The Fine Art of Medical Messages

I already used the title The Art of the Message in 2018, but I have more to say on this topic, which is a big and often frustrating one in primary care.

In that post, I gave the example of a call with a blood pressure reading without any explanation or reminder why I had wanted that information. Even worse is a weight in a heart failure patient. I don’t care how much they weigh, just whether they lost or gained weight, and how much, so I can dose their fluid pill. Don’t expect me to remember or find their last weight on the fly.

Equally frustrating is the patient who has an infection and asks for an antibiotic. If someone is of the belief that azithromycin never works for their respiratory infection, I wish they would include that in their message, so I don’t have to cancel my prescription for that exact medication and send in something else. And even when patients think they’re helpful by saying the last time they were sick, my prescription was a miracle, they’re not making it much easier for me if they don’t also reveal that that was five years and two EMRs ago. Such details could save me countless minutes of research.

I have heard managers saying that the people who take messages don’t have enough medical training to ask such questions. I disagree. They are just too often discouraged from using common sense.

I seldom trust a message with just a diagnosis, like “I have a sinus infection”. That one requires details like how long, how severe the symptoms are and so on. And “I have a urinary tract infection” often means that the patient has low back pain without urinary symptoms but assumes that their urine is the culprit.

And, turning my attention to poor Autumn, my nurse for many years, she toiled under an unreasonable number of phone messages. Of the 40-50 voicemails she got every day, too many were just “please call me back”, sometimes even without saying who the caller was, counting on her recognizing their voice. Her desk phone did not display the caller’s number, so she then had to rely on her small town memory of the locals. Once in a while, she would have me listen to see if I could figure out who had called and left a message.

And in recent years we’ve had another scourge: patient portal messages, sometimes hundreds of words “so you’ll know before our next visit”. Gee thanks, since doctors in general have no time set aside for inbox management. I definitely prefer having a commonsensical screening of messages to open access to my inbox or “please call” voicemails for poor Autumn.