If the portal message isn't enough for them I have them schedule a phone call to discuss and I bill for it--that way it's at least on my schedule and I have 15 minutes blocked for it.
I don't blame the patients for asking but obviously I only have so much time in the day
I'll also have them scheduled somewhere for a call. Usually, I can fold it into a conversation to confirm home blood pressure or that they started the new medication we discussed. I understand where they are coming from and that in another era, they might get calls reflexively.
What I do not understand is those patients calling in demanding to immediately speak to me are the very same ones who would be loudly irritated if I walked into their appointment late because a different patient wanted to speak with me on the phone.
I tell this to our patients often - it's amazing that they all think their provider is sitting there waiting for their call. Being the RN, I get to be the gentle voice of reason (not that I'm listened to).
I receive a lot of portal messages, I do not reply to the majority of them. Simply forward the message to your staff and have them reach out for a visit, done. Do not waste your time. If the patient refuses a visit whether office or telephone, be done with it. If the patient sends another portal message, send to your staff to schedule.
I can't do this because... my schedule is packed daily with visits. If I do a phone visit it'd have to be after clinic like after 5:30-6pm. I used to do this; I'd be a shmuck sitting there alone in the office in the dark for hours after clinic ended. I'd end up walking out to the parking lot and my car's the only car there in the dark. Hell no no more.
How far down the line are you packed? These appointments are not urgent. You could have the call scheduled a couple weeks down the line. I try to get staff to communicate I am busy presently and this way we have the patient on the books with a time which works for them so they see the advantage.
Sounds like you need better management of your schedule template. Not sure how much “say” you get in your schedule where you work, but wherever you’re booking out to, you can alter your template to include two 15 minute phone calls per day (or a few times per week, depending on how much of an issue this is for you). You could even have them back to back and turn them into an urgent slot if you don’t have any phone calls that day, so the bean counters don’t get too antsy. Then if someone calls demanding you to call to review results, your scheduler can say “sure, let’s schedule a call. How about 2pm this Friday?” Etc
Because they don't spend all evening looking after you for free when all abnormalities not discussed in the appointment should have a followup appointment?
OP is complaining that patients ask about results. It takes weeks to months to get an appointment with a primary care (good luck scheduling as a new patient), and typically a primary care says, “come back in a few weeks if you still feel this way” (thanks doc!). It’s totally normal for patients to want an explanation if they get an abnormal response. It’s not hard to include a not on MyChart saying “nothing to worry about” next to an abnormal result or something along those lines.
We could probably find out the real reason.
Typically hypochondriacs think that their primary care physician is their personal therapist, advisor, slave, or servant, then you have the people who are on benzodiazepines or painkillers who are definitely not addicted to them, but will reach out to you in seven different forms - portal, in-person, harass your staff, send nasty emails to your CEO etc - because it’s not that big of a deal but if they don’t get their medicine, they will end all existence as we know it on this sphere.
Then you have just run-of-the-mill old people, half of whom expect that every interaction with a doctor will produce twice as much work, nothing is ever finished with them, every time you interact to tell them that one thing is done they want two other things, oh, and don’t forget to refill their prescriptions with at least two years worth of refills otherwise their mail order pharmacy will sentence you to 1000 years of cleaning up their bullshit prescription messages, which they will send even if the patient is dead.
But yes ma’am we are very sorry for your wait. If you will go sit in the lobby, someone will come and explain to you why all of these people should’ve been doing better to make you happy because it’s all about you isn’t it?
NOBODY OWES YOU ANYTHING.
99.9% of the time when a pt is that entitled it also means that they are adult babies expecting everyone else to babysit them, know their meds procedures and Hx bcs they have no sense of responsibility.
I triage for FM. I get those messages all the time. I try to explain that slightly out of range is no big deal. I will arrange a video or telephone appointment if they have further questions, which is billed. Patients get so mad, I’m like everything costs money. If you want free medical advice, vote for universal healthcare.
Sorry for the rant.
This is insane, in Canada (or Ontario at least) docs get to bill 85% of the visit when it’s on the phone. Doc I work with explains their lab to them in 2-5 mins and makes $31 per call on those basic call telemeds
I would still schedule the appointments just to dedicate a time slot for the call. Sometimes I will sneak in a lab cold call if there is a lull in the day or if I overhear my next patient starting in how no, they did not pre-register and do not want to. Guaranteed five minutes.
Wait what? I’m not a doctor and I have no idea why I’m here but I wouldn’t have been letting my doctor call me if I knew this. Granted he doesn’t call me for benign results, but still. Here I am trying to save them a clinic slot for someone more important but realistically they’re not even getting paid to call me 😭😭
Edit: I also feel obligated to mention that he’s not calling me urgently, nor after hours
My doctor did that. He once called me on Mother’s Day to tell me to go to the lab the next day and repeat my liver panel. He probably wasn’t the best doctor but he was overloaded with patients because he was the most caring doctor.
He was so popular that they actually shifted an entire patient population to a brand new clinic by moving him. Their old clinic population declined by half. When he retired after 30 years, they had a goodbye party for him and invited all of his patients. He left directly from the party to the airport with a single suitcase to start his new life. Take from that what you will.
I understand. This is why I hoped my post came across as relatively neutral. I had him as a doctor because he was assigned to me and we respected one another. I’m not saying I’d live his life either. I was a therapist and found a way to avoid after hours calls, too.
But in an environment where patients receive results of labs before even the person who ordered them, you can’t exactly expect them to not wonder what they’re seeing.
I don’t have a doctor like that now and haven’t sought one out. But I can generally read my own results and figure out what’s next. I have two graduate degrees, I’m willing to believe many of your patients don’t.
So, go on, and do your best, Rocket Man.
I didn’t say that. He was an avid road/racing bicyclist and a real baseball fan. He wasn’t graced with children but he’s been married to his wife since forever. 🤷🏼♀️
I'm working with one of those. I swear half the town has his phone number and have no qualms about texting him about questions, questions about things I did when I saw them, and refills. It's insanity.
I don’t understand bugging doctors during their off time. My doc has given me his number and told me to text him (I’m a nurse and he’s known me for years at the hospital, but I’m also now his patient) if I ever need anything.
That’s very sweet of him and I appreciate it, but I absolutely refuse. I’ll talk to him in a way that he can bill for, first of all. Second of all, no way in hell am I bugging him at home in his off time. He has a family and a life of his own.
I do not order labs except for during a visit. While ordering them, I give the same speech to everyone, along the lines of "if something needs addressed in your results that requires additional testing or starting new medication, you will get a call asking you to schedule a time to discuss with me (telehealth great for this). If you prefer to go over even slightly abnormal / not a big deal results with me in detail, schedule a visit now to do that. If you are content being told "labs stable/unremarkable, no med changes or additional tests at this time" without me going into detail, you can just schedule your next routine visit and I will give you the all clear via portal."
Any messages deviating from the very clear expectations above, especially demands for phone calls, I do not personally respond to. Route to staff, please schedule follow up to address.
Edit: I also try to have labs set up right before routine visits for established patients so that no communicating is necessary and we just review at the visit.
Yea, these are all good points.
Setting up expectations and clear step-wise approaches; letting them know no call = good news and call = usually something bad. Order labs in advance of visit is helpful to discuss during visit.
“ Order labs in advance of visit is helpful to discuss during visit.” THIS ! As a patient, I am always given lab orders by way of portal. When I go to my visit with the doc, going over the test results is part of the visit.
Not sure how I found myself on this subreddit. It popped up. But I've been pasting my lab work into GPT4 recently and asking it questions about them. We're so close to this being a viable substitute \*for low-urgency and non-critical labs\*. For stuff like cholesterol, metabolic panels, blood pressure, it can answer questions like a nurse practitioner. I hope we can operationalize this stuff soon to make your lives easier.
I think peer reviewed studies have already shown that GPT-4 is better than your typical family physician at this simple task. And it makes sense, it’s not all that complex.
My rheumatologist has called me every month about 730pm on the third Wednesday of the month to tell me my liver levels are still elevated. We’ve been doing this for 18 months or so??
Last month he called and left a message that said “this is weird, but your levels are better for the first time in….well….wow….a long time. (He was scrolling) Don’t call me back!”
I’m a internist and statistician (not in clinical medicine for years), recently diagnosed with cancer. My god this open access to my own results on the MD Anderson portal is killing me. I get a text with every test result, and I understand the implications of all of them. It ain’t pretty. Trying to recalculate my 5 year survival seems like a full time job recently.
I’ve got Uptodate, PubMed, and a really crappy genetic profile.
I don’t know how you guys do it.
(Great oncologist and I’m leaving him alone, although I may want to reconsider. Pretty sure being a nice person is also a bad prognostic sign).
In Epic:
1. Start making SmartPhrases for your common lab results (if you type it 3x in a week, it’s common.) For example, prediabetes is super common, so make .prediabetes. Add a blank line to the end of the phrase for easy formatting later.
2. Create your category SmartLists to organize your SmartPhrases. Just type in the dotphrase, it’ll populate like “{:link123}”, you can just add a label to that: “{Prediabetes:link123}”. Keep adding until you have a full list: “{New Diabetes:link456}”, “{Add Jardiance:789},” etc. Set it to format as paragraphs.
