Huge topic. Long post.
Who's Who and What They Do
First off, let's talk about "who does what" in a typical pediatric doctor's office:The receptionist: Poor lady. Cut her some slack. She gets to try to talk to half-a-dozen people at the same time, make triage decisions (determine who needs immediate care, who can wait), and take all the heat when people are ticked off or plain panicked. She also talks with hundreds of people DAILY, so don't expect her to remember who you are. Just give her the basic info and let her get on with scheduling you or connecting you to the right person.
The nurse: Your best advocate and the person who takes care of 95% of all the things you need done. REMEMBER THE NURSE'S NAME. Especially if she identifies herself in this way, "I am Dr. So-and-so's nurse." ESPECIALLY remember her name if she leaves a phone message for you. There is nothing worse than playing phone tag with multiple voice mailboxes. The nurse fills out paperwork, prescription orders, keeps track of lab orders and faxes of all kinds. The nurse has the power to override scheduling defaults (more on that later). The nurse can get your paperwork back on top of the inbox pile. Etc., etc., etc....
The billing person: may or may not actually be a person in the office. Ask the receptionist. I don't have a lot of advice about this.
The doctor (or physician's assistant or nurse practitioner...in essence the same thing as a doctor. Really. Don't get snobbish.) : Always remember that your doctor is only paid for the time they are talking to you face-to-face...and the rest of the staff is paid through the doctor's fees. If the doctor talks to you on the phone, or does research, or even reads your chart, it's on her own time. If you need to ask questions that only the doctor can address, consider scheduling another appointment...but save this as a last resort. If you do this just so you can bypass the nurse, you aren't going to get on her good side. You NEED to be on the nurse's good side!! On the flip side, if your doctor's office has been doing TONS of off-the-clock work for you (forms, arguing with insurance, research), you might want to make another appointment just so they can get some form of compensation and you can all communicate together at the same time. Have a good reason for this extra appointment, such as "lingering symptoms after my kid's strep throat" or "questions about medications in school" or "discussing the diagnosis the other specialist gave my child and how it affects this doctor's recommendations." Or maybe it's just time for a well-child visit.
Interns or residents: I LOVE these guys!! If you want someone to really read over your child's chart rather than just glance at it, they will. If you want someone to spend excessive amounts of time researching, they often do. If you want someone to ask your doctor a question they don't seem to have time for, the intern or resident will. Don't ever bypass these guys and ask for "a real doctor." Usually, in an office that has interns or residents, the "real" doctor is totally burnt out and only has two seconds to spare for you. But the intern/resident has tons of time, will listen to the whole story, and will take any pressing questions directly to the doctor much, much faster than any other means possible. This only works while you are in the office- don't request to talk to the intern/resident over the phone. They don't stay in the same office very long and they don't have any power beyond the fact that their terms of work/study require the doctor to answer their questions.
Default Scheduling
I'm sure there is a better term for this, but that's what I call it. Some offices do this more than others. You know how you can get your child in the same day if they have a high fever but can't get in for three weeks if you want to discuss behavior questions? Or ever notice that they always want to schedule your child for the same day of the week or same time of day? In order to handle "traffic", a doctor's schedule is blocked out for different types of appointments. A primary care doctor usually has certain appointments set aside for acute illnesses (fever, injury, etc.), and other appointments set aside for well-child checks and physicals, etc. A specialist tends to have "clinic days" where certain days of the week are set aside for certain diagnosis's (i.e. cystic fibrosis clinic on Tuesday, asthma clinic on Wednesday...) and may actually be in different locations on different days of the week. Don't pretend your child has a high fever just to get in faster. If you think your appointment needs to happen sooner than the receptionist will schedule, go ahead and take the appointment she offers you. Then call back later and leave a message for your doctor's nurse and ask if she agrees that the appointment needs to be moved up to a sooner date. You'd better have a good reason to request that. If she agrees, she can reschedule your appointment.
If your doctor goes to multiple locations, let the receptionist know that you are willing to see the doctor at other offices. That will open up the schedule considerably.
Getting the Right Message to the Right Person
First, if you need an appointment, set it up with the receptionist. Some tips:
-If you have done research and think your child has a certain disease, don't proclaim your diagnosis. Instead, give three pressing symptoms or maybe an important risk factor. For example: "I think she has celiac disease" won't go over as well as "she hasn't gained weight in ____ amount of time, she has constant diarrhea, and her cousin has celiac disease."
-If you are following up from a recent appointment, let the receptionist know. "Chronic stomachaches" may not convey the right information. "Last Tuesday, the doctor said to call back if he is still having stomachaches" will let the receptionist know that this is something the doctor is following more closely. You might get sent to the nurse's voicemail for this, but that's fine. The nurse will schedule you when she calls you back.
