What is the first thing the medical assistant should do when answering a telephone call?

Although great emphasis is placed on rules for speaking, the importance of active listening often is overlooked. The same attention should be given to a telephone conversation that would be given to a face-to-face conversation (Box 9-1). Concentration is not always easy for a medical assistant who is juggling several duties at once in the medical office; therefore, he or she must practice focusing on the call at hand. Effective active listening also provides vital information about the nature of the call—whether the caller is distressed, agitated, or has a concern that must be addressed immediately. Review listening skills in Chapter 5.

Individuals who call a physician’s office should be greeted by a pleasant, friendly voice. A common sales technique is to make sure the caller “hears a smile.” Customer service is critical in today’s medical offices, and this technique is quite useful for medical assistants, because they are likely to be the caller’s first point of contact with the practice. Be sure to enunciate clearly, pronouncing each word separately and distinctly. Diction, pitch, and clarity also are important. Avoid speaking in a monotone; instead, use inflection, or a change in the pitch and loudness of the voice. This helps the speaker emphasize certain points during the conversation.

When a telephone call is received from a stranger, one usually tries to visualize that person’s appearance and perhaps forms an opinion of the individual’s personality. The caller may sound mature, somewhat worried, well educated, or frantic. Because communication is a two-way street, the caller also forms an impression of the person answering the phone. Sometimes these impressions are incorrect, but much can be inferred from what is heard on the telephone.

The tone of voice used by the medical assistant and other medical staff members plays a role in the patient’s attitude. A study by Harvard University claims that the tone of voice used by surgeons is directly linked to medical professional liability claims. How something is said to a patient is just as important as what is said. Always use a friendly, warm tone of voice and project confidence when speaking with patients. Be courteous and tactful and choose your words carefully. Every caller should be made to feel that the medical assistant has time to attend to his or her needs. If the medical assistant is rushed to pick up the telephone, he or she should wait a few seconds until able to answer graciously without seeming breathless or impatient.

Be alert and interested in the person calling. Always give your full attention to the caller, and do not allow distractions to interfere with the conversation. Build a pleasant, friendly image for the office. Talk naturally and avoid repetition of mechanical words or phrases, such as “uh-huh” and “you know.” Do not use professional jargon, such as referring to otalgia when the patient reports an earache. Using correct grammar adds to a favorable impression. Speak distinctly; clear pronunciation and enunciation are vital. Move the lips, tongue, and jaw freely. Talk directly into the mouthpiece. Never answer the telephone while eating, drinking, or chewing gum. A well-modulated voice carries best. Use a normal tone of voice, neither too loud nor too soft. Talk at a moderate rate, neither too quickly nor too slowly. Be expressive, and vary the tone of voice. This brings out the meaning of sentences and adds color and vitality to what is said.

9-1

Critical Thinking Application

Ashlynn has a tendency to speak a little fast in her normal conversations. How will she need to adjust as she is answering phones in the medical office? She also is a friendly person and enjoys talking on the phone. What precautions should she take so that this does not become an issue on the job?

A medical assistant must develop professional telephone habits and correct the more casual ones that are used at home. The handset should be placed so that the medical assistant’s voice is relayed distinctly and accurately. Practice holding the handset around the middle, with the mouthpiece approximately 1 inch from the lips and directly in front of the teeth (Figure 9-2). Never hold it under the chin. Check the proper distance by taking the first two fingers and passing them sideways through the space between the lips and the mouthpiece. If the fingers just squeeze through, the lips are the correct distance from the telephone and the voice will go over the line in as close to its natural tone as possible. When using a headset, speak directly into its mouthpiece, positioning it the same distance from the mouth as a telephone handset.

Speak directly into the telephone immediately after removing it from its cradle. When turning to face another part of the room, make sure the handset moves, too; otherwise, the voice will be lost. A medical assistant who speaks too quickly, enunciates poorly, or fails to speak directly into the transmitter may not be easily understood by the person on the other end of the line.