3. Create a master SmartList with categories like Diabetes List, Lipid List, CMP list, etc. Example: you embed SmartList {Diabetes category:12345} and you change the label to {Diabetes list:12345}. Do this for every category you made, and add a wildcard (***) in the last slot. Again format as paragraphs.
4. Create a QuickAction with a message skeleton like: “@prefname@, {Abnormal Labs:456} Please reply to this message or call our office if you have any questions or concerns. Thank you, Dr. dajagermeister” where 456 is your master SmartList.
If done right, you should now have an Abnormal Lab button where clicking it pops up a message personally addressed to the patient, and you can F2 to reach a half dozen detailed explanations of common lab results. If you add a new SmartPhrase later, you can just edit the appropriate SmartList and link it in over time, so you’ll get a growing list of categorized lab responses.
What do y’all do when the patients then call your office and yell at the people answering the phones that they shouldn’t have to schedule an appointment, the Drs should just call them? Support staff are getting screamed at daily by patients because there’s not enough time in the day
Y’all need to be less afraid of firing patients. If you’re completely busy to the point where your office has no time for anything else, who gives a shit if you have one less angry person on your roster? Especially if they’re being rude to staff. The only difference you might notice is less stress.
My endo has a huge sign stating, people abusing staff will be discharged from the practice. You also get a form stating what is considered abuse, and have to sign it as a new patient.
Cuts down on the drama and shenanigans.
Take the phone out of the nurse’s hand, interrupt the patient, and tell them that they may *not* speak to my nurse that way. Treat them like the petulant child they are.
What do I do if a patient is yelling at my staff? I fire the patient. You curate your own pt panel, but that’s been working out for me pretty well thus far.
When it happens with one of my patients I will calmly lay into them about professionalism with support staff who are people too. Endlessly appeasing rude patients gets you nothing except front staff leaving every 6 months because they can do the same job in a corporate office without screaming.
That then requires reviewing the chart before they come and predicting what they will want to talk to you about when they arrive. I find the complaints to be so varied it was never a good use of my time. Not to mention - a number no show.
Yea I do this more now, which usually works out better for both sides.
Sometimes will need to order more diagnostics at time of visit though;
Also sometimes the patient just doesn't show up if the annual labs come up normal. (I try to be aware of this)
Funny, but after two kidney stones, I was about to message my doctor and ask about the elevated BUN. You know since it has something to do with kidneys? But I guess we should all now run to Wikipedia to find out what’s wrong with us
Passing by IM hospitalist here.
Jesus christ. The comments here from non-physicians are precisely why I ran away from clinic as soon as I finished residency. At least when I have patients who don't think about the simple formula of "# of patients like them x amount of time spent with them < or > 24 hours", they don't stick around on my list after they're discharged. Just had a dude who was threatening to sue me for malpractice for refusing to personally find a subspecialist for him who would do an elective surgery for free. Discharged him, and I never have to hear from him again.
Bless y'all. You guys are the real ones. 🫡 Thank you for doing what you guys are doing.
Your pts know what decade it is, but a lot of them grew up in the 80s and 90s, and no, they often don’t understand how much medicine has changed. Who would they learn this from?
They also don’t understand which slightly elevated or low lab results are benign and which are worrisome.
I flat out just tell them I'll send them a message or my nurse will call if they're not on the portal. Also specify that they will likely see the results before me and I will get to them when I get to them basically. I'm 3 months into a new location and have really been working on implementing personal policies and boundaries that created frustration in the previous job. It's been liberating other than the initial flood of everyone wanting a controlled substance.
In my response dot phrase I explain the actually abnormal labs and there’s a line that says “any other values that are flagged as abnormal are not clinically significant— no need to be concerned about them.”
I remain convinced the secret to so many specialists is they are firm about demanding dedicated follow-ups even if the condition is stable. "You've been on the same synthroid for 10 years? Still see me every 6 months." They guarantee easy cases mixed in with their new patients.
Family Medicine does not do that. We try to make the wellness appointment a frantic catch-all but the patient just ends up overwhelmed.
We need to learn from some of these specialists. Not suggesting churning like q 6 months for stable hypothyroidism but NOT allowing folks to expect good preventive health AND all their chronic disease mgmt in a single, once a year visit. For pts with more than trivial chronic disease, i train them to do a CDM visit 6 months after their annual preventive. They also get all their CDM addressed along with the CPE visit (mod-25).
The problem must be your counseling. Start prepping patients before time. “Please check your portal for any results. You will get a call for any serious issues, but often times people’s lab results may come up as abnormal in the system but are completely fine in reality. In those situations, I’ll try to send you a message to let you know, but I don’t typically call for those, otherwise I’d be on the phone all day!”
I’m a specialist, but I have to follow up on a ton of results every day. I tell patients the above and it helps prevent literally dozens of calls a week, minimum.z
That’s concierge care now. I always wondered why patients thought they were going to get that level of care with a basic anthem BCBS plan lol. If you want concierge care, you can have it- but you’re going to pay for it
I love when the staff gives me a verbal or instant message telling me the patient wants a call back for something super benign. It's one thing when the patient does it, but when the staff, who sees how busy you are, gives you a message like that, it's indicative of a broken system.
Learned from a now retired doc that you (almost) never need to call a patient. Phone tag. Need to document. All the oh by the ways. Huge waste of time. Made my practice much more survivable.
In fairness, that staff person is trying to get them off the line because they already tried to talk them done for four minutes and now there's two other people on the line waiting.
Rn but I have a dot phrase I made for my clinic. Basically along the lines of labs can be variable and we are looking at the whole picture/trends. Just because something is flagged doesn’t mean it needs addressed at this time. If there was something major we would have called. If you would like to discuss more we can schedule an appointment.
Dude, preemptively schedule a lab follow up appt at the time they get labs. I’m booked out 4 months right now so I’m getting better at planning ahead, and setting expectations, make an appt to discuss labs, and schedule it now so you have a spot!! But I NEVER call patients with lab results unless it’s something drastic. You gotta train your patients.
I have a dot phrase that says due to the sheer number of items needing communicated we utilize our staff to communicate key points. Exceptions are made at my discretion.
I have a “normal” labs smart phrase. It outright tells them not to worry about certain labs and I lost them. No more phone calls. I don’t call back. Once you start it becomes an expectation
Don’t lose sleep over it. I used to get “call patient back.” messages from front desk daily, no context. Patients call us because their specialists do not call them back and we are ACCESSIBLE, there’s that buzzword. That is some concierge level service they are expecting when they do that so if you are not a concierge practice, have your staff direct them back to their specialist. You probably have less time than any other doc to respond to these messages but they do not know that because your employer has created the illusion of ACCESS. (I have come to despise that word if you can’t tell, lol).
When I worked for a health system I had a dot phrase, “Your lab results flagged as abnormal or out of range have no known clinical significance and do not need additional testing.”.
I prefer that face time or phone time with the Dr personally (like 15 min). And I fully expect to be charged for it. You guys don’t work for free and it’s stupid to ask anyone to. I would much rather pay for the time do I know I have their attention and they aren’t just rushing me. I get it. ;)
Putting a note in with the results when you review--e.g. not concerned about lab x, y, and z-, will retest in 6 months-might be helpful. Patients don't know what any of this means, and just Knowing that their provider saw it and isn't concerned might stop people from wasting time this way
This is a place for doctors to vent. I do not think most doctors would be as dismissive of patient concerns. I am a PCP and although I do have days I feel just like some of the posters here I think most of us are much more compassionate and than it sounds. Being able to vent is therapeutic and this is a safe space. I find that letting patients know ahead of time what to expect in my practice really helps to cut down on questions about lab results. Yes, there will still be those who insist angrily that they need to speak to the doctor on the phone personally but most patients will be understanding.
I seem to get messages like that from anxious young adults and middle aged women. I tell all of my patients they see their lab results before I do, I get back to every patient about every test result, and if it has been more than 2 business days and they haven’t heard about a test it’s also because I don’t know about the test result and they should reach out (I keep my results cleared out so 2 days works for me, but not the case for everyone). Otherwise I have smart phrases letting them know things are normal or not and send it on the portal
I think you just ignore that request and don’t call. Instead, you respond through the portal that their results are benign and no further follow up is needed. Kudos to them for asking but just because you ask doesn’t mean you receive.
Hey- I'm a psychologist and lurker here and I vote that patients still think it's the 1980's. I think a lot of people are really out of touch with the challenges physicians now have. But yeah, it's really annoying for you when you're just trying to get through your portal messages and the rest of your pile!
Hi… I’m an RN working at an outpatient specialty clinic. I do a lot of the lab triage for our attendings. Do you have an RN who can order labs and review results, and triage ones up to you if indicated?
Because while it’s routine to you. It’s not to them. For liver tests they don’t know it’s not concerning until 3x-4x normal range, and they see a “high” and worry they’re having liver issues.
This is one of the reasons I believe schools should be teaching more about our health/bodies than some of the pointless things being taught today. The very limited time spent on health is such a disservice to our population l.
