Sunday, September 26, 2010

I'll Take That Call Now.

Jill of All Trades, MD
is a family physician blogger who has a post on KevinMD titled Why answering a cell phone during an office visit is a problem. She writes from the perspective of a primary care doc, and talks about the awkwardness of patients talking on the phone during their office visits. She talks about it with a detective/spy metaphor:

Me: “Your recent lab test shows that your diabetes is currently not sufficiently controlled with the current regimen. Your hemoglobin A1C, which is a lab test that tells me what your sugar level has been at home for the past three months, is 8.1. We need to add a medication at this point because…”

Riiinnnggg!!,” a quite startling sound lifts me off my seat, as if signaling a new secret-agent assignment.

Patient: “Oh, Doctor, hold on one minute please.”

Is this a conspiracy? Before I can even respond, she picks up the cell phone and starts talking to this rather shady intruder.

Patient: “Hi, honey. I’m at the doctor’s office. What do you need? …”

I wait about thirty seconds, with what seems like an eternity in the secret agent world, and she is still on the phone with this suspicious invader. At this point, I decide to exit the premises.

For some people, answering the phone immediately seems to be a bit of a compulsion. And for someone who's waited a long time to see an over-booked doctor, I can see why they might want to take a call. Maybe it's a call that was prearranged for a time long after the patient thought they'd be free...but the patient was surprised to find the doctor was running late, and so why should they put someone on hold for a doctor who's kept them waiting? Why is it a one-way street? Oh, because it is.

In psychotherapy it's a different story: people pay for time by the chunk and there aren't patients backed up waiting to fit into the same time slot. I feel like it's the patient's time, and I don't feel like I should say to an anxious mother, "Don't take that call." Still, I'm always a bit surprised when people feel the need to take non-urgent calls during an appointment, and to talk for a bit. I feel a little uncomfortable listening. And even for those who quickly say, "I'm with the doctor, I'll call you back," I'm not sure what that gains over having the phone off.

Does my phone ring during sessions? Yes, because sometimes I forget to turn it off--and if it rings, I reach over and silence it . Do I answer it during a session? Never. Whatever it is waits until the session is over. The only exception I make is if I'm trying to get in touch with another physician regarding the care of the patient I'm seeing during that block of time.

I let people talk on the phone or text or deal with their families or clients. No one has done it repeatedly or in a way that notably distracts from therapy. I'm a bit surprised when anyone wants to pay my fee to talk on the phone, or even when anyone runs late, but hey. If I weren't "rented out" in blocks of time, so to speak, I'd be exiting with Dr. Jill-of-all-trades whenever the phone rang.
And on a completely different note, I noticed that Jill of All Trades has a link on her sidebar to "Shrink Rapping"....I clicked on it thinking it would be us. But, no....There's another Shrink Rapping doc out there-- Dr. Gregory Smith from Georgia and he's been at it a while. How'd we miss that?


Rach said...

My shrink answers his phone during sessions. I don't feel an iota of guilt doing it too.

HappyOrganist said...

I'm happy to say I don't have a cell phone ;DDD
well I do, but I don't even know the phone number, and I only have it in the car on long trips for emergencies.
I'm GLAD you acknowledge that patients might be tired of waiting to see a doctor and therefore not feel bad about answering a call on their time (that's the first thing I thought of was how long I sit in waiting rooms sometimes - and feeling like a cow at that.) But that said - let's toss the cell phones and talk to the people sitting in front of us (even if that person is not a doctor). ^^

Sarebear said...

My psychologist answers his occasionally during therapy, but only if he seems to be expecting something, or if there's a possibility, which I'll explain.

There was a period about 18 months ago when, for a couple of months, I was prone to cancel at the last minute or the day before, our appointments. Since his phone goes to voice mail ALWAYS, this made it easy and a lot less guilty for me to do, so eventually he put my number on, I'm guessing, a special ring so that he'd know to pick it up, because one day when I was calling to chicken out on the next day's appointment, I was surprised as all hell to get HIM on the phone!

I can try to justify my poor behavior by saying that we were discussing alot of difficult stuff at the time and that I was having a really hard time with it and going through a stressful time in my life, but still that doesn't excuse my poor behavior anyway.

So he made it so that if I was going to try to poop out on our appointments, I'd have to do it straight to him, and not to his voice mail. Basically I wasn't able to, then, heh. But the thing is, that time I got him on the phone, it wasn't actually to call to poop out on an appointment, it was because I was afraid that I was GOING to the next morning, and I had strategized a way, a method, that was new, to avoid doing so, and I was calling to leave him a message about it, to relieve any worries about me dumping him again, or so I thought. Instead, I actually got HIM on the phone, surprise surprise!