Keep in mind that all communications in a healthcare facility are confidential. If others are nearby, use discretion when mentioning the name of the caller. Be careful about being overheard when repeating any symptoms or other information received by telephone. Never use a speaker phone to listen to voice mail or hold a phone conversation within the hearing range of others. Do not place patients on speaker phone at any time. Another individual may hear private medical information, which is a violation of regulations established by the Health Insurance Portability and Accountability Act (HIPAA).

9-2

Critical Thinking Application

Ashlynn hears an employee speaking on the intercom to a patient. How should she handle this situation? To whom, if anyone, should Ashlynn report this activity and why? What problems might be caused if this type of conversation is overheard?

Each employee must be courteous on the phone since it is the lifeline of the office. The medical assistant’s phone manner sets the tone for the caller’s perception of the entire practice. Patients expect good customer service, and because they can decide who their providers are, courtesy must be a part of every patient encounter. Additionally, if patients are happy with the experience they had, they may refer others to the physician’s office.

Always think ahead when an important call must be made. Have the patient’s chart or the bill in question at hand before dialing the phone and a pen and pad nearby ready to take notes. Write down a list of questions to ask or goals for the conversation. Keep the call short and simple, then free the line for other calls.

Most offices keep a list of frequently called phone numbers both for staff use and to offer to patients. A list of local pharmacies, hospitals, and their departments is helpful. All of these are time-savers that help the medical assistant better serve patients.

Whenever possible, answer the telephone on the first ring and always by the third ring. If the facility has several incoming lines or more than one telephone, a conversation sometimes must be interrupted to answer another call. It is courteous to say, “Excuse me just a moment; the other line is ringing.” Answer the second call and determine who is calling. If it is not an emergency, ask that person to hold while the first call is completed. If possible, get the phone number of the second caller, but do not allow that request to turn into a lengthy conversation. Do not make the mistake of continuing with the second call while the first caller waits. Return to the first call as soon as possible and apologize briefly for the interruption. Think of what would happen during a face-to-face conversation. A second person who approaches people involved in a conversation should not expect to interrupt and be heard at length. However, if the second call is an emergency, take a moment to return to the first line and alert the caller that he or she will have to be kept waiting or be called back.

Never answer a call by saying, “Please hold” without first finding out who is calling. The call could be an emergency, and this type of greeting is extremely discourteous. It takes only a moment to be polite. If the call is an emergency, prompt attention to it could save a life. The medical assistant must know how to activate emergency medical services (EMS) in his or her area. Usually this is as easy as calling 911; however, each medical assistant should be able to communicate quickly and efficiently with the EMS staff.

Keep the focus on the call. Do not attempt to multitask while answering the telephone, because this practice takes attention away from the patient. Callers can hear keyboard strokes and other office activity; a caller therefore might assume that the medical assistant is not giving full attention to the person on the phone. Treat the phone call just as if the patient were standing in the office (Procedure 9-1).

Procedure 9-1

Demonstrate Telephone Techniques

GOAL: To answer the telephone in a physician’s office in a professional manner and respond to a request for action.

The medical assistant should identify the facility first, then state his or her name. Numerous telephone greetings can be used. Discuss which are best with the physician or office manager. Some physicians prefer a very formal statement when answering the phone, whereas others allow a more casual script. Always follow the procedure outlined in the policy manual. Examples of telephone greetings include:

Some physicians avoid using the title “Doctor” to protect their patient’s confidentiality. For instance, if a physician needs to call a work number and leave a message for a patient, curious co-workers might attempt to investigate what type of physician is being seen. Dropping the “Doctor” when leaving messages and when answering the telephone can be an effective means of protecting a patient’s privacy. However, merely saying “Hello” is unsatisfactory; the name of the facility should always be mentioned to callers. Otherwise, the caller invariably asks if he or she has reached the physician’s office, which wastes time, and the opportunity to create a favorable impression of the facility has been lost.

The use of a salutation in telephone identification is optional. Sometimes adding “Good morning” or “Good afternoon” to the identification is awkward. A rising inflection or a questioning tone of voice indicates interest and a willingness to assist and eliminates the need for an additional greeting. When the type of greeting has been chosen, practice until it can be said easily and smoothly. Never rush, so that all callers can clearly understand exactly what is said.

