The way that we communicate has dramatically changed over the years. Even with the introduction of modern communication means, such as email and text, a telephone call is still the most widely used communication tool. Telephone conversations may be inherently deceptive because they lack the facial expressions and body language that clarify and qualify what the voice is expressing.
When carelessly conducted, telephone communications can lead to diagnostic errors and misunderstanding that may culminate in medical malpractice claims and lawsuits. The best way to protect yourself from such potential liability is to practice effective telephone communication by following these general guidelines:
- Refer calls concerning abdominal or chest pain, fever of unknown origin, high fever lasting more than 48 hours, convulsion, vaginal bleeding, head injury, dyspnea, casts that are too tight, visual alterations, or the onset of labor to an emergency room or for an immediate office visit.
- Obtain as much information as possible about a patient’s current complaint as well as the medical and surgical history. Allow the caller both the time and opportunity to ask questions. Listen very carefully, and pursue questions relevant to the medical problem.
- When speaking with the patient, speak clearly and enunciate carefully. Use standard language when at all possible. Obtain the services of an interpreter if there is a language difficulty.
- Always see the patient yourself when in doubt.
- Be especially cautious when the caller is an unknown patient. This type of patient is best managed by you in person.
- Avoid distractions, such as checking email or attending to other duties, when speaking with the patient. Remember that drowsiness, fatigue, or distraction on the part of either party is a giant step toward miscommunication.
- Be aware of your surroundings and who is around you when talking to a patient using a cell phone outside of the clinic.
- Document all phone calls to and from patients, and keep medical records updated.
- Prescribe or advise by phone only when you know the patient and his or her medical and surgical history. Ask the patient to repeat the instructions back to you to ensure his or her understanding.
- Accept a third party’s description of a medical condition only when you have confidence in that person’s competence to describe what he or she sees.
- Be sure to document any telephone conversations with nurses pertaining to a patient in the patient’s hospital medical record.
- Make a prompt referral, and follow up with the referred provider if the patient’s medical problem is outside your specialty.
- Be particularly careful that pharmacists understand all dosages and instructions for drug prescriptions given by phone. Spell out any similar drug names and use individual numbers for dosages, such as “five zero” for 50. Include the reason for the use of the drug. Insist that pharmacists repeat information back to you. Do the same with hospital nurses taking your orders.
- Verify patient compliance in a follow-up contact to ensure continuity of care.
- Document, document, document.
When you either will be away or covering for another physician, these additional guidelines may help avoid problems:
- Be especially careful if you take a call for another doctor. In several instances, covering doctors have been held completely responsible for damages resulting from telephone misdiagnoses while the original physicians were exonerated.
- Provide your covering physician with a brief status report on your acute patients.
- Prescribe only the amount of patient medication required for the period you are covering for another physician. Pain medications and narcotics should be refilled or ordered only in small amounts.
- Provide the absent physician with documentation of your coverage period.
The information you receive, what you advise, and the orders you give must be immediately recorded because disagreements about what was said are invariably a major problem when cases are tried. This is especially important when a phone call occurs after office hours or on weekends. During office hours, office staff should tell the caller when the physician is most likely to return his or her call and follow up to ensure that the caller’s questions and problems were resolved and documented.
It is of prime importance, therefore, to obtain all of the necessary information on the phone. The critical point is that you must arrive at an accurate and totally reliable appraisal of the patient’s condition either while you are on the phone or within a few minutes thereafter. If you still feel there is any area of ambiguity, we strongly advise that you see the patient.
Effective telephone communication is particularly important for the prevention of future litigation. It is the first impression a patient has of the practice or of the staff. It often sets the standards that could potentially reduce misunderstanding that may lead to legal action.