Who Is Responsible For Following Up Test Results


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How does your surgery deal with any abnormal results that might come in for a patient? These might come in via the hospital via the computer/paper and at times via a telephone call from the hospital itself if immediate action is needed.

How do you communicate with your patients that they need to be seen regarding the tests or perhaps notifying them that they have a prescription to collect?

In my experience the Doctor/Nurse or often the receptionist will phone the patient and advise them to either make an appointment or come in and collect a prescription.

Does your surgery keep a record of all test taken and check that all results are back and dealt with in the appropriate way?

There had been at times when I was a Receptionist that some results for what ever reason  never come back from the hospital to the surgery.

There is always a chance on human error – and although we all know how hard we work and how good we are at our jobs that it can still happen. Sometimes A doctor might intend to ring a patient and that gets overlooked, a receptionist has a message to call a patient and that for whatever reason that does not get done, or someone could presume that someone else has done it, there could be a number of reasons why a patient might not be contacted. The hospital may have mislaid the test – sometimes the test is not labelled correctly and therefore needs to be repeated – and for whatever reason the patient does not get told about this.

These occasions are I am pleased to say very far and few between. But they could happen.

An incident similar to one of those above did happen years ago when paper copies of tests came through daily to the surgery – a patient abnormal test results were overlooked and filed away. It did cause a lot of unnecessary worry for the patient when they came back in to the surgery with the ongoing illness and of course this was not good for the surgery.

Just recently a friend of mine her young baby had a bad eye infection; the test was taken and sent off to the hospital. She didn’t hear anything from the surgery on my advise phoned the surgery to see if the results were  back – she was told twice they still were not back. No one at her surgery suggested they would follow them up. My friend was under the impression as there was no news that the tests would have been ok.

She went to see the nurse about another issue and asked about the results – which had been done some days ago by this point. This highlighted to the nurse that they didn’t have the result back so she phoned the hospital to find that the results were there and that there was an infection and antibiotics were needed. The hospital had not contacted the surgery and the results for whatever reason had not been sent out by this point (which now is done via computer link). My friend was of the opinion that if she hadn’t asked it could have gone on over the weekend before she had heard from the surgery – if at all.

In my experience as a Receptionist I would always suggest to the patient that if they had not heard with a certain timescale (depending on the test takes) to phone the surgery to check if the results were back.

Your surgery might want to try to avoid patients phoning for test results, tlephones are busy at the best of times, and I know there are quite a few tests done on a daily/weekly basis – but I think it is worth taking that extra phone call to ensure that the tests have actually come back.  Then if the patient decides not to phone – which many don’t then you as a surgery cannot be held responsible if in the event that a result is overlooked.

So, whose responsibility is it in your surgery to ensure that the patient receives the results of any abnormal results? Everyone would automatically say it’s the responsibility of the surgery. But patients sometimes need to take responsibility too.

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Telephone Call From a 4 year old


When I was a receptionist I answered the forever ringing telephone early one Monday morning.

I gave the surgery name and followed this with my own name. I was not expecting the reply I received. A young voice came over the telephone asking me “who is that”.

I gave her my name again and straight away asked for her name. She gave me her first name – Holly.  I was very friendly towards her and told her my full name and asked her full name thankfully she gave me this – I was speaking to Holly Smith.

I took a note of the name and tried to keep her attention. I asked the girl where her mummy was and she replied that her mummy was “asleep” upstairs. I asked her if there was anyone else in the house besides her mummy and herself  – she confirmed that her uncle Dave has just left and it was just her and her mummy in the house. Holly seemed to be happy and not upset.

I asked what her mummy was called – she replied “mummy”.  I asked her if her mummy had another name – she replied “yes” “Mummy Smith”.

I asked the girl how old she was and she told me she was 4 years of age. I asked her if she went to school and she told me that she always went after lunch.

I asked Holly where she lived – and she said that she lived “down the road, the house with the blue gate”.

I realised at this point I was not going to get any more information out of Holly – I asked her to go and check her mummy again and to keep hold of the telephone as I wanted to talk to her some more.

