Phone triage leaves too much room for error

Phone triage leaves too much room for error
Phone triage leaves too much room for error

 Early one Saturday morning, I received a text message from the answering service about a patient who was having some mild anxiety since decreasing her estrogen and wanted to discuss these side effects. The final line of the message was “patient has not been seen by doctor in over a year.”

I did not call this patient back. Instead I let the answering service know that she would need to call during regular office hours to schedule an appointment to discuss her issues.

These types of calls are becoming more and more common. Patients want to be triaged, diagnosed, and treated over the phone. While this happens frequently after hours and on weekends, our office is fielding more calls from patients who decline to make an appointment but still want to be evaluated and managed via the telephone.

I do believe there is a time and a place for telephone triage. A good phone triage system can reduce unnecessary office and emergency department visits for low risk patients with minor symptoms. However it cannot replace the in-person care from a medical practitioner.

I have many patients who prefer to diagnose themselves and call in to request medication for their self-diagnosed ailment. I will even have patients who offer to text or email photos of a rash or discharge in order to be treated without an office visit.

The problem here lies in that so many problems have overlapping symptoms. For example, vaginal itching and discharge could be symptoms of Candidal vulvovaginitis or bacterial vaginosis — both vaginal infections, but each requiring different treatments.  

From a business standpoint, there is no way to bill for time spent doing telephone triage for complex issues. Provider time is more effectively spent seeing patients for visits in the office, rather than implementing management plans and treatment over the phone.

For all except the most basic and straightforward complaints, I prefer to see patients in person, rather than triage and treat via the telephone — there is too much room for error, and it does not allow a provider to assess the patient as whole.

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.

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