I briefly explained, since I didn't know if he was in with someone (he was in the last 10 mins of the hour which can be free of someone, but he sometimes extends the appointment into that time period if needed)) and he seemed genuinely pleased for ME that I had come up with it, for MY sake, not just because it would make life easier for him. I mean I could tell he was genuinely pleased on my behalf, and not just for what it would mean for him, anyway.

So, it wasn't like he was exactly EXPECTING my call, but he knew I might be LIKELY to call, trying to cancel, from panic or fear or laziness or whatever was going on with me at that time in my life. The weeks I canceled tended to be the weeks after I'd had a hard time discussing something.

I don't do this behavior anymore.

tracy said...

i would NEVER take a call during a Doctor appointment or a therapy appointment...the phone is OFF.

i do however understand the Doctor taking a call in an emergency.

Now, if in a VERY rare instance i were expecting an emergency call, that would be a differnt story and i would explain that....however, that has never happened.

Cell phones...GAH!!!!!

Unknown said...

I have no problem with patients taking calls in session. Heck it is their money.

I sometimes make calls on a patient's behalf while in session. "Let's call the pharmacy right now and see if you can refill medication x." Or, "Let's call for that lab result right now."

Those kinds of calls save us both a lot of time in the long run.

I do not answer my own phone in session. Though I am not perfect and it vibrates by accident on occasion. I just apologize and turn it off.

Anonymous said...

My shrink never took calls during our session (& neither did I if I forgot to turn my phone off). However, her answering machine went off (phone ringer was off but answering machine was @ full volume) in the middle of our appt almost every week. Each time, she'd jump up, run over to her desk to turn it off and apologize. I can see forgetting every once in a while, but it seems intentional when it happened so frequently. It was really disruptive and rude.

Sarebear said...

I don't have a cell phone, but there's been one or two times I've made a call during the appointment; it's been something I've been procrastinating that's been very important, or that I haven't been able to cope with, that he's been concerned about, so I've used his encouragement to do it right there. I try not to use him as a crutch for that, but they have been pretty critical things.

Sometimes his cell phone goes off when he's thought he's turned it off, and he's embarrassed.

There's been a time or two that he's left it on because his car's been in the shop and he's expecting a call from the repair people, or from the person going with him to trade cars for the rental or whatever (couldn't help hearing the conversation). So there was some time-sensitive stuff that had to be arranged before he had an hour free that afternoon in which to get the car-swapping done, and I completely understood. It's one of those things in life that pops up that you can't plan for, having your car break down and stuff. He somehow managed to juggle things in a way he made it to the repair place and to work without missing an appointment after he broke down on the way in, so he was a bit pleased.

Anyway. Sadder was the occasion the family cat died, and his teen kept calling in a needy way. My psychologist felt bad at the interruptions, and I felt bad for his son, and for him, losing a family pet. He did let the appointment go long to make up for it, and eventually cut off the son after the third or fourth interruption, which is hard when the young teen is grieving and doesn't have the judgment, but it has to stop somewhere. Again, something you can't plan for, but that was more of an internal family issue of when do you interrupt dad at work, and I didn't have any problem forgiving the boy for not having the usual judgment to not do it given the circumstances. For most of the conversations my psychologist left the room, given the personal nature. The shorter one or one(s) he just went to the far corner.

Sunny CA said...

My cell phone is always off except when I was substitute teaching and needed a 45 sec. call to book the next day's work and all others could be ignored.

My psychiatrist does the forgetting-to-turn-the-volume-down routine on his answering machine at MANY appointments and he then has to jump up, run past me, squeeze through a door to his "inner office" to turn off the volume because it is only separated by a waist-high half wall and upper arch so no sound-proofing. I believe he really does forget.

katie said...

I typically put my phone on silent or vibrate when I'm in a session. I tend towards vibrate usually if there's something more rough on the table or if I'm feeling unsettled for some reason and want the potential distraction of a vibrating phone - even though I neither take it out of my pocket nor answer it.

My shrink has never answered her phone but does not-so-occasionally seem to forget to turn it off/put it on silent. She always apologizes and never takes the call, but it still annoys me - I don't appreciate the moment it takes to flip over her phone, look at it (register who's calling), press a few buttons to not take the call and turn it to silent. Petty? Perhaps. But like you all said - I'm paying (a lot - she does not take insurance!) for every moment of her time.