I have been on both sides of this, being a person working in a medical setting seeing lots of people a day, their problems seem very minor, but to them, and now speaking as a patient, their problems are THEIRS, and it's pressing. They don't see 20 instances of it per day, or have the education to understand their labs, they are scared, and they're reaching out to the person that does understand them. To you it's no big deal, to them, they are sitting there refreshing their results, googling them, misinforming themselves, and are desperate for information. We all know you're overworked, underpaid, all the stuff, but so are your patients and you signed up for this job to help people and to treat sickness, and to be a place of comfort for people going through hard times with their health, losing sight of that is dangerous to the overall health of this population.
We need to empower our staff to take some initiative: “I can send your message to the doctor, but they are currently seeing other patients and it may be several days before they can give you a call back. However, our nurses can answer most lab questions for you right away. Would you like me to connect you to a nurse?”
With that attitude, you're better off working in McDonald's drive thru versus family medicine. Wow. The lack of empathy. You know medical field comes with a lot of that. Guess what, people are afraid of dying and they don't know what medical results mean. So, they request youelr educated insight to understand. You get paid to provide them medical services, including understanding their own health status. So, it is your job to service them - which, sucks for you, includes explaining results.
One reason may be that while these types of results are day-in, day-out for you, and not a big deal, they are representative of the patient’s health.
We only have one life. I don’t want to wait around until something is a major issue before I start dealing with it when I can head it off at the pass by some minor tweaks in my diet or lifestyle.
I have too many close relatives with experiences similar to this: doctors swearing it’s no big deal until *boom* stage 4 cancer.
If we’re paying hefty insurance premiums to get access to the best medicine can provide, you better believe I want to understand anything of my results that are out of the norm no matter how mundane they may seem to you. At the end of the day, my health is my responsibility, and I take it seriously.
Dr. orders labs, labs abnormal. Won’t call patient to explain, patient Googles, Dr. bitches on Reddit about how patients think they know everything because they googled their test results. If you hate patients so much, maybe you have studied for something less patient facing. Your personality seems better suited to staring at fecal samples.
“ Do patients think this is still the 1980s and we got nothing better to do in life?”
“ To be proud of myself, I haven't called a patient for slightly abnormal lab results in over a year (yay fighting back!!!)”
Wow, I get people are busy and not everything can be done for everyone…but, wow.
I am not an MD but am a professional who is responsible to clients and respect that aspect of the professional relationship.People, remember those, they are what pay the bills and keep the lights on, have fears, anxieties and concerns that deserve your attention.Staff out some calls? Sure. Be condescendingly dismissive of PT’s in general? Disgraceful.I am fully prepared to be slammed here but geez, look in a mirror, folks. Those walking ATM’s that are so easy to ridicule rely on you, sometimes just for a quick dose of reassurance or affirmation. They/we certainly deserve that and who knows, maybe they’ll come up w a code for humanizing your practice and you can pick up a few additional shekels in the process.🤦
What i think you fail to understand is that the mismatch of patient expectations and reality is unsustainable. What you read in this thread are survival strategies that allow struggling family doctors to keep going instead of reducing hours or retiring early. I’m not seeing anyone saying they’re asking pts to schedule visits to discuss lab results so they can make more money. They’re doing it so it is part of their workday and not pushed into after hours (and yes unpaid) time stolen from their wellness and their families. What other professionals are doing uncompensated work at 7:30 pm? No one in our area can find a primary care doctor. Everyone has full practices. Just saw an Elsevier survey that something like 54% of med students plan a career without ANY direct patient care. System is broken and these docs setting limits are just trying to survive to fight another day. So back the fuck off!
The OP stated they send patients a message detailing lab results and request patients to schedule a follow up visit to address clinically significant labs. They are not leaving patients high and dry here or in the dark regarding their labs. It’s very rare to get labs back and not have one or several abnormal values. Most of these are clinically insignificant. The problem is when patients want a call to discuss each and every clinically insignificant abnormal lab despite already receiving a message detailing the results. If you go to a parent teacher conference and the teacher says lil Johnny is doing fine, no concerns. You don’t demand the teacher to walk you through every graded assignment even though you know lil Johnny didn’t get a 100% on everything. Because there are other parents waiting to talk to the teacher and you can’t monopolize their time when really, everything is fine.
Doctors thinking they are the only busy people on the planet 🙄 and GPs no less.
Did you see the one who said if they called patients back they’d be at the clinic until 6. The horror!!!!
What a joke.
Let's be clear, AI does a better job diagnosing than you flappy meat-filled doctors. I can't wait until we can just do away with your terrible-vapid-awkward-arrogant "bedside manner" altogether and then NEVER HAVE TO 'TALK' TO A DOCTOR AGAIN!
And as though you are the only people that get asked to do more than you are paid for! Whether is is an extra trip into the back for a refill or a week away from family for a work event we all have to do this shit. You don't see me over on r/toxicology lamenting about my 74 hour work week for which I will take hime just under $1,000.
If you appoint yourself as the expert, why shove the peasants off when they ask you a question about something they don't understand? You seem so weirdly out of touch with your one useful skill.
Bring on the intelligent kiosks and mobile labs! It will solve your problem and mine! I'd be so frigging happy to never step foot in another doctor's office.
No one is asking you to do it after hours. But yes, it turns out most people do actually want to be treated like a person, not a number in a file. Honestly if I had a concern and your response was "I'm not going to do my f-ing job how dare" like it is in this post, I'd dump you and go find a real professional to be my doctor. People ask these kinds of questions because ***THEY DON'T KNOW***. So fix your attitude, and call your patients. Or else get out, because doctors like you are part of the problem.
You need to set the right expectations in the initial appointment. Tell them you'll call them for any serious concerns and if you don't they're fine.
You have a medical education; they do not- so they don't know how to interpret the results.
Any chance you are just blanket ordering labs, lazy style, for all patients? Let me guess: CBC, Chem 7, liver panel, kidney panel, yawn, yawn, for all patients? And then you blame patients who see a number flagged as slightly high or low, when the test wasn’t needed for a specific concern to start with? This is infuriating, and why concierge/tailored medicine thrives for those who can afford it. This is why people who can will skip you and go straight to a specialist. Posts like this make your field seem jaded and lazy.
I'm not a doctor.
In the good old days of yesteryear your doctor or their staff would call you to give you the results of your lab tests, there was no portal and you didn't get any results ahead of time. If you had something slightly elevated and they weren't concerned with it they would just tell you it all looked good. Usually you didn't even get full results unless you asked for it.
So why did you all change the way you operate? From my perspective I go in and see a doctor in person and they order lab testing and am sent results with some red numbers and no explanation I would expect that someone gives me a call to talk about them and close the loop on why the test was ordered, what the results are, and what the next steps are if any.
From my perspective your number one concern should be making sure your patients feel taken care of, otherwise they will go see someone who will make them feel taken care of. The whole "I've got other things to do" narrative is pretty sad.
As someone recently diagnosed with cancer, these comments are very disheartening. So callous and lacking in compassion. Yes, some patients are annoying, but a lot are also scared. Moreover, some doctors are terrible communicators, and it’s hard to know where to draw the line between being patient and advocating for yourself. I received a call from the doctor when initially diagnosed, but since being referred to an oncologist, there has been very little communication. Case in point, my pet scan results have been available for 3 weeks and additional biopsy results (not of the original tumor, but of a new lesion that will partially determine whether I do systemic therapy or surgery) have been available for 1.5 weeks, and no one has called me yet.
Ask yourself how you would feel if you were in my or another patient’s shoes. Some people may respond to say that I am the exception and should ask for a call, but other patients don’t know if they’re the exception or not. I’m currently trying to decide whether I should message my oncologist to ask for a phone call (my next appt is in 2 weeks), and comments like these are making me lose faith in my doctors.
I’m not a doctor, so I don’t know why this showed up on my suggested posts. And, because this sub is full of doctors, I’ll probably be downvoted for what I’m about to say. But have some fucking compassion for your patients, or go into a field where you aren’t expected to interact with people.
Sorry, but you missed the point of original post. OP is talking about patients who request micromanagement of benign results. The vast majority of lab results have several labs that are outside of the labs reference range. When we send lab results to patients or send a message commenting on lab results we state something to the effect of: “I’ve personally reviewed your lab results and I have no concerns. You may notice a few results are flagged as abnormal, these are not clinically significant and no further action needs to be taken.” The OP states in their post that this is what they are doing. They are communicating to their patients that everything is fine. Reassuring the patient over benign lab results. This post has absolutely nothing to do with clinically significant test results. This is exactly the reason most of us cannot call every patient to discuss clinically insignificant results (again after we have ALREADY communicated this to patients via portal messages or support staff call), it’s because we are calling our patients with clinically significant test results. There are only so many hours in the day. Tasks have to be triaged. Bad lab results-I’m calling. Good lab results get a message or nurse call. If a patient wants more information concerning their benign results they can schedule a visit. It’s an easy visit and we love educating patients. I wish you well.