9-3

Critical Thinking Application

Most offices dictate how the phone is to be answered. What should Ashlynn do if she is very uncomfortable with the way she is asked to answer the phone? Who ultimately should decide how the phone is answered?

If the caller does not identify himself or herself, ask who is calling. Write the name down immediately on a pad of paper or phone message form. Repeat the caller’s name by using it in the conversation as soon as possible. Individuals like to hear their own names, and name repetition assures the patient that he or she has been identified correctly. Try to use the person’s name at least three times during the call, and remember other courteous expressions, such as “thank you,” “please,” and “you’re welcome,” as often as possible. However, if other patients are within the range of your voice, remember that the caller’s privacy must be respected.

Occasionally a caller refuses to identify himself or herself to the medical assistant and may be quite insistent on speaking with the physician. The individual could be a patient; therefore, every attempt to identify the patient and assist him or her should be made. Such callers may also be salespersons who are fully aware that if their identity is revealed, they will never get the opportunity to speak to the physician. These people may be firmly told, “Dr. Frank is busy with a patient and has asked that we take messages for her. If you will not leave a message, you may wish to write a letter to her and mark it ‘personal.’ ” This phrase usually prompts the caller to provide his or her name, and the call then can be handled according to office policy. Rarely does the caller choose to write a letter to the physician and deal with the wait time that course of action requires. If the patient agrees, the situation may be best handled with a regular appointment, during which the patient can speak privately with the physician.

Most physicians expect the medical assistant to screen all telephone calls. The physician and office manager provide guidance on the type of calls to be routed to the physician and those that he or she will return at a later time. The medical assistant should become familiar with their preferences and also use good judgment, much of which comes with experience, in deciding whether to put through a call to the physician.

If it is office policy, put calls from other physicians through at once. If the physician is busy and cannot possibly come to the telephone, explain this briefly and politely, then say that the physician will return the call as soon as possible.

Many callers ask, “Is the doctor in?” or “May I speak to the doctor?” Avoid answering with a simple “Yes” or “No” or by responding with the question, “Who is calling, please?” If the physician is not in, say so before asking the identity of the caller. Otherwise, the impression may be created that the physician is just not willing to talk with this person.

If the physician is away from the office, the rule of offering assistance still holds. The medical assistant may say, “No, I am sorry, Dr. Frank is not in. May I take a message?” or “No, I am sorry, but Dr. Frank will be at the hospital most of the morning. May I ask her to return your call after 1 o’clock?”

If the physician is in and is available for telephone calls, a typical response would be, “Yes, Dr. Frank is in; may I say who is calling, please?”

When physicians prefer to keep telephone calls to a minimum, say, “Yes, Dr. Frank is in the office, but she is not free to come to the phone. May I take a message, please?” By responding in this way, the physician is not committed to taking the call.

During the time a physician is examining a patient, he or she will not wish to be interrupted with a routine call. In such cases you might say, “Yes, Dr. Frank is in, but she is with a patient right now. May I help you?” or “Yes, Dr. Frank is in, but she is with a patient right now. Is there anything you would like me to ask her?”

Try to guard against being overprotective. A patient should be able to talk with the physician when absolutely necessary, but unless it is an emergency, the patient probably is willing to do so at the physician’s convenience. The medical assistant who answers the telephone acts as a screen, not a roadblock.

Although no one wants to sit next to a telephone waiting on a physician to call, this is the reality in most cases. In fact, physicians almost always rely on their staff to give them messages from patients and then follow up on the instructions the physician gives for each patient. Staff members should provide an approximate time frame within which the patient’s call will be returned, but they must always stress that the time is an estimate. Emergencies cannot be predicted, and it may be impossible to abide by that time frame. Always ask for the patient’s cell phone number, if available, then ask him or her to keep the phone handy for the rest of the day. Make every effort to return calls by noon for morning messages and by the time the office closes for afternoon messages. By cross-training all employees to take accurate messages and document calls, any employee can return calls, even if he or she did not take the original message.

