Telephone Personality

In addition to words, many nonverbal cues are given in the quality of a medical assistant’s voice on the telephone. The “telephone personality” is important. It is important to stay focused on the call and smile. The medical assistant should use the same volume as when speaking in person and speak naturally. An artificial telephone voice may be perceived as cold and “fake.”

All words should be spoken clearly so that they are easy to understand. Enunciation is the act of speaking so that the message can be easily understood. It may be necessary to speak a little more slowly on the telephone, and it is very important to avoid mumbling. It may be helpful for a medical assistant to record a telephone greeting and analyze the quality of his or her voice and the personality that is projected.

Qualities such as interest, friendliness, concern, and understanding are clearly communicated over the telephone. So too are boredom, anxiety, and indifference.

Effective Telephone Communication

When speaking on the telephone, the medical assistant should try to complete the call without interruption. If it is necessary to put someone on hold, the medical assistant should give a reason and apologize to the caller when the call is resumed. Information and materials should be readily available to handle calls and take messages. These include message slips, a pen, the office appointment book or computer appointment screen, and a list of frequently used telephone numbers. A desk clock, computer clock, or wristwatch should be visible to note the time when taking messages.

The medical assistant begins the conversation by identifying the practice—for example, “Primary Care Associates, Channa speaking.” If the caller asks a question or asks for a staff member without identifying himself or herself, the medical assistant asks politely for the caller’s name: “With whom am I speaking?” or “May I ask who is calling?” Using complete sentences is important because the medical assistant does not want to sound abrupt or rude.

The medical assistant should sit with the back supported and the head in a neutral position (not forward or to one side). The feet should be flat on the floor or supported on a foot stool. Figure 39-1 shows proper body position for answering the telephone. If the receiver is tucked between the head and shoulder, it places strain on the shoulder muscles and may change the voice quality, so this should be avoided. A headset, which consists of an earpiece that fits over the ear and a mouthpiece in front of the mouth, allows for good body posture and leaves the hands free. This is recommended if the medical assistant spends a lot of time on the telephone. Figure 39-2 shows such a headset.

The medical assistant should be clear with callers who leave messages about when they can expect their calls to be returned. Many physicians have specific times when they return nonurgent telephone calls, such as late morning, lunch time, or the end of the day.

One should avoid cutting into a person’s replies, even if he or she rambles on and repeats information. When the medical assistant gets the chance to speak, he or she should try to give a focused answer that lets the caller know what can be done and what the medical assistant is going to do.

Multiline Phones

Most offices have a multiline phone, with several extensions. It is important for the medical assistant to learn how to determine which line is ringing, how to place calls on hold, and how to transfer calls to all parts of the medical office. Figure 39-3 illustrates a multiline telephone with many extensions.

A flashing light usually identifies a line that is ringing; it flashes at a different rate on a line where a person is on hold. The medical assistant answers a call by pressing the button on the telephone that corresponds to the line that is ringing. If a second call comes in while the medical assistant is speaking to a caller, the medical assistant should tell the first caller that he or she needs to place the caller on hold, then he or she presses the hold button. The medical assistant answers the second call, identifies the caller, and usually places that caller on hold before returning to the first caller and apologizing for the interruption. The calls are then handled in order.

If the caller asks to be connected to another extension or person, the medical assistant should first obtain the caller’s name. To transfer a call, the medical assistant may need to press another button and/or dial an extension number, depending on the type of telephone system. Knowing the caller’s name allows the medical assistant to announce the caller when the call is connected, and it is also helpful if the call is disconnected for some reason.

While a caller is on hold, the light on that line will flash. If the light continues to flash, the medical assistant should pick up that line about every 30 seconds and ask if the person would like to continue holding or leave a message. Sometimes transfers do not go through or the call is not picked up.

Answering Machines and Voicemail

Physicians have always needed to be available at all times. Most physicians’ offices still use an answering service for getting messages to physicians during hours when the office is normally closed. This is an independent company that answers telephones for a number of clients. Some offices also have an answering machine or voicemail system, which has a message with a number to call outside of office hours and gives people the option to leave a nonurgent message. Voicemail is a method for message delivery, storage, and retrieval that is built into the telephone system. It is usually attached to each individual extension. Answering services and answering machines are activated whenever the office is closed, including during lunch break if no one is assigned to take phone calls during that time. The answering service should be notified if the office is closed, although they usually pick up phones after a predetermined number of rings.

Increasingly, physicians’ offices are going to voicemail systems. Voicemail is a system provided by the office’s telephone carrier that allows for messages to be left in a number of “mailboxes” for different people. Each physician might have his or her own voicemail box, as well as each medical assistant, the business manager, and so on.

