Telephone Techniques
Multiple-Line Telephone Systems and Equipment
General System Features: Even the smallest healthcare facilities typically utilize at least telephone lines. These systems allow staff to transfer calls between extensions, set up conference calls, and provide a dedicated button for every individual line.
Headset Equipment: Headsets are recommended to improve workplace ergonomics and reduce neck strain. They consist of a combination earphone and microphone with an adjustable volume control in the earpiece.
Common Telephone Features:
Speakerphone capability.
Conference call functionality.
Caller ID.
Voice mail.
Call forwarding.
Intercom systems.
Call hold buttons.
Speed dialing for frequently contacted numbers.
Cell Phone Considerations: Cell phones are increasingly common as many patients no longer use landlines. However, they present risks in a healthcare environment, such as cameras potentially capturing confidential data and interruptions caused by calls at inopportune times.
Facility Equipment Needs:
A minimum of incoming lines and one private outgoing line with a separate, unlisted number is required.
Staffing ratio: One medical assistant can effectively manage no more than incoming lines at once.
Accessibility: Telephones must be placed where they are accessible to staff but remain private to prevent patients from overhearing sensitive information.
Professional Communication and Active Listening
Active Listening Skills:
Be fully present in the moment and focus exclusively on the conversation.
Avoid interrupting the caller.
Discipline yourself not to formulate a response while the person is still speaking.
Confirm understanding by summarizing what the speaker said and asking for verification.
Maintain a respectful and professional demeanor at all times.
Developing a Telephone Personality:
Use proper enunciation, clarity, diction, and pitch.
Employ a pleasant inflection with a warm, friendly tone.
Practice courtesy and tact.
Use correct grammar and strictly avoid medical jargon that patients may not understand.
Confidentiality Protocols:
All communications must adhere to patient confidentiality standards. Discuss sensitive information in areas where others cannot hear.
Exercise caution when using speakerphones to ensure information is not projected into public areas.
Call Management and Preparation
Thinking Ahead: Before placing or receiving calls, ensure all necessary information is ready. Have a pen and notepad available for note-taking. Draft a list of questions or goals for the conversation to ensure efficiency. Maintain a list of frequently called numbers to save time.
Answering Procedures:
Answer calls promptly, ideally by the ring.
Managing multiple lines: Place the first caller on hold only long enough to greet and ask the second caller to hold. In emergency situations, inform callers on hold they may have to wait or be called back.
Do not multitask (e.g., typing unrelated documents) while on the phone.
Identification Procedure:
Identify the facility first, then state your name.
Use a practiced, professional greeting.
If the caller does not self-identify, ask for their name immediately and write it down. Try to use the caller’s name at least times during the conversation.
Manage anonymous callers according to specific office policy.
Screening and Emergency Protocols
Screening Procedures: Understand the physician's specific preferences for receiving versus returning calls. Inform callers the physician will return the call as soon as possible and provide an approximate timeframe. Always record messages and document calls accurately.
Emergency Screening Questions: When an emergency is suspected, ask these specific questions:
At what telephone number can you be reached?
Where are you located?
What are the chief symptoms?
When did the symptoms start?
Has this occurred previously?
Are you currently alone?
Do you have transportation available?
Screening Guidelines: A provider may designate a specific individual as the telephone screener. Protocol must state that employees are bound by written guidelines and that unauthorized personnel are prohibited from giving medical advice. Use a specialized instruction sheet for specific medical emergencies. Route emergency calls to the provider immediately.
Message Documentation and Retention
The Seven Elements of a Telephone Message: Every message must include:
The name of the person calling.
The name of the person to whom the call is directed.
All contact numbers for the caller.
The reason for the call.
The action to be taken.
The date and time of the call.
The initials of the person taking the message.
Action and Follow-up: A message is considered incomplete until the necessary action is taken. Use notations to carry unresolved messages over to the next day. Note the patient’s attitude if significant to assist the physician in returning the call.
Record Retention: Offices must have a policy regarding message records. Electronic systems should send messages directly to the medical record. Maintain handwritten message pads for the duration of the statute of limitations.
Specialized Incoming Call Types
Prescription Refills: Collect the following details: medication name, dosage, number of pills taken daily, any issues with the medication, pharmacy address/phone number, and whether they prefer mail-order or local pickup.
Requests for Directions: Maintain a clear, written set of directions from various local points to read to callers. Place a map on the office website for printing. Do not simply refer callers to a general internet map.
Billing and Fee Inquiries: Access the patient ledger before answering billing questions. Help with routine inquiries and refer to the billing office when necessary. Always provide fee estimates before a visit, while clarifying that fees vary based on conditions and tests. Maintain a schedule of fees and a list of participating insurance plans/managed care organizations.
Reports: Urgent radiology or lab reports may arrive via phone, fax, or email. Relay these to the physician immediately. Reports marked "STAT" require immediate attention. Take careful messages for hospital progress reports or satisfactory reports from patients.
Referrals: Handle these using a provided list of referral practitioners. If the insurance requires a written referral, the physician must handle it (often requiring an office visit). Call the referral physician to notify them and document the referral in the medical record.
Third-Party Inquiries: Information can only be given to third parties (accountants, auditors, etc.) if the patient has provided written permission. Release of information forms must include an expiration date. Carefully review these forms before sharing data.
Managing Difficult and Sensitive Calls
Refusal to Discuss Symptoms: If a patient refuses to disclose symptoms over the phone, suggest they schedule an appointment to speak with the physician in person.
Test Results: Physicians must review results and give permission before they are shared. Only provide abnormal results if specifically authorized and provide follow-up instructions. Serious abnormal results should be delivered in person during a scheduled appointment. Always identify the patient properly before disclosure.
Angry or Aggressive Callers:
Angry callers: Lower your own tone and volume to encourage calmness. Avoid getting angry. Acknowledge the importance of the call and show interest in solving the root problem.
Aggressive callers: Maintain a poised attitude and do not let aggression lead to inappropriate actions. Explain when they can expect a response and follow through with the promised action.
Other Challenges: For callers with difficulty communicating (e.g., non-English speakers), use enhanced listening skills and ask clarifying questions. For sales calls or pharmaceutical reps, keep the interaction brief and take a message regarding the specific product they wish to discuss.
Outgoing Calls and Telephone Services
Outgoing Protocol: Plan and organize outgoing calls in advance to increase efficiency. Most outgoing calls are responses to previous inquiries.
Time Zones and Long Distance: Be mindful of the four Continental U.S. time zones: Pacific, Mountain, Central, and Eastern. Use Directory Assistance (dialing , the area code, and then ) or the internet ( or free searches) to obtain numbers.
After-Hours Services:
Answering Services: Features live operators to answer calls, which many patients find comforting during emergencies.
Automatic Call Routing: Uses a menu of choices to handle high call volumes efficiently.
Patient Coaching: Recorded messages can provide health information or announce special events while patients are on hold.
Legal and Ethical Considerations
Privacy and Professionalism: Ensure no sensitive info is overheard. Avoid placing or receiving personal calls during work hours.
Documentation as Evidence: Telephone and message records are legal documents that can be subpoenaed as evidence in court. Therefore, all messages must be complete, accurate, and legible.