. Although I'm sure there are cheaper alternatives out there.

You are wasting money. Get Google voice. Can be set up so patient enters name and you always know who is calling. Can always cancel the number patients don't have access to my personal cell number.

 

[air bud]

And yes as stated, so easy to manage complications and keep them out of the ER and keep other people from knowing your business.

For those of us here that do give patients your number you know it really is a great thing and really helps endear you to them and provide them with a better experience. Countless times patients have said how much they appreciate it and no doctor has ever done that before.

 

[air bud]

For the record, I totally understand some people not doing this for large segments of their patient population. I have very compliant patients. When I tell them about people walking on stuff ealry the universally saw well why would I do that and half to do this all over again

 

[Feli]

I give my cell to all OR elective (scheduled) or the parent for peds. I give it to most trauma fractures/amps too. I have done this at all my jobs from educated burbs patients to pretty "economically diverse." This was advised to us by my school's Pod Surg professor. I have heard other surgeons say it is crazy, but it works for me. I don't mask/change the number and have had the same number for 20+ years.
I have never had a problem (some dates awhile ago might have made me consider a new phone number... but not pts). I give it to patients (usually their spouse/family driver) in pre-op on the day of surgery around the time I arrive and mark the foot... I just write my cell on the back of my card that also reminds/confirms they know when their first office f/u is. I tell the patient to please call the office during hours for questions, or on evenings or weekends or if the office doesn't answer, they can leave me a cell voicemail or text and I will call back... but I'm super busy saving all of my other patients suffering from like two or sometimes even five calluses.
...I usually get texts from most calc fractures, ankles, RRA, etc about pain or where to put the ice pack. I think just hearing a calm voice say the pain will get better and knowing you are available keeps some of them from going to ER. Dunno. A few of the bunions or forefoot ask about weightbear status or showering (or if they can use a massage gun on it a month post op, true story). Some of the amp patients get bandage a bit wet or it spots through or whatever. I would say that only about 20% or fewer text or call. I think it is very helpful overall... keeps them from ever feeling abandoned. My number sorta acts like Dumbo's feather and probably makes them feel like they're taken care of, even if they don't ever use it.

I like to print the c-arm XR with all hardware in for the driver/visitor and give it them in wait room, but I tell them I will show the patient a better xray at office f/u and explain it. I don't send surgery picturs unless it is maybe a plastics case or something, and I usually ask for their email just since hospitals are hipaa crazy.

I try not to do surgery on the nervous/CRPS/fibro types or the multiple revision surgery types... definitely not elective. I am getting significantly better at sniffing them out ("CRPS prone"???). If I have the beady eyed smoker tweaker type who has a Lisfranc fx, I try to turf, try to just cast and hope they learn to control their emotions and start yoga and maybe worshipping Jeebus by the time post-trauma OA sets in and they need fusion years later... or I at least make sure they know where ER is if I do the case and just let the answering service chips fall where they may on those ones.

The "worst" I ever had was a lady texting asking about her son's foot a couple months after her own surgery healed. I have had a couple other patients who try to socialize a bit (I just stay polite but lag awhile and reply "hey, was in office, are you good" so they know I'm busy). I will take that, though. I find that people are pretty respectful of your time. For airbud, it is probably also that he shaves his head and ppl are kinda afraid of him.

 

[podoloco]

I have an alias email that goes directly to my main inbox. Also, my Facebook page, professional not personal, has a message option. Our website also has a message form. All of these options have been great. I don't mind the occasional message after hours when it helps prevent unnecessary trip to the ER, or panic calls to the hospital operator trying to reach me. I've never given my phone number out. My associate gives her number out to elective patients and recently we had a stalkerish situation with a patient that was sending non-stop messages at all hours. We had to discharge the patient, who still calls the office asking to come back. Patient has some anxiety issues or something. I thought she should have known better. None of her other patients have ever acted that way though.

 

[shadesofgrey]

In general, anyone I operate on gets my cell phone number. There have been probably about 5 patients that I felt were a bit to crazy to have my number and they are directed to call our office for the on call doc if there issues. Thus far no one has taken advantage of it. Definitely agree that it helps ease the patient and builds good rapport.

 

[NatCh]

I use the Doximity app that lets you call your patient and make it look like you're calling from your office. It also lets you send a secure text without showing your personal cell number.

I don't give patients my personal cell because it totally bypasses our group's triage system, which is set up to go through our office phone. If I'm on vacation or out hiking or something like that I don't want patients sending me a direct text asking if their foot is infected because I might not see the text for awhile, and when I do I'd need to address it even if I'm out of the country. We share call for a reason.

I also have several runners as patients and they can be a little extra. "Can I get your cell in case I think of some random questions while I train for my upcoming 5K?" Oh HELL no.