The message will have a number to call for urgent messages outside of office hours but will also offer the caller the option of leaving a message in any voicemail box. Each box has a two- to four-number extension. Many voicemail systems have a directory by which people can find voicemail box numbers by using their touch-tone phone to type in some or all of the letters of the last name of the person with whom they would like to speak.

Even if an office has a voicemail system, most medical offices will still need to have a contract with an answering service. The answering service provides a medical office with coverage outside of normal business hours. The service either answers all of the office’s telephone calls or takes calls that are forwarded to it by individuals who listen to the voicemail system message and press the appropriate message code for an urgent message. The answering service must be informed how to deal with urgent calls.

Putting It All into Practice

My name is Channa Eng, and I am a certified medical assistant. I work for an internal medical practice with two physicians and two nurse practitioners in an urban area. We have many Asian and Hispanic patients. I don’t speak much Spanish, but I do speak Cambodian and some Vietnamese. Another medical assistant speaks Spanish, and we both help with translating telephone calls from patients who have difficulty in English. When patients call our office, they get three choices right away. They can hear the message in English, Spanish, or Cambodian. Most patients like this because they can hear the instructions in a language they are comfortable with. On Tuesdays and Thursdays, I spend most of the day on the telephone making appointments and responding to patients with medical problems. I don’t usually sit at the front desk. Instead, we have a telephone room with three telephones. When it is very busy, there are usually two of us. I can tell if a patient wants a routine appointment or has medical questions depending on which line the call comes in on. When patients are sick, I have to ask a lot of questions to find out how urgent their problem is. Last year I worked with the office manager to revise our procedure manual, so I am very familiar with what questions to ask. My goal is to handle each call as quickly and efficiently as possible while still making the patients feel that their needs were met. Every time I take a message, I put it on the corner of my desk, and a file clerk takes it to get the patient’s medical record. In our office we think that telephone conversations are very important. We try very hard to answer all telephone calls promptly and to avoid putting patients on hold. 

Cell Phones and Smartphones

Cell phones allow two individuals to speak to each other as they would using regular telephones, but the cell phone uses radio signals instead of telephone wires. A smartphone is a device that adds computer capabilities to the cell phone, with a drug reference, address book, and other tools; an Internet connection; the ability to send and receive e-mails; and sometimes even access to the electronic medical record system used by the health care facility. This type of handheld computer was formerly called a personal digital assistant (PDA), but today almost all PDAs are smartphones. Many physicians use cell phones or smartphones to remain in contact with the medical office when they are in other locations. The physicians’ cell phone numbers should never be given to patients, but they should be available to office staff so that physicians can be contacted as needed.

Pagers

Pagers are used in areas with unreliable cell phone service and sometimes in large institutions such as hospitals. A pager (also called a beeper) is like a radio that is always tuned in to a single station. When it “hears” its unique access code signal, it lights up, beeps, or vibrates to indicate that a message is being received. Some pagers are also linked to voicemail. Pagers used by physicians or other health professionals are either numeric or alphanumeric. A numeric pager’s message is a telephone number (e.g., the answering service, the office, the emergency department, home, a colleague). The physician then returns the call to the number on the display. An alphanumeric pager displays an entire message, so the physician can return a phone call or act on the information that is relayed to the pager. Some pagers also include e-mail so that a return message can be sent. If the physicians use pagers, the office staff should have the pager numbers for each physician in the practice.

A simple type of pager may also be used for patients in ambulatory care areas of hospitals or clinics. It is similar to pagers used in restaurants and lights up and/or vibrates to notify patients when it is their turn. Patients can leave the waiting area and be notified when to return. This type of pager provides patient confidentiality because it eliminates the need to call the patient by name.

Centralized or Electronic Routing

Many offices use an electronic routing system to direct calls. At each extension, the telephone may be answered or the call will go to voicemail, and the caller can leave a message for office staff members who are not available. By offering the caller several options (e.g., scheduling an appointment, speaking with the medical assistant, discussing a billing question), the electronic routing system directs the call to the appropriate part of the office, saving the expense of a staff person who would otherwise be answering the call. It also keeps patients from being put on hold, which some people appreciate.

However, other patients find electronic routing of messages confusing and frustrating, especially if the person they need to speak with is not available and does not return calls promptly.

If electronic routing is used, the message should be kept up to date and should be as clear and concise as possible.

In other offices, incoming calls are answered directly by the medical assistant. Although the personal touch is appreciated by many patients, when several calls come in at the same time, some callers end up on hold. If the office has several staff members, many of the calls end up being transferred anyway.