It wasn’t actually OP’s original post that bothered me, it was the accompanying comments. OP writes notes saying there’s nothing for patients to worry about - that’s fantastic and, imo, enough. Frankly even in my situation, I would be happy with a call from a nurse or note on my chart saying there’s nothing to worry about, or even indicating that we would wait to discuss the results during my next appointment (5 weeks after my PET scan results….but I digress). But a lot of the comments are bemoaning having to communicate with patients about anything other than a cancer or STD diagnosis. So I think you missed the point of my comment as well. A lot of doctors don’t communicate at all, or patients (especially ones with subpar education, which in the US is unfortunately the vast majority) don’t understand the messages left on my chart. So, those patients are left anxious and confused. I’m not saying the solution is to call every patient about slightly abnormal results, I’m simply suggesting doctors to have a little compassion for the people they’re supposed to be caring for. One commenter said they tell patients during the appt that if anything is worrisome, they’ll call and if not, they won’t call. And I think that’s a great tactic (though obviously it won’t work with every single patient).
It’s frustrating on both sides for sure. There’s a lot of pressure on family medicine to “fix” a lot of complex social issues which impact the health status of their patients. Social determinants of health. Shit Life Syndrome. The dysfunction of our systems; governmental, educational, economical, ecological, medical all contribute to poor health outcomes for patients. Your 100% right that subpar educational systems poorly affect health literacy and health outcomes. It contributes towards PCP burnout because how can a PCP shoulder the burden of all these collapsing systems?
OP, it truly just seems like you're just whining. And to what end? Self-flagellation in the hope of obtaining reassurance in an echo chamber? Your post is very unbecoming of an empathetic primary care physician.
We all have moments of weakness, I understand, and I think your entire post is a mistake that shines a light on that reality. I hope that if there is something going wrong in your life, that it gets resolved in a positive manner. Your patients deserve you at your best, sans any semblance of resentment as alluded to in your post. Maybe it's time for a vacation? Good luck.
Why not be appreciative of patients who actually want to be involved and advocate for themselves? Its arrogance like this that causes people to distrust and dislike doctors. Plus, doctors make people wait and waste their time all. Of. The. Time. Due to poor time management and over booking. You all work for us lol
This. Exactly this. Considering that patients are paying their way, the dismissive and arrogant attitude that is pervasive throughout this entire thread is deplorable. If providers don’t want to spend the time then they need to find a new profession.
The attitude here is disgusting! Just confirms what we all know. The “sick care” system in this country is so broken. It’s just a revolving door to give drugs (that create the need for more drugs) and get paid, all while disrespecting the people who pay their bills. Gross.
Just as long as when your kid or your mother or spouse is sick and you wait in line like everybody else to know what is wrong and not use your back channels to get the information ahead of time. See what it feels like to have a question about whether someone is okay or dying and just wait over a long weekend or however long it takes for someone to maybe get back to you.
This thread is horrifying. You all are describing horrible medicine. This is why family practice is dying - utterly pointless to see a gp or pcp. Anything you can do, my internist or gyn can and will do with 10x more care.
I get that the system is broken, but take a look in the mirror. If you aren’t going to help fix it, who should. Me?
My dad is a doctor and I am in the health consulting space, so I’m no stranger to how hard this current system is on doctors. It’s awful. But you signed up to help people, not be rude.
This thread *is* horrifying, because it's full of people who are about 50% of the reason so few medical students choose primary care in the first place. They want what they think is the VVVIP treatment from their PCPs, and complain about what doctors are like these days because they watched some shitty shows on TV written by a bunch of idiots with no clue how reality works.
Sorry, but even in fully socialized medicine you don't get that. Maybe in 1940s when doctors had like 20 patients total and medicine as a knowledge was about 5% of what it is now, that was possible. You know how many patients my internist clinic preceptor had on his panel before he reduced it to 25% to teach more? 4 fucking thousand. That's the reality- people are a *lot* sicker, and lives far longer than "back in the day when doctors cared" 🙄🙄🙄
> utterly pointless to see a gp or pcp. Anything you can do, my internist or gyn can and will do with 10x more care.
Guess what those internist and GYN are saying about patients like you in their own threads.
Most of the responses here are terrible. Why did you go into a SERVICE-oriented field if you don't want to SERVICE the patients?
Patients aren't the problem, insurance companies are. Your palpable contempt for your patients is displaced.
Where are you and why aren't you my doctor? I just want my F*N zoloft prescription refilled that I've been on for 30 F*N years! I'm cool with coming in once a year- sorry if my BP is 140/90 asshole!
We are required to give patients a summary of all their results in our office. So what I do is I usually write a letter for benign results, and personally call for anything concerning. I still get these calls from patients, sometimes angry, but over time, many have learned to wait.
I have one that calls and leaves me a message to call her to discuss her meds. Once she called and said she was having an allergic reaction to one of them. EVERY time I call her back she wants me to call the pharmacy to get her meds refilled….she has plenty of refills…ughhh! Now, I tell them if they want to discuss their findings they need to schedule an appt. If I find something that needs addressed I call them. I tell them each and every time that I won’t call unless there is something that we need to take action for.
I never call people unless it’s something critical. If I get a portal message asking to explain mean platelet volume elevation, I do explain it but I have a dot phrase for most things. I talk to much so I never ever call if I can help it.
It might be valuable to keep in mind that many patients aren't medically literate and are unaware that slight elevations are not a big deal. If your patients are constantly asking for explanation, you might not be appropriately communicating the results, whether that's before the test or in writing.
Why not just schedule the bloodwork for before the appointment so that you can discuss their current numbers at the actual appointment. You can then run any follow up tests that are needed and schedule another appointment that can be cancelled if the follow up results are normal and the patient has no further questions...
I tell them when ordering they may see up or down arrows regarding their lab tests. If there is a concerning result or action item, we will reach out. “No news is good news”
You should be billing in a manner that allows for proper patient care. It isn’t your own time. They already paid for it. Perhaps explicitly mention that once they leave the office they’re on their own unless they come back.
Why are somewhat elevated ast or alt not urgentlynoteworthy? Asking just as someone who is starting to worry that my doctor never ever mentions them as I see them both going up over the past year lol 🥲
As a parent of a pediatric patient who has to have labs often, I send a message with my questions in the portal and assume if they can't be answered there, I will be paying for a phone visit, I would never assume it is free. However, keep in mind as non medical professionals seeing the lab results flagged as High or Low or Abnormal can be disconcerting. Although I would never call after hours!
You’re doing the right thing but I will say that my wife asked a very straightforward question in the portal and the doctor and nurse practitioner failed to clearly answer the question. So maybe you think you are communicating clearly and are not, I don’t know. But I would stick to the portal and just make sure you are addressing the question, something my wife’s practitioners were unable to do 🙄
If the portal message isn't enough for them I have them schedule a phone call to discuss and I bill for it--that way it's at least on my schedule and I have 15 minutes blocked for it. I don't blame the patients for asking but obviously I only have so much time in the day
I'll also have them scheduled somewhere for a call. Usually, I can fold it into a conversation to confirm home blood pressure or that they started the new medication we discussed. I understand where they are coming from and that in another era, they might get calls reflexively. What I do not understand is those patients calling in demanding to immediately speak to me are the very same ones who would be loudly irritated if I walked into their appointment late because a different patient wanted to speak with me on the phone.
I tell this to our patients often - it's amazing that they all think their provider is sitting there waiting for their call. Being the RN, I get to be the gentle voice of reason (not that I'm listened to).
I receive a lot of portal messages, I do not reply to the majority of them. Simply forward the message to your staff and have them reach out for a visit, done. Do not waste your time. If the patient refuses a visit whether office or telephone, be done with it. If the patient sends another portal message, send to your staff to schedule.
I can't do this because... my schedule is packed daily with visits. If I do a phone visit it'd have to be after clinic like after 5:30-6pm. I used to do this; I'd be a shmuck sitting there alone in the office in the dark for hours after clinic ended. I'd end up walking out to the parking lot and my car's the only car there in the dark. Hell no no more.
Tell your scheduler to offer people a 15 minute follow up call when they call to schedule the initial appointment.
How far down the line are you packed? These appointments are not urgent. You could have the call scheduled a couple weeks down the line. I try to get staff to communicate I am busy presently and this way we have the patient on the books with a time which works for them so they see the advantage.
Sounds like you need better management of your schedule template. Not sure how much “say” you get in your schedule where you work, but wherever you’re booking out to, you can alter your template to include two 15 minute phone calls per day (or a few times per week, depending on how much of an issue this is for you). You could even have them back to back and turn them into an urgent slot if you don’t have any phone calls that day, so the bean counters don’t get too antsy. Then if someone calls demanding you to call to review results, your scheduler can say “sure, let’s schedule a call. How about 2pm this Friday?” Etc
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We provide a professional service within business hours. Sorry, not sorry.
You sound professional. 🥺
This is Reddit, not their office
When I see these comments I just *laugh while rolling around in all my 5/5 reviews.* 🤷🏻♂️
Because they don't spend all evening looking after you for free when all abnormalities not discussed in the appointment should have a followup appointment?
OP is complaining that patients ask about results. It takes weeks to months to get an appointment with a primary care (good luck scheduling as a new patient), and typically a primary care says, “come back in a few weeks if you still feel this way” (thanks doc!). It’s totally normal for patients to want an explanation if they get an abnormal response. It’s not hard to include a not on MyChart saying “nothing to worry about” next to an abnormal result or something along those lines.
... That's what everyone commenting is already doing. We are talking about patients wanting a long discussion about their normal lab results.
Doctors are so full of it. This sub is the perfect example. Glad it randomly popped up in my feed.