IF you don't need an appointment or you have a complicated situation, bypass the receptionist by simply asking to leave a message for the doctor's nurse. Remember the nurse's name!! If you are following up on ANYTHING, know which nurse was working on it and tell the receptionist, "I need to leave a message for Janie" not "I need to leave a message for Dr. So-and-so."
When leaving a message, always say the full name of the patient and his birthdate first. Spell names, even common ones. This lets them pull up your file easier, or recognize you from that form that keeps coming up in their paperwork pile. Also, always be pleasant in the message. They will want to talk to you if you sound understanding. They will put off calling you if you sound mad. If your message isn't returned, wait a couple days if possible, and try again. If you have been trying to reach one person in particular, check with the receptionist to see if they have been out of town or are only in the office certain days of the week.
Communicating Between Multiple Doctor's Offices
If your child is being referred to a specialist for the first time, or sees multiple specialists, you will be dealing with privacy laws and medical records. If all the doctors are in the same hospital's online medical records system, this isn't always a big deal, but if you leave that hospital's jurisdiction, be prepared. Signing a release of medical information in a new office is useful, but it takes time and possibly an extra doctor appointment just to get anywhere. Save yourself time by requesting your own copy of important lab results or office notes and carrying those in person to the new appointment. Your doctor's office SHOULD fax these for you ahead of time, but sometimes those faxes get misfiled, lost, or overlooked. When your doctor says they are sending you to another specialist, ask if they would like you to hand-carry a copy of the records to make sure they aren't lost. Many doctors think that's a great idea.
If you see multiple specialists working out of different hospital systems, always ask them to send you a copy of their office notes as soon as they are dictated. If a nurse calls with lab results, ask if she can mail you a copy. If you have imaging done in radiology, ask for a copy of the report to be mailed to you (do this when the receptionist asks who the ordering doctor was and if the results need to be sent to any other doctors.) Keep these notes in a 3-ring binder and carry this file with you whenever you see other specialists. Specialists only get copies of records from the doctor that referred you to them, and only the first time that you are sent to them. After that, they are left in the dark about the rest of your medical care unless you bring them the information yourself. You can keep requesting that copies of labs, office notes, and radiology reports be sent to multiple doctors, but the nurse receiving that unexpected fax will not know why it was sent to her and may file it in the wrong spot so your doctor might not end up seeing it anyway. That's why I like to bring it myself.
The Best Time to Call
Avoid Mondays.
Fridays are usually dead days in most doctor's offices, so those are great days for contacting the nurse, checking up on decisions, reminding about requests, etc. Leave a message Thursday evening or Friday morning.
However, take note: some offices are closed Fridays. Of these, more than half are genuinely closed and you can't even leave a message. Others are closed to appointments and the doctor is out but the nurses are in, catching up on paperwork and such. If you can, leave a message and you might get lucky. If not, well, your message will be first in line on Monday.
If you see your doctor in an outreach clinic (where the doc and his nurse are only are there once or twice a month) make sure you are calling his regular office number. You may end up with a different nurse, so let her know which office you usually see the doctor at so she can talk with that nurse if necessary.
Incoming Calls
As of 2013, most doctor's offices do not send or receive texts. I don't see this feature coming anytime soon. ANSWER YOUR PHONE CALLS!!Memorize the prefix to the hospital your doctor is affiliated with. Often the incoming number will not be the one you have programmed to your phone. Check the incoming call's prefix (the three numbers AFTER the area code) and answer all calls with that prefix.
Some doctor's offices use their email accounts. Others do not. Don't rely on this as a form of effective communication until after some trial and error. If they do use email, make sure to put the patient's name and a one or two word statement in the subject line. For example, "Jane Doe's allergic reaction" or "John Doe's referral form". That way they know it's not spam. In the body of the email, identify the patient, include the date of birth, tell them the last time they saw the patient in the office (or communicated with you), identify who you are following up with (which nurse or doctor), and identify who you are (your email address isn't gonna help if it's something like "crunchysoccermama").
Never mail anything to the doctor's office. It will get buried under a huge in-box pile. Unless it's a payment. ;o)
Faxes are fine but if the doctor's office isn't expecting it, call them ahead of time if possible and leave a message for the nurse to expect this fax and tell her what it's for.
If you need to update phone numbers or addresses or insurance, don't wait for the next appointment. Call the office. Then, at the next appointment, double check that the right info got "through the computer system" (always blame computers, never blame people). Then, when you are in the office and the nurse is adding notes into her clipboard or file folder, tell her about the updated contact info, too. Unless all the files are on computer (in which case she would be adding notes to a computer and not on paper), the nurse will keep trying to use the old contact info she hand-wrote in her notes despite what the receptionist's computer files say.
It sounds like overkill, but trust me. If your kid is like my Nate and has many doctors, many nurses, and frequent appointments, it's necessary.
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