Patient Care, Customer Service, and a Tail of Two Doctors’ Offices

Blog posted by Alan Simons

With all the buzz about health reform and change and rewarding quality and patient-centered care, it’s easy to lose sight of the most essential aspect of any business that deals with people: solid customer service. To demonstrate, consider the differences in the experiences at two different doctor’s offices. One is my primary care doctor’s office; the other is my best friend’s doctor’s office.

My doctor

I had not been a significant consumer of medical services until recently, so this experience was new to me. My primary care doctor is a caring and skilled physician. His practice is owned by a good suburban hospital. However, when I call to make an appointment I wait on the phone for a long time. Then I may wait to get an appointment; sometimes a few days, sometimes a week. When I arrive for my appointment, the staff at the reception desk doesn’t recognize me, and they don’t make me feel particularly welcome.

I recently developed a chronic cough that lasted for more than three weeks. It was a side effect from a medication I was prescribed. It was keeping me up at night and got so bad my sides ached. So I called the doctor’s office, and they told me that the doctor or his nurse would call me back the same day. No one called. So I checked back at around 5 p.m. but the office was already closed, or they weren’t picking up the phone. The message said that if this was an emergency I should go to the hospital or call 911. So I went to my pharmacist that night and asked for something to suppress the cough so I could sleep. It helped some, but I was still coughing.

The office called me the next day and told me to come in. The doctor said I should get an X-ray of my lungs. There is a lab in the basement of the office owned by the same hospital, but I cannot get my X-rays there (most likely, a reimbursement issue). So I went to get an X-ray at a hospital nearby. The hospital told me that the doctor’s office would have my results within 24 hours, if not the same day.

I called my doctor’s office every day—but no results. They said they sometimes had trouble with their fax machine jamming or running out of paper. I followed up with the hospital where the X-rays were taken, and they said they had sent the results multiple times.

In the mean time, I was still coughing. So I went back to the hospital and picked up the X-ray results myself and faxed them to my doctor’s office. They called me with the results the next day, which were negative.

The benefits of a mail order pharmacy

My drug plan is a benefit offered through my wife’s employer. It is administered through a mail order pharmacy, and the policies are complicated. They will let you fill your first 30-day prescription at a local retail pharmacy, but after that you have to order 90-day refills through the mail order pharmacy. So a physician needs to write two prescriptions, a 30-day for the retail pharmacy to get you started and a 90-day for the mail order pharmacy if you need a renewal. Though illnesses are rarely treated in either 30- or 90-day increments, those are the only two options available.

I was new to this system, so I filled the prescription at my local retail pharmacy and, after 23 days, tried to fill it again. This was against the rules, so I called the mail order pharmacy, and they said the fastest way to get a refill was for my doctor to call in the prescription on their toll free line. I could also fax in the prescription, or I could fill out a reorder form and mail it in, but that would take longer.

I called my doctor’s office and told them what we needed to do, but they have a policy not to call in mail order pharmacy prescriptions because it ties up their phone lines. She said she could try to fax it or I could pick up the prescription and send it in myself. Either way, she doubted I’d get the prescription sooner than two weeks.

Remembering that this was the same office that couldn’t get my X-ray via fax, I picked up the prescription and sent it myself. Then I went back to my local retail pharmacist and told them my problem, and they kindly gave me enough pills to get by until my prescription arrived. I felt awful because they were so nice, and I knew they were loosing business to the mail order pharmacy that made getting my medicine so difficult.

My friend’s doctor

Now let me tell you about my best friend’s primary care office.

When you call up for an appointment, the telephone is answered right away. The staff is always cheerful and helpful. Although he may not be able to see his personal doctor for a same day appointment, he’s always given the choice of seeing one of the other doctors and can get in right away.

When he shows up, the employees at the front desk recognize him and make a fuss over him. If he needs an X-ray, blood work, and other basic medical procedures and tests, they do it right there. If he needs basic medications, they have them on hand.

When he does have a test outside the practice, or if they need to wait for test results, they call as soon as they get the results. When he’s really having a problem, his doctor provides her cell phone number, and the office frequently calls to see how he’s doing. Recently the office called because one of the other patients died and the family returned the balance of the prescription drugs that were left over. They offered it to my best friend for free, because they know he’s been taking the same costly medication for a chronic illness.

I’m not sure if this is just an issue of customer service because there are other differences in our providers. Frankly, I’m quite jealous of my best friend, and I would like to go to his doctor’s office instead of mine. However, I can’t really see his doctors because my best friend goes to a vet. Sure, they’d treat me like a dog, but in this case, it would be an improvement.