Find out exactly how calls are to be handled when the physician is out of the office and under what circumstances he or she can be interrupted when on the premises. Cultivate a reputation for being helpful and reliable. A medical assistant can save the physician many interruptions if patients develop confidence in the medical assistant’s ability to help them and have faith in his or her promises to take messages and deliver them properly. (For more tips on handling telephone calls, visit the Evolve site at evolve.elsevier.com/kinn.)

9-4

Critical Thinking Application

Ashlynn answers the phone; the caller is a male pharmaceutical representative who has been visiting the clinic for several months. She cheerfully greets him and asks if he is calling to make an appointment. He states that he wants to make an appointment with Ashlynn—for a date. How should she handle this call? What problems could arise if this were a patient and Ashlynn were to accept the date?

When a call cannot be put through immediately, ask, “Would you prefer to wait, or should I call you back when Dr. Frank is free?” If the caller elects to wait, remember that waiting with a silent telephone can be irritating and tedious. The waiting time always seems long, no matter how brief it really is. Many of today’s phones are equipped with timers that tell the caller exactly how long they have been waiting on hold. The longer they wait, the more irritated they may become. Let no more than 1 minute pass without breaking in with some reassuring comment. For instance: “I’m sorry, Dr. Frank is still busy. Would you like to continue to hold?” or “I’m sorry to keep you waiting so long, Ms. Hughes. Would you prefer to have me return your call when Dr. Frank is free?” If the wait is longer than expected, the caller may wish to reconsider and call back at another time or have the call returned. By going back on the line at frequent intervals, the medical assistant allows the caller an opportunity to express such concerns. In any event, be considerate and remember that irritation can be lessened each time the medical assistant returns to the call by saying, “Thank you for waiting, Ms. Hughes.”

When it is necessary to leave the telephone and obtain information, ask the caller, “Will you please wait while I get the information?” Listen for a reply. If getting the information will take longer than a few seconds, give some estimate of the time required and offer to call back. When returning to the telephone, always thank the caller for waiting. Requests that might require pulling the patient’s chart from the files are best handled with a call back to the patient.

Remember that leaving a person on hold ties up one of the physician’s telephone lines, and an emergency call could be coming through or new patients might be attempting to call. Most phone calls to a physician’s office during the day are important, therefore the lines should be kept clear as much as possible.

Always ask the patient’s permission to place him or her on hold and to transfer the call. Identify the person on the phone when a call is transferred to the physician or another person in the facility. Transferring the call to a co-worker’s voice mail without warning the caller that the person is not available is considered poor customer service. Any person who refuses to give a name should not be put through unless the medical assistant has been specifically instructed to do so. If the person is not immediately available, ask the caller whether he or she would prefer to be put through to voice mail. Some callers simply believe their call will receive more attention if a human takes the message. If the caller insists, take a written message and deliver it to the proper person as soon as possible.

All medical assistants should learn “who does what” in the medical facility. Knowing about the functions of the office and which person is responsible for which areas makes a significant difference in the customer service provided to the patient. For example, suppose that the medical office employs one insurance receptionist, named Sarah, and three insurance billers. Opel handles names that begin with A through G, David handles names that begin with H through P, and Andrea handles names that begin with Q through Z. If a call comes to the office and the patient has an insurance question, the medical assistant could put the call through to Sarah. However, better customer service dictates that the medical assistant ask the name of the patient and put the call through to the person who handles that patient’s particular claims. If the patient’s name is Rebecca Whitehead, the medical assistant should call Andrea and ask if she may transfer Ms. Whitehead’s call to her. The fewer times the caller is transferred, the happier the caller.

When the caller is a patient, the physician or clinical medical assistant probably will need his or her medical record at hand during the conversation. Remember, protecting the patient’s right to privacy is vital. If others are in hearing range, take the chart to the person responsible for the call and say, “This patient is waiting on the telephone.” Because the physician’s office often is a hectic place, most require that a message be taken so that the medical record can be reviewed, the patient’s request considered, and the patient called back with questions or instructions from the doctor.

If the office uses a manual message-taking system, always have a pen or pencil in hand and a message pad nearby when answering the telephone. Several calls may be answered before an opportunity arises to relay a message or carry out a promise of action. The telephone message, whether taken through a computer system or by hand, is a vital part of competent patient care (Procedure 9-2).