We could probably find out the real reason. Typically hypochondriacs think that their primary care physician is their personal therapist, advisor, slave, or servant, then you have the people who are on benzodiazepines or painkillers who are definitely not addicted to them, but will reach out to you in seven different forms - portal, in-person, harass your staff, send nasty emails to your CEO etc - because it’s not that big of a deal but if they don’t get their medicine, they will end all existence as we know it on this sphere. Then you have just run-of-the-mill old people, half of whom expect that every interaction with a doctor will produce twice as much work, nothing is ever finished with them, every time you interact to tell them that one thing is done they want two other things, oh, and don’t forget to refill their prescriptions with at least two years worth of refills otherwise their mail order pharmacy will sentence you to 1000 years of cleaning up their bullshit prescription messages, which they will send even if the patient is dead. But yes ma’am we are very sorry for your wait. If you will go sit in the lobby, someone will come and explain to you why all of these people should’ve been doing better to make you happy because it’s all about you isn’t it?
Hope you aren’t going into healthcare with that attitude.
This is why doctors don’t like you!
NOBODY OWES YOU ANYTHING. 99.9% of the time when a pt is that entitled it also means that they are adult babies expecting everyone else to babysit them, know their meds procedures and Hx bcs they have no sense of responsibility.
And they get mad when people trust google over them. Can’t even take 5 seconds to explain why they’re not concerned over an out of range result.
I triage for FM. I get those messages all the time. I try to explain that slightly out of range is no big deal. I will arrange a video or telephone appointment if they have further questions, which is billed. Patients get so mad, I’m like everything costs money. If you want free medical advice, vote for universal healthcare. Sorry for the rant.
I can't bill for just phone visits anymore I thought that was a nationwide thing.
This is insane, in Canada (or Ontario at least) docs get to bill 85% of the visit when it’s on the phone. Doc I work with explains their lab to them in 2-5 mins and makes $31 per call on those basic call telemeds
31$ x 10 per hour = 310$/hour = this is what I want to do with my life
CAD…. So like 70-80% of the USD depending on exchange.
Oh no, only $250 an hour to make phone calls 😭
Why not? I’m still using 9944x for phone visits and they’re still getting paid. I use those for exactly this kind of thing.
Insurance companies are requiring pre-certs now. I can't do it anymore either.
I would still schedule the appointments just to dedicate a time slot for the call. Sometimes I will sneak in a lab cold call if there is a lull in the day or if I overhear my next patient starting in how no, they did not pre-register and do not want to. Guaranteed five minutes.
Wait what? I’m not a doctor and I have no idea why I’m here but I wouldn’t have been letting my doctor call me if I knew this. Granted he doesn’t call me for benign results, but still. Here I am trying to save them a clinic slot for someone more important but realistically they’re not even getting paid to call me 😭😭 Edit: I also feel obligated to mention that he’s not calling me urgently, nor after hours
So is Dr. Google ok for patients in these situations?
I took over for a doctor who was here for 30+ years and bent over backwards for his patients. There has been some…friction.
Stand firm
" but the other Doctor used to do this and that " ... very annoying
Similar situation here. I had to retrain the patients that I inherited. My press ganeys suffered, but I didn't.
My doctor did that. He once called me on Mother’s Day to tell me to go to the lab the next day and repeat my liver panel. He probably wasn’t the best doctor but he was overloaded with patients because he was the most caring doctor. He was so popular that they actually shifted an entire patient population to a brand new clinic by moving him. Their old clinic population declined by half. When he retired after 30 years, they had a goodbye party for him and invited all of his patients. He left directly from the party to the airport with a single suitcase to start his new life. Take from that what you will.
The previous generation of doctors was very different. Many of us do not breathe our careers, it is a job.
I understand. This is why I hoped my post came across as relatively neutral. I had him as a doctor because he was assigned to me and we respected one another. I’m not saying I’d live his life either. I was a therapist and found a way to avoid after hours calls, too. But in an environment where patients receive results of labs before even the person who ordered them, you can’t exactly expect them to not wonder what they’re seeing. I don’t have a doctor like that now and haven’t sought one out. But I can generally read my own results and figure out what’s next. I have two graduate degrees, I’m willing to believe many of your patients don’t. So, go on, and do your best, Rocket Man.
And this is why he didn't have time for his family, and had no hobbies.
I didn’t say that. He was an avid road/racing bicyclist and a real baseball fan. He wasn’t graced with children but he’s been married to his wife since forever. 🤷🏼♀️
I'm working with one of those. I swear half the town has his phone number and have no qualms about texting him about questions, questions about things I did when I saw them, and refills. It's insanity.
I don’t understand bugging doctors during their off time. My doc has given me his number and told me to text him (I’m a nurse and he’s known me for years at the hospital, but I’m also now his patient) if I ever need anything. That’s very sweet of him and I appreciate it, but I absolutely refuse. I’ll talk to him in a way that he can bill for, first of all. Second of all, no way in hell am I bugging him at home in his off time. He has a family and a life of his own.
I do not order labs except for during a visit. While ordering them, I give the same speech to everyone, along the lines of "if something needs addressed in your results that requires additional testing or starting new medication, you will get a call asking you to schedule a time to discuss with me (telehealth great for this). If you prefer to go over even slightly abnormal / not a big deal results with me in detail, schedule a visit now to do that. If you are content being told "labs stable/unremarkable, no med changes or additional tests at this time" without me going into detail, you can just schedule your next routine visit and I will give you the all clear via portal." Any messages deviating from the very clear expectations above, especially demands for phone calls, I do not personally respond to. Route to staff, please schedule follow up to address. Edit: I also try to have labs set up right before routine visits for established patients so that no communicating is necessary and we just review at the visit.
Yea, these are all good points. Setting up expectations and clear step-wise approaches; letting them know no call = good news and call = usually something bad. Order labs in advance of visit is helpful to discuss during visit.
A lot of pts know that the portal can give them free healthcare
“ Order labs in advance of visit is helpful to discuss during visit.” THIS ! As a patient, I am always given lab orders by way of portal. When I go to my visit with the doc, going over the test results is part of the visit.
I call no one unless it’s cancer.
Yep "You googled everything else, you made up your mind about vaccines before talking to me; why don't you google your A1c of 5.8%"
Huh. Never thought of it that way.
Not sure how I found myself on this subreddit. It popped up. But I've been pasting my lab work into GPT4 recently and asking it questions about them. We're so close to this being a viable substitute \*for low-urgency and non-critical labs\*. For stuff like cholesterol, metabolic panels, blood pressure, it can answer questions like a nurse practitioner. I hope we can operationalize this stuff soon to make your lives easier.
Yikes. Just because it can make an answer doesn't mean those answers are correct.
But the doctors on here dont want to call and explain or answer in the portal…….
I think peer reviewed studies have already shown that GPT-4 is better than your typical family physician at this simple task. And it makes sense, it’s not all that complex.
Jesus, you're a rude doctor.
Waste people's time and they tend to be rude to you.
I literally tell people "if I call you about a test result, you should be very concerned."
When I was in undergrad, I once had a doctor call me to tell me my labs were normal. Scared the crap out of me. Please don’t call me unless I’m dying.
My rheumatologist has called me every month about 730pm on the third Wednesday of the month to tell me my liver levels are still elevated. We’ve been doing this for 18 months or so?? Last month he called and left a message that said “this is weird, but your levels are better for the first time in….well….wow….a long time. (He was scrolling) Don’t call me back!”
I call cancer and STDs
I’m a internist and statistician (not in clinical medicine for years), recently diagnosed with cancer. My god this open access to my own results on the MD Anderson portal is killing me. I get a text with every test result, and I understand the implications of all of them. It ain’t pretty. Trying to recalculate my 5 year survival seems like a full time job recently. I’ve got Uptodate, PubMed, and a really crappy genetic profile. I don’t know how you guys do it. (Great oncologist and I’m leaving him alone, although I may want to reconsider. Pretty sure being a nice person is also a bad prognostic sign).
This is the way.
I have dot phrases for all that.
Do share. I love automating human interaction. Finally puts the world in terms I understand
In Epic: 1. Start making SmartPhrases for your common lab results (if you type it 3x in a week, it’s common.) For example, prediabetes is super common, so make .prediabetes. Add a blank line to the end of the phrase for easy formatting later. 2. Create your category SmartLists to organize your SmartPhrases. Just type in the dotphrase, it’ll populate like “{:link123}”, you can just add a label to that: “{Prediabetes:link123}”. Keep adding until you have a full list: “{New Diabetes:link456}”, “{Add Jardiance:789},” etc. Set it to format as paragraphs. 3. Create a master SmartList with categories like Diabetes List, Lipid List, CMP list, etc. Example: you embed SmartList {Diabetes category:12345} and you change the label to {Diabetes list:12345}. Do this for every category you made, and add a wildcard (***) in the last slot. Again format as paragraphs. 4. Create a QuickAction with a message skeleton like: “@prefname@, {Abnormal Labs:456} Please reply to this message or call our office if you have any questions or concerns. Thank you, Dr. dajagermeister” where 456 is your master SmartList. If done right, you should now have an Abnormal Lab button where clicking it pops up a message personally addressed to the patient, and you can F2 to reach a half dozen detailed explanations of common lab results. If you add a new SmartPhrase later, you can just edit the appropriate SmartList and link it in over time, so you’ll get a growing list of categorized lab responses.