Sarebear said...

When, this spring, I was making phone calls to psychiatrists, trying to find a new one, and I had come up with my little "spiel" that was very brief to indicate what my need was, and then had a pretty brief follow up to it, if I didn't get shut down initially, or even if I did . . . I ran across one that answered her phone in a session, and she surprised herself even that she did. I had thought I was calling a male psychiatrist actually, but I made it really brief, without trying to seem pathetically desperate, whilst being extremely conscious that she was in with a patient; she was VERY kind to me, and is how I finally found a psychiatrist (not her) who was accepting new patients. It's very hard around here to find one who is, and as some here may have read on my blog, even at that the one I found is a bit . . . different. Still, in the end we began clicking, at least at the last appointment before the insurance ran out. I haven't seen her since, since Medicaid contracts through somewhere specific.

ANYWAY, it was this lady's unexpected compassion that I remember to this day, and if I should ever have to search again, I want to put myself on a waiting list for her practice; the 2 minutes I was on the phone with her, maybe 3 since she took a quick 30 seconds to give me the names and numbers of two colleagues she thought were taking new patients, since I had said that last time it took me six months of searching before I found a psychiatrist who'd take a new patient, well the two to three minutes I was on the phone with her, she really made a great impression on me, and yet her need to get back to her patient also did too, and her surprise that she had picked up the phone, because she never does that during a session; I suspect that maybe and this might sound hokey to some but I believe in this, that she was inspired to pick it up, for some reason.

Anyway. Especially since it was critical that I find a shrink before my next knee surgery, at that time. Which I did, because of her. She actually conveyed the same kind attitude that Dinah conveys all the time on this blog, at least that I've maybe imagined from Dinah's posts, anyway.

Sometimes that odd thing can make a big difference in someone's life.

Anonymous said...

There is a small sign on the waiting room that requests that mobiles are switched off. I comply without hesitation always.

My 50 mins with my pdoc is precious. It is discourteous to him not to turn it off. Quite frankly in sessions there is nothing more important than me and him.

I change hats, I am the doc in the chair, the patients phone rings... the dog is ready to be collected from the spa. I discern from this how much my services are valued.

I see live from both sides (isn't that a song.......).

As pt and doc, turn the phone off!


snoring solutions said...

Sometimes his cell phone goes off when he's thought he's turned it off, and he's embarrassed.
I can try to justify my poor behavior by saying that we were discussing alot of difficult stuff at the time and that I was having a really hard time with it and going through a stressful time in my life, but still that doesn't excuse my poor behavior anyway.i do however understand the Doctor taking a call in an emergency.

Crissy said...

I NEVER turn my phone off unless my young daughter is with me. Obviously she is not with me in my pdoc appt. If my phone rings I check to see who is calling and then silence it without taking the call...unless it is a call from whomever my daughter is with at the time. I think I've only ever answered the phone once during an appt and my doc completely understood. My daughter is my priority.

Of course I take this same approach to my cell phone regardless of where I am. Shopping, errands, driving, etc...check to see who it is and then silence it to go to voice mail unless it is someone trying to reach me about my daughter.

Bippidee said...

I have had multiple Psychiatrists answer phones during my appointments with them - all phone calls that have been nothing to do with me. A couple have clearly been personal calls, in fact one psych started explaining to me something about her daughter having lost her cardigan or something. It seemed fairly trivial, and I was unimpressed that she had taken a call about a cardigan in the middle of my appointment, but it is the NHS - I am not paying so I didn't really have the right to complain about it - I just thought it was a bit off. I virtually always have my phone on silent in appointments. Occasionally I will forget and then get a text or something and put it on silent. I have answered the phone a couple of times, but only if I have known it is something important - as a rule I wouldn't answer my phone or send texts or anything else, unless strictly necessary. I think it is rude. I don't mind if a psych/therapist has to take an emergency call, but there have so often been calls that are clearly either personal or routine, and that does irritate me a bit. And one psych I saw - her phone must have rung at least 4 times in the one session, and she apologised every time, but never turned it off. Thought that was a little weird and a little rude. Phones are a distraction. If you are in the middle of explaining how you feel and a phone rings, it throws you! I think urgent calls only on the side of both professional and patient is appropriate.

Anonymous said...

Hi I am 14 and I am a freshman in high school. I am working on being a psychiatrist. I'm sorry, but by reading your story its your husband that needs a psychiatrist.