Waiting for the call back is hell: doctors’ offices need to improve their communication strategies

Here’s the deal, doctor. You called me. I didn’t call you. More precisely, one of your employees called me. Here’s the message he left on my voice mail.

“We just got the results of your blood work and would like to talk to you about it. Nothing life threatening, but please call us back.”

The distance between “everything is normal” and “nothing life threatening” is several hundred acres, all filled with prairie grass swaying in the wind. Swish, swish. Swish, swish.

I did call you back, just as soon as I got out of class, but there was no one at the other end. Just voice mail. I called three or four times, and every time it was voice mail. I knew in my heart that I wouldn’t hear from you again until after 4:30 when you stopped seeing patients and things calmed down.

You’re busy. I know that. I also know that I’ve gotten bad news and good news after a morning phone call like this one. But, usually, when you call me and actually want to talk to me, it isn’t good news.

So, I got on your portal and printed off all the results of the blood work to scour it for myself. Everything looked normal except for the “GFR,” which I discovered is the “glomerular filtration rate.” My result, your report informed me, was that I had Stage II CKD (chronic kidney disease).

That didn’t make sense to me, so I did some research on GFR and bladder cancer. The only thing I’ve ever had wrong with my urological system is bladder cancer, so I went straight to Medline.

Please don’t use that patronizing voice of yours and tell me to stay off Dr. Google. I’m sitting at a universiy, logged in to my university library. I went straight to the research. And this is what I found in the Journal of Urologic Oncology, published in May 2014: “Impaired glomerular filtration rate is a significant predictor for non-muscle-invasive bladder cancer recurrence and progression.”

I am not a scientist. I am a smart woman who has read lots and lots of these research reports, I have taken them to my urologist for translation and sometimes have sent them to a research biologist for translation, too. And, on top of all that, I’m a “survivor” of bladder cancer. I read this research inside a cloud of fear, hoping I won’t see my test results in a table labeled “Recurrence Predictors” or see my name in the statistics.

I wasn’t even entirely sure if you, as a GP, understood the implications of these results. I still don’t know what Stage II CKD really is. All I knew at that moment was that I needed to talk with you and then I needed to make an appointment with my urologist.

And then, do you know what happened?

Nothing. Nothing at all.

By noon I had exhausted all my options. I had called your office, pulled up research, debated whether I should call the urologist immediately, knowing that he wouldn’t call me back promptly either.

I had reports to write, meetings to attend and another class to teach. It was business as usual, no matter what my blood work said. I shut my office door, took a few moments to cry, did a meditation practice, and then tried to get back to work.

Every where I went I clutched my phone, hoping that you’d call, but not really knowing what I’d do if you did. Do I leave in the middle of class to talk with you?

I reminded myself to not catastrophize, to realize it wasn’t black and white, to breathe. I distracted myself with work and tried to focus everything on the papers I had to read and the lessons I had to plan.

As I walked out the door to go home, a nurse finally called asking me why I’d left so many messages. I was very confused and told her I was returning the office’s call. Another nurse came on and I walked her through the blood work that concerned me, which was weird because I wasn’t concerned about anything until YOU called me.

She finally brought everything into focus, telling me that the GFR was meaningless on its own and was only relevant in light of the Creatinine numbers, which were normal. Everything was normal.

“Do I have Stage II CKD?” I asked her.

“You would only have Stage II CKD if you had other abnormal numbers,” she answered. “But your numbers are all normal.”

After we hung up, I went back to listen to the voice mail again. Maybe I just heard it wrong. Maybe your medical assistant had left a message that everything was normal. But, no. He told me nothing was life threatening and that I should call back, albeit in a cheerful tone.

That’s just bad communication. You don’t need a patient with normal test results to call you back and you should never tell me that my results aren’t “life threatening” when they’re normal. Surely you can see that the implications there are negative.

I don’t work inside your office, and I have no insights into how you can fix the communication problems that plague every single doctors’ office with which I engage.

But I can tell you that you stole my peace of mind. You set off alarm bells, got the hazard lights blinking, got my attention, and then left me alone.

It’s not your fault that when alarm bells go off I overreact to them. I know that’s on me. But parts of me are still responding to them. I’m still seeing the lights flashing in my peripheral vision.

The hardest part of cancer for me is finding a sense of safety again. Believing that how I feel is indicative of how healthy I am. Cancer taught me that tests know better than I do and that everything can seem fine and not be fine at all.

I’m still reeling a little bit. I’m meditating more, but I’m also increasing my anxiety meds because I’ve had two panic attacks since Monday. My head knows that all is well, but my body is misbehaving.

And, it’s all because of your phone call, your stupid, unnecessary, and a little bit glib, phone call.

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Filed under: Doctors, Uncategorized

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