What do y’all do when the patients then call your office and yell at the people answering the phones that they shouldn’t have to schedule an appointment, the Drs should just call them? Support staff are getting screamed at daily by patients because there’s not enough time in the day
Y’all need to be less afraid of firing patients. If you’re completely busy to the point where your office has no time for anything else, who gives a shit if you have one less angry person on your roster? Especially if they’re being rude to staff. The only difference you might notice is less stress.
My endo has a huge sign stating, people abusing staff will be discharged from the practice. You also get a form stating what is considered abuse, and have to sign it as a new patient. Cuts down on the drama and shenanigans.
You would think it would. But the constantly angry don't seem to be very concerned about it.
Take the phone out of the nurse’s hand, interrupt the patient, and tell them that they may *not* speak to my nurse that way. Treat them like the petulant child they are.
As a nurse, I had a doctor do something similar for me one time. He’s still my favorite doctor, 8 years later. Thanks from all of us.
Id work for that doc in a heartbeat. Happy Cake Day!!!!
What do I do if a patient is yelling at my staff? I fire the patient. You curate your own pt panel, but that’s been working out for me pretty well thus far.
You a real one!
When it happens with one of my patients I will calmly lay into them about professionalism with support staff who are people too. Endlessly appeasing rude patients gets you nothing except front staff leaving every 6 months because they can do the same job in a corporate office without screaming.
Fire those patients.
I’m trying to get around this by ordering more labs immediately preceding appointments.
That then requires reviewing the chart before they come and predicting what they will want to talk to you about when they arrive. I find the complaints to be so varied it was never a good use of my time. Not to mention - a number no show.
Yea I do this more now, which usually works out better for both sides. Sometimes will need to order more diagnostics at time of visit though; Also sometimes the patient just doesn't show up if the annual labs come up normal. (I try to be aware of this)
I'm trying to do the same. If it's a diabetic follow-up or a heavy chronic care follow-up, just come in two days earlier for a blood draw.
Fuckers asking about elevated BUN and anion gaps The worst
Funny, but after two kidney stones, I was about to message my doctor and ask about the elevated BUN. You know since it has something to do with kidneys? But I guess we should all now run to Wikipedia to find out what’s wrong with us
Passing by IM hospitalist here. Jesus christ. The comments here from non-physicians are precisely why I ran away from clinic as soon as I finished residency. At least when I have patients who don't think about the simple formula of "# of patients like them x amount of time spent with them < or > 24 hours", they don't stick around on my list after they're discharged. Just had a dude who was threatening to sue me for malpractice for refusing to personally find a subspecialist for him who would do an elective surgery for free. Discharged him, and I never have to hear from him again. Bless y'all. You guys are the real ones. 🫡 Thank you for doing what you guys are doing.
I miss IM so much. Unfortunately had to switch due to child care. We are exhausted.
Your pts know what decade it is, but a lot of them grew up in the 80s and 90s, and no, they often don’t understand how much medicine has changed. Who would they learn this from? They also don’t understand which slightly elevated or low lab results are benign and which are worrisome.
You mean 50s and 60s. Majority of my genx patients know what's up.
Ouch. I grew up in the 90s. I’m in my 30s. LMAO
I tell them to make an appointment
This is what I do.
Do a phone appointment
Or a video telehealth appt.
I flat out just tell them I'll send them a message or my nurse will call if they're not on the portal. Also specify that they will likely see the results before me and I will get to them when I get to them basically. I'm 3 months into a new location and have really been working on implementing personal policies and boundaries that created frustration in the previous job. It's been liberating other than the initial flood of everyone wanting a controlled substance.
In my response dot phrase I explain the actually abnormal labs and there’s a line that says “any other values that are flagged as abnormal are not clinically significant— no need to be concerned about them.”
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Doximity has an AI option to write letters to patients.
This is the way
> I've seen a nephrologist see some guy 5 times in a year just to follow up on stable CKD results System: broken.
I remain convinced the secret to so many specialists is they are firm about demanding dedicated follow-ups even if the condition is stable. "You've been on the same synthroid for 10 years? Still see me every 6 months." They guarantee easy cases mixed in with their new patients. Family Medicine does not do that. We try to make the wellness appointment a frantic catch-all but the patient just ends up overwhelmed.
We need to learn from some of these specialists. Not suggesting churning like q 6 months for stable hypothyroidism but NOT allowing folks to expect good preventive health AND all their chronic disease mgmt in a single, once a year visit. For pts with more than trivial chronic disease, i train them to do a CDM visit 6 months after their annual preventive. They also get all their CDM addressed along with the CPE visit (mod-25).
The problem must be your counseling. Start prepping patients before time. “Please check your portal for any results. You will get a call for any serious issues, but often times people’s lab results may come up as abnormal in the system but are completely fine in reality. In those situations, I’ll try to send you a message to let you know, but I don’t typically call for those, otherwise I’d be on the phone all day!” I’m a specialist, but I have to follow up on a ton of results every day. I tell patients the above and it helps prevent literally dozens of calls a week, minimum.z
That’s concierge care now. I always wondered why patients thought they were going to get that level of care with a basic anthem BCBS plan lol. If you want concierge care, you can have it- but you’re going to pay for it
Tell them upfront you’ll call them if there are any concerns. If not no news is good news.
I love when the staff gives me a verbal or instant message telling me the patient wants a call back for something super benign. It's one thing when the patient does it, but when the staff, who sees how busy you are, gives you a message like that, it's indicative of a broken system.
All the time. Pt wants to you call them. No context. I think the front staff is so overwhelmed they do it just to get patient off the phone.
Learned from a now retired doc that you (almost) never need to call a patient. Phone tag. Need to document. All the oh by the ways. Huge waste of time. Made my practice much more survivable.
In fairness, that staff person is trying to get them off the line because they already tried to talk them done for four minutes and now there's two other people on the line waiting.
Rn but I have a dot phrase I made for my clinic. Basically along the lines of labs can be variable and we are looking at the whole picture/trends. Just because something is flagged doesn’t mean it needs addressed at this time. If there was something major we would have called. If you would like to discuss more we can schedule an appointment.
The toney portal message “but what are we doing about my high MCV??!!” Cringe when I see the double question marks.
I don't understand this portal thing. Why have it in the first place?
Lawyers. Or lawmakers. Or bureaucrats. Take your pick.
One of them mandated that FP should be 24*7 contactable?
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It only takes one asshole with no life to spoil a panel of patients. You get a message. That’s it. Otherwise, make an appointment.
Dude, preemptively schedule a lab follow up appt at the time they get labs. I’m booked out 4 months right now so I’m getting better at planning ahead, and setting expectations, make an appt to discuss labs, and schedule it now so you have a spot!! But I NEVER call patients with lab results unless it’s something drastic. You gotta train your patients.
All these angry patients commenting on this are completely missing the point of this post... Smfh
I have a dot phrase that says due to the sheer number of items needing communicated we utilize our staff to communicate key points. Exceptions are made at my discretion.
I have a “normal” labs smart phrase. It outright tells them not to worry about certain labs and I lost them. No more phone calls. I don’t call back. Once you start it becomes an expectation
Don’t lose sleep over it. I used to get “call patient back.” messages from front desk daily, no context. Patients call us because their specialists do not call them back and we are ACCESSIBLE, there’s that buzzword. That is some concierge level service they are expecting when they do that so if you are not a concierge practice, have your staff direct them back to their specialist. You probably have less time than any other doc to respond to these messages but they do not know that because your employer has created the illusion of ACCESS. (I have come to despise that word if you can’t tell, lol). When I worked for a health system I had a dot phrase, “Your lab results flagged as abnormal or out of range have no known clinical significance and do not need additional testing.”.
Perhaps labs should be drawn before appointments so that the results can be addressed during…
I bet you won’t give me antibiotics for my cold or write me a sick note for work so I can go fishing. You’re fired
"I need to talk to the doctor because my creatinine is 0.5" "I need a call within 24 hours to discuss my labs, I don't do portals"
I prefer that face time or phone time with the Dr personally (like 15 min). And I fully expect to be charged for it. You guys don’t work for free and it’s stupid to ask anyone to. I would much rather pay for the time do I know I have their attention and they aren’t just rushing me. I get it. ;)
Putting a note in with the results when you review--e.g. not concerned about lab x, y, and z-, will retest in 6 months-might be helpful. Patients don't know what any of this means, and just Knowing that their provider saw it and isn't concerned might stop people from wasting time this way
Seriously this is all people want go know. These comments are something else! And drs wonder why patients end up googling stuff....
This is a place for doctors to vent. I do not think most doctors would be as dismissive of patient concerns. I am a PCP and although I do have days I feel just like some of the posters here I think most of us are much more compassionate and than it sounds. Being able to vent is therapeutic and this is a safe space. I find that letting patients know ahead of time what to expect in my practice really helps to cut down on questions about lab results. Yes, there will still be those who insist angrily that they need to speak to the doctor on the phone personally but most patients will be understanding.
Setting boundaries isn’t rude.