Managing Incoming Calls

Performing Telephone Screening

The first step in handling telephone calls is to find out how urgent the call is and what is necessary to handle the call.

Most calls are routine and can be taken in the order in which they come. In most cases a new call is placed on hold while the previous call is handled. However, there are some exceptions:

• Calls from other physicians are put through at once.

• Emergency calls are treated as urgent and receive top priority. They will be discussed in detail later in this chapter.

• If the caller is a relative of the physician, the medical assistant either puts the caller through or speaks to the physician via intercom to determine how to handle the call.

When answering calls, it is polite to obtain the caller’s name and ask permission to place the caller on hold. This gives the caller the opportunity to identify the call as urgent.

After the caller’s name has been obtained, the caller usually states the reason for the call or asks for a staff member or department. When the caller asks for a staff member by name, the medical assistant usually transfers the call. If that staff member is with a patient, the medical assistant may offer to take a message or transfer the call to voicemail. Often the caller asks for the physician. Most physicians do not take calls while they are seeing patients. Additional questions may show that the medical assistant can handle the call, or it may be necessary to take a message for the physician (Procedure 39-1).

 Procedure 39-1   Performing Telephone Screening

Outcome

Screen incoming telephone calls.

Equipment/Supplies

• Telephone

• Message pad

• Pen or pencil

• Appointment book or computer terminal

• Clock or watch

1. Procedural Step. Answer every telephone call within the first three rings.

    Principle. Callers become annoyed when their calls are not answered promptly.

2. Procedural Step. Identify the medical office and give your name. Each practice will have a preferred way for all employees to answer the telephone. Example: “Primary Care Associates, this is Channa speaking.” Do not rush through the greeting. The caller needs to hear this first sentence clearly.

    Principle. Callers need to know what business they have reached and with whom they are speaking. Otherwise they will have to ask if this is Primary Care Associates.

3. Procedural Step. Listen carefully to what the caller says, and decide as soon as possible whether this is a call you can handle, whether you need to take a message, or whether the call should be transferred to someone else in the office.

    Principle. The caller does not want to have to repeat all the details if the call must be transferred. If you need to take a message, begin writing.

4. Procedural Step. Ask for the caller’s name. “May I ask who is calling?”

    Principle. You will need the caller’s name to address the caller by name, to take a message, or to identify the caller before transferring the call.

5. Procedural Step. If you can handle the call, such as a call for an appointment, do so promptly.

6. Procedural Step. If you need to take a message, see Procedure 39-2, Taking a Telephone Message.

7. Procedural Step. If you need to transfer the call to someone else in the office, place the caller on hold, noting the caller’s name and the extension. Tell the person you are transferring the call to who is calling and what extension the call is on.

    Principle. It is a courtesy to tell the person you transfer a call to who is calling; he or she must be able to locate the call if more than one line has a call on hold.

8. Procedural Step. If the caller describes symptoms that require immediate care, ask questions to assess the problem, following guidelines in the office procedure manual. If there is a physician or other licensed professional in the office, transfer the call immediately. Otherwise, assess the urgency of the problem and follow up according to office guidelines. If the patient’s health is at risk, instruct the caller to call 911.

    Principle. Patients expect correct medical advice from a health care facility when they have urgent medical problems.

9. Procedural Step. If your telephone has more than two lines, it is helpful to keep a list of the names of callers and extensions. When a call is on hold, the light for that telephone line blinks. If you have transferred a call but the call remains on hold, within 30 to 45 seconds you should determine if the caller is still holding; if so, you should try to transfer the call again or take a message.

    Principle. Sometimes a transfer does not go through or the call is not picked up. The caller has no way to get back in contact with you to leave a message or ask to speak to someone else.

10. Procedural Step. If the telephone rings for another call, ask if you may put the caller you are speaking to on hold and wait for the caller to agree. After pressing the hold button, answer the other call and explain that you are speaking to a caller on another line. Give the second caller the option to hold and wait for you or take their number and offer to call back as soon as you are finished.

    Principle. In general calls are handled in the order they are received. By asking for permission to put the caller on hold, you give the caller a chance to tell you if it is an emergency. Some callers prefer to hold; others prefer to be called back. Time passes slowly when a caller is on hold, and the caller may become tired of waiting and wish to leave a message.

11. Procedural Step. At the end of the call, repeat any information you have discussed (such as the date and time of an appointment). End the call politely by thanking the caller (if appropriate) and saying goodbye.

    Principle. Confirmation helps avoid misunderstandings. Thanking the caller and closing the conversation demonstrates telephone courtesy.

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