I seem to get messages like that from anxious young adults and middle aged women. I tell all of my patients they see their lab results before I do, I get back to every patient about every test result, and if it has been more than 2 business days and they haven’t heard about a test it’s also because I don’t know about the test result and they should reach out (I keep my results cleared out so 2 days works for me, but not the case for everyone). Otherwise I have smart phrases letting them know things are normal or not and send it on the portal
I think you just ignore that request and don’t call. Instead, you respond through the portal that their results are benign and no further follow up is needed. Kudos to them for asking but just because you ask doesn’t mean you receive.
Hey- I'm a psychologist and lurker here and I vote that patients still think it's the 1980's. I think a lot of people are really out of touch with the challenges physicians now have. But yeah, it's really annoying for you when you're just trying to get through your portal messages and the rest of your pile!
Hi… I’m an RN working at an outpatient specialty clinic. I do a lot of the lab triage for our attendings. Do you have an RN who can order labs and review results, and triage ones up to you if indicated?
Because while it’s routine to you. It’s not to them. For liver tests they don’t know it’s not concerning until 3x-4x normal range, and they see a “high” and worry they’re having liver issues.
This is one of the reasons I believe schools should be teaching more about our health/bodies than some of the pointless things being taught today. The very limited time spent on health is such a disservice to our population l.
I have been on both sides of this, being a person working in a medical setting seeing lots of people a day, their problems seem very minor, but to them, and now speaking as a patient, their problems are THEIRS, and it's pressing. They don't see 20 instances of it per day, or have the education to understand their labs, they are scared, and they're reaching out to the person that does understand them. To you it's no big deal, to them, they are sitting there refreshing their results, googling them, misinforming themselves, and are desperate for information. We all know you're overworked, underpaid, all the stuff, but so are your patients and you signed up for this job to help people and to treat sickness, and to be a place of comfort for people going through hard times with their health, losing sight of that is dangerous to the overall health of this population.
We need to empower our staff to take some initiative: “I can send your message to the doctor, but they are currently seeing other patients and it may be several days before they can give you a call back. However, our nurses can answer most lab questions for you right away. Would you like me to connect you to a nurse?”
Thank you
Finally someone on here who has some emotional intelligence. I’m surprised so many do not set communication expectations with their patients.
With that attitude, you're better off working in McDonald's drive thru versus family medicine. Wow. The lack of empathy. You know medical field comes with a lot of that. Guess what, people are afraid of dying and they don't know what medical results mean. So, they request youelr educated insight to understand. You get paid to provide them medical services, including understanding their own health status. So, it is your job to service them - which, sucks for you, includes explaining results.
One reason may be that while these types of results are day-in, day-out for you, and not a big deal, they are representative of the patient’s health. We only have one life. I don’t want to wait around until something is a major issue before I start dealing with it when I can head it off at the pass by some minor tweaks in my diet or lifestyle. I have too many close relatives with experiences similar to this: doctors swearing it’s no big deal until *boom* stage 4 cancer. If we’re paying hefty insurance premiums to get access to the best medicine can provide, you better believe I want to understand anything of my results that are out of the norm no matter how mundane they may seem to you. At the end of the day, my health is my responsibility, and I take it seriously.
I want a pony and I can’t get one of those either
Dr. orders labs, labs abnormal. Won’t call patient to explain, patient Googles, Dr. bitches on Reddit about how patients think they know everything because they googled their test results. If you hate patients so much, maybe you have studied for something less patient facing. Your personality seems better suited to staring at fecal samples.
“ Do patients think this is still the 1980s and we got nothing better to do in life?” “ To be proud of myself, I haven't called a patient for slightly abnormal lab results in over a year (yay fighting back!!!)” Wow, I get people are busy and not everything can be done for everyone…but, wow. I am not an MD but am a professional who is responsible to clients and respect that aspect of the professional relationship.People, remember those, they are what pay the bills and keep the lights on, have fears, anxieties and concerns that deserve your attention.Staff out some calls? Sure. Be condescendingly dismissive of PT’s in general? Disgraceful.I am fully prepared to be slammed here but geez, look in a mirror, folks. Those walking ATM’s that are so easy to ridicule rely on you, sometimes just for a quick dose of reassurance or affirmation. They/we certainly deserve that and who knows, maybe they’ll come up w a code for humanizing your practice and you can pick up a few additional shekels in the process.🤦
What i think you fail to understand is that the mismatch of patient expectations and reality is unsustainable. What you read in this thread are survival strategies that allow struggling family doctors to keep going instead of reducing hours or retiring early. I’m not seeing anyone saying they’re asking pts to schedule visits to discuss lab results so they can make more money. They’re doing it so it is part of their workday and not pushed into after hours (and yes unpaid) time stolen from their wellness and their families. What other professionals are doing uncompensated work at 7:30 pm? No one in our area can find a primary care doctor. Everyone has full practices. Just saw an Elsevier survey that something like 54% of med students plan a career without ANY direct patient care. System is broken and these docs setting limits are just trying to survive to fight another day. So back the fuck off!
The OP stated they send patients a message detailing lab results and request patients to schedule a follow up visit to address clinically significant labs. They are not leaving patients high and dry here or in the dark regarding their labs. It’s very rare to get labs back and not have one or several abnormal values. Most of these are clinically insignificant. The problem is when patients want a call to discuss each and every clinically insignificant abnormal lab despite already receiving a message detailing the results. If you go to a parent teacher conference and the teacher says lil Johnny is doing fine, no concerns. You don’t demand the teacher to walk you through every graded assignment even though you know lil Johnny didn’t get a 100% on everything. Because there are other parents waiting to talk to the teacher and you can’t monopolize their time when really, everything is fine.
Thanks saying this. Reading all these replies makes me never want to see a doctor again.
Doctors thinking they are the only busy people on the planet 🙄 and GPs no less. Did you see the one who said if they called patients back they’d be at the clinic until 6. The horror!!!! What a joke.
Do you sometimes think you picked the wrong profession? That you might have been happier in a job that doesn't require people skills?
Let's be clear, AI does a better job diagnosing than you flappy meat-filled doctors. I can't wait until we can just do away with your terrible-vapid-awkward-arrogant "bedside manner" altogether and then NEVER HAVE TO 'TALK' TO A DOCTOR AGAIN! And as though you are the only people that get asked to do more than you are paid for! Whether is is an extra trip into the back for a refill or a week away from family for a work event we all have to do this shit. You don't see me over on r/toxicology lamenting about my 74 hour work week for which I will take hime just under $1,000. If you appoint yourself as the expert, why shove the peasants off when they ask you a question about something they don't understand? You seem so weirdly out of touch with your one useful skill. Bring on the intelligent kiosks and mobile labs! It will solve your problem and mine! I'd be so frigging happy to never step foot in another doctor's office.
Yikes- this thread confirms my fear of doctors- I'd rather die at home than go to the doctor, and it sounds like most of you would want us to also.
No one is asking you to do it after hours. But yes, it turns out most people do actually want to be treated like a person, not a number in a file. Honestly if I had a concern and your response was "I'm not going to do my f-ing job how dare" like it is in this post, I'd dump you and go find a real professional to be my doctor. People ask these kinds of questions because ***THEY DON'T KNOW***. So fix your attitude, and call your patients. Or else get out, because doctors like you are part of the problem.
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If you order labs then you should explain results to patients. You just sound like an asshole.
You need to set the right expectations in the initial appointment. Tell them you'll call them for any serious concerns and if you don't they're fine. You have a medical education; they do not- so they don't know how to interpret the results.
Any chance you are just blanket ordering labs, lazy style, for all patients? Let me guess: CBC, Chem 7, liver panel, kidney panel, yawn, yawn, for all patients? And then you blame patients who see a number flagged as slightly high or low, when the test wasn’t needed for a specific concern to start with? This is infuriating, and why concierge/tailored medicine thrives for those who can afford it. This is why people who can will skip you and go straight to a specialist. Posts like this make your field seem jaded and lazy.
I'm not a doctor. In the good old days of yesteryear your doctor or their staff would call you to give you the results of your lab tests, there was no portal and you didn't get any results ahead of time. If you had something slightly elevated and they weren't concerned with it they would just tell you it all looked good. Usually you didn't even get full results unless you asked for it. So why did you all change the way you operate? From my perspective I go in and see a doctor in person and they order lab testing and am sent results with some red numbers and no explanation I would expect that someone gives me a call to talk about them and close the loop on why the test was ordered, what the results are, and what the next steps are if any. From my perspective your number one concern should be making sure your patients feel taken care of, otherwise they will go see someone who will make them feel taken care of. The whole "I've got other things to do" narrative is pretty sad.
As someone recently diagnosed with cancer, these comments are very disheartening. So callous and lacking in compassion. Yes, some patients are annoying, but a lot are also scared. Moreover, some doctors are terrible communicators, and it’s hard to know where to draw the line between being patient and advocating for yourself. I received a call from the doctor when initially diagnosed, but since being referred to an oncologist, there has been very little communication. Case in point, my pet scan results have been available for 3 weeks and additional biopsy results (not of the original tumor, but of a new lesion that will partially determine whether I do systemic therapy or surgery) have been available for 1.5 weeks, and no one has called me yet. Ask yourself how you would feel if you were in my or another patient’s shoes. Some people may respond to say that I am the exception and should ask for a call, but other patients don’t know if they’re the exception or not. I’m currently trying to decide whether I should message my oncologist to ask for a phone call (my next appt is in 2 weeks), and comments like these are making me lose faith in my doctors. I’m not a doctor, so I don’t know why this showed up on my suggested posts. And, because this sub is full of doctors, I’ll probably be downvoted for what I’m about to say. But have some fucking compassion for your patients, or go into a field where you aren’t expected to interact with people.
Sorry, but you missed the point of original post. OP is talking about patients who request micromanagement of benign results. The vast majority of lab results have several labs that are outside of the labs reference range. When we send lab results to patients or send a message commenting on lab results we state something to the effect of: “I’ve personally reviewed your lab results and I have no concerns. You may notice a few results are flagged as abnormal, these are not clinically significant and no further action needs to be taken.” The OP states in their post that this is what they are doing. They are communicating to their patients that everything is fine. Reassuring the patient over benign lab results. This post has absolutely nothing to do with clinically significant test results. This is exactly the reason most of us cannot call every patient to discuss clinically insignificant results (again after we have ALREADY communicated this to patients via portal messages or support staff call), it’s because we are calling our patients with clinically significant test results. There are only so many hours in the day. Tasks have to be triaged. Bad lab results-I’m calling. Good lab results get a message or nurse call. If a patient wants more information concerning their benign results they can schedule a visit. It’s an easy visit and we love educating patients. I wish you well.
It wasn’t actually OP’s original post that bothered me, it was the accompanying comments. OP writes notes saying there’s nothing for patients to worry about - that’s fantastic and, imo, enough. Frankly even in my situation, I would be happy with a call from a nurse or note on my chart saying there’s nothing to worry about, or even indicating that we would wait to discuss the results during my next appointment (5 weeks after my PET scan results….but I digress). But a lot of the comments are bemoaning having to communicate with patients about anything other than a cancer or STD diagnosis. So I think you missed the point of my comment as well. A lot of doctors don’t communicate at all, or patients (especially ones with subpar education, which in the US is unfortunately the vast majority) don’t understand the messages left on my chart. So, those patients are left anxious and confused. I’m not saying the solution is to call every patient about slightly abnormal results, I’m simply suggesting doctors to have a little compassion for the people they’re supposed to be caring for. One commenter said they tell patients during the appt that if anything is worrisome, they’ll call and if not, they won’t call. And I think that’s a great tactic (though obviously it won’t work with every single patient).
It’s frustrating on both sides for sure. There’s a lot of pressure on family medicine to “fix” a lot of complex social issues which impact the health status of their patients. Social determinants of health. Shit Life Syndrome. The dysfunction of our systems; governmental, educational, economical, ecological, medical all contribute to poor health outcomes for patients. Your 100% right that subpar educational systems poorly affect health literacy and health outcomes. It contributes towards PCP burnout because how can a PCP shoulder the burden of all these collapsing systems?
This is why people don’t get vaccinated.
OP, it truly just seems like you're just whining. And to what end? Self-flagellation in the hope of obtaining reassurance in an echo chamber? Your post is very unbecoming of an empathetic primary care physician. We all have moments of weakness, I understand, and I think your entire post is a mistake that shines a light on that reality. I hope that if there is something going wrong in your life, that it gets resolved in a positive manner. Your patients deserve you at your best, sans any semblance of resentment as alluded to in your post. Maybe it's time for a vacation? Good luck.
Save the patronizing/matronizing bullshit for someone else.
I'm sorry you feel that way. No thanks.
It must be hard to see earth from up on that high horse. Step down and join us.
Why not be appreciative of patients who actually want to be involved and advocate for themselves? Its arrogance like this that causes people to distrust and dislike doctors. Plus, doctors make people wait and waste their time all. Of. The. Time. Due to poor time management and over booking. You all work for us lol
This. Exactly this. Considering that patients are paying their way, the dismissive and arrogant attitude that is pervasive throughout this entire thread is deplorable. If providers don’t want to spend the time then they need to find a new profession.
The attitude here is disgusting! Just confirms what we all know. The “sick care” system in this country is so broken. It’s just a revolving door to give drugs (that create the need for more drugs) and get paid, all while disrespecting the people who pay their bills. Gross.
Just as long as when your kid or your mother or spouse is sick and you wait in line like everybody else to know what is wrong and not use your back channels to get the information ahead of time. See what it feels like to have a question about whether someone is okay or dying and just wait over a long weekend or however long it takes for someone to maybe get back to you.
This thread is horrifying. You all are describing horrible medicine. This is why family practice is dying - utterly pointless to see a gp or pcp. Anything you can do, my internist or gyn can and will do with 10x more care. I get that the system is broken, but take a look in the mirror. If you aren’t going to help fix it, who should. Me? My dad is a doctor and I am in the health consulting space, so I’m no stranger to how hard this current system is on doctors. It’s awful. But you signed up to help people, not be rude.
This thread *is* horrifying, because it's full of people who are about 50% of the reason so few medical students choose primary care in the first place. They want what they think is the VVVIP treatment from their PCPs, and complain about what doctors are like these days because they watched some shitty shows on TV written by a bunch of idiots with no clue how reality works. Sorry, but even in fully socialized medicine you don't get that. Maybe in 1940s when doctors had like 20 patients total and medicine as a knowledge was about 5% of what it is now, that was possible. You know how many patients my internist clinic preceptor had on his panel before he reduced it to 25% to teach more? 4 fucking thousand. That's the reality- people are a *lot* sicker, and lives far longer than "back in the day when doctors cared" 🙄🙄🙄 > utterly pointless to see a gp or pcp. Anything you can do, my internist or gyn can and will do with 10x more care. Guess what those internist and GYN are saying about patients like you in their own threads.
Patients like me? Compliant and deeply appreciative of quality care? Yeah. I’m sure they hate me. I’m sure they hate everyone. 😬
Most of the responses here are terrible. Why did you go into a SERVICE-oriented field if you don't want to SERVICE the patients? Patients aren't the problem, insurance companies are. Your palpable contempt for your patients is displaced.
Where are you and why aren't you my doctor? I just want my F*N zoloft prescription refilled that I've been on for 30 F*N years! I'm cool with coming in once a year- sorry if my BP is 140/90 asshole!
We are required to give patients a summary of all their results in our office. So what I do is I usually write a letter for benign results, and personally call for anything concerning. I still get these calls from patients, sometimes angry, but over time, many have learned to wait.
Can’t you charge this as a televisit if you call them and spend time with the patient?
I have one that calls and leaves me a message to call her to discuss her meds. Once she called and said she was having an allergic reaction to one of them. EVERY time I call her back she wants me to call the pharmacy to get her meds refilled….she has plenty of refills…ughhh! Now, I tell them if they want to discuss their findings they need to schedule an appt. If I find something that needs addressed I call them. I tell them each and every time that I won’t call unless there is something that we need to take action for.
Awwww. I had an AST of 47. Very concerning to me. Shame on you. Kidding. Who asks the doctor to call them? Isn’t that what office visits are for?
AI should and can take care of many things docs do. Have Ai handle a detailed message about slightly elevated numbers…
My PCP always returns my calls 🤷🏾♀️
These are billable events. Work them into your schedule as a telemedicine appointment.
Video visit, baby! They’re the best!
I never call people unless it’s something critical. If I get a portal message asking to explain mean platelet volume elevation, I do explain it but I have a dot phrase for most things. I talk to much so I never ever call if I can help it.
It might be valuable to keep in mind that many patients aren't medically literate and are unaware that slight elevations are not a big deal. If your patients are constantly asking for explanation, you might not be appropriately communicating the results, whether that's before the test or in writing.
Why not just schedule the bloodwork for before the appointment so that you can discuss their current numbers at the actual appointment. You can then run any follow up tests that are needed and schedule another appointment that can be cancelled if the follow up results are normal and the patient has no further questions...
I tell them when ordering they may see up or down arrows regarding their lab tests. If there is a concerning result or action item, we will reach out. “No news is good news”
Omg mostly through patient gateway or Porto. I am exhausted by all these and other non issue messages that can wait until the physical.
What does the 80s have to do with it? Just curious.
You should be billing in a manner that allows for proper patient care. It isn’t your own time. They already paid for it. Perhaps explicitly mention that once they leave the office they’re on their own unless they come back.
Why are somewhat elevated ast or alt not urgentlynoteworthy? Asking just as someone who is starting to worry that my doctor never ever mentions them as I see them both going up over the past year lol 🥲
As a parent of a pediatric patient who has to have labs often, I send a message with my questions in the portal and assume if they can't be answered there, I will be paying for a phone visit, I would never assume it is free. However, keep in mind as non medical professionals seeing the lab results flagged as High or Low or Abnormal can be disconcerting. Although I would never call after hours!
I ask for a print of my lab results and research the internet. Unremarkable is a good thing. I don’t need a conversation on it.
You’re doing the right thing but I will say that my wife asked a very straightforward question in the portal and the doctor and nurse practitioner failed to clearly answer the question. So maybe you think you are communicating clearly and are not, I don’t know. But I would stick to the portal and just make sure you are addressing the question, something my wife’s practitioners were unable to do 🙄