She came back on the phone and confirmed that her mummy would not wake up. She then quickly said to be “I have to go now” and put the phone down.

While having the telephone conversation I put Holly’s name into the computer, she was a patient at our surgery and the records showed that she was in fact 4 years of age. It also confirmed that her mum was also a patient at the surgery. We had an address – but there was no telephone number listed.

I went into the duty doctor and informed him of the conversation, he said that he would go around to the house immediately – I also informed the Health Visitor. She said that she would go with the doctor. The Health Vistor knew the family and felt she could be support if needed.

While the Doctor and the Health Visitor were on their way I phoned directory enquiries to see if they had a number listed for that address – they did.

I phoned the number and Holly picked up the phone – I told her who I was and she remembered me. I asked if her mummy was still asleep and she replied “no mummy is taking a bath now”.  I asked her to tell her mummy that I was on the phone – but she replied with “I have to go now”– and put the phone down.

The Doctor and Health Visitor arrived shortly after and found one very embarrassed mum in her dressing gown. They explained what had happened and pleased that all was ok. Mrs Smith said that she would make sure that it didn’t happen again.

Questions:

1.        As a Receptionist would you have done anything differently?

2.       What do you think was important in this incident?

3.       What could be done to make a similar situation easier to deal with?

Answers:

1.        As a Receptionist I felt that I did as much as I could have done in this situation. I  got the information that was needed and from that we were able to confirm that the patient (or her daughter) was not in any danger.

2.        The most important thing is to get a name, a contact telephone number and an address – and if you can a date of birth. Try putting this into the computer as you get the information at the same time to see if they match up.

Try to get as much information as you can.

Speed on such an incident is vital.

Once you have sufficient information ensure that you pass this onto the correct person to deal with (ie duty Doctor / Nurse / Ambulance Control)

If Holly had continued talking to me I would not have disconnected the call – I would have passed this on to another Receptionist to deal with whilst I continued to chat to Holly – it would be better her talking to me rather than being perhaps on her own with a poorly mum to deal with.

If there had been a health care professional in the reception area at the time I would have got them to have taken over the call – but in this instance that was not possible – so I had to deal with the call.

3.        The most important thing from this was to get a telephone number for the family. I had the girl’s name, but no address and if I had not been able to obtain a telephone number we would have been powerless on what to do next – and would have probably had to report it to the police.

The lesson from this was I made notices to put up in the surgery and left leaflets on the reception desk asking patient to update us with their telephone numbers. It was quite scary just how many patients we did not have telephone numbers for – and quite a few that in fact had changes their telephone numbers. 

Also when patient phoned in to make appointments or with any queries I got in the habit of checking if we had a telehpone number for them and updated their records if we did not.

This incident was before we had phones that had caller id– but of course not all numbers come up – some are withheld – so do not rely on this alone.

Have you ever had such an incident in your surgery?

 

 

 

A Cry For Help


It was a normal Wednesday morning and it was getting towards lunchtime. There was a Health Visitors Clinic going on at the time and there were mums and dads in the waiting room with their little ones waiting to be seen.  Often this clinic overruns and we would have to close for lunch leaving the Health Visitor to let the patients out of the building.

Most of the doctors had gone out on their visits – there was one just finishing off his paperwork at the back of reception. Some of the receptionists had taken an early lunch, so it was me another receptionist and the Practice Manager who was in her office.

Five minutes before we were due to close the Surgery for lunch a young lad about 23 years of age came up to the reception desk. I could tell that he was very agitated – he asked to see a Doctor.

I knew that the doctor doing his paperwork had visits to do and a full surgery to come back to that afternoon and would not appreciate being asked to see this patient at this point – I felt sure it was not urgent. The Doctor was in the background and could hear the conversation and did not intervene so I felt right in explaining to the young man that there were not doctors available at that time as they were all out on their visits.

I checked on the computer and saw we had a cancellation later on that afternoon for 4.30. I asked the young man if he would like that appointment. He started pacing the reception area cursing and swearing.

He then started to shout and throw his arms around – I could see the patients in the waiting room ushering their little ones towards them. They started looking worried. It was obvious that this patient was getting very aggressive and giving some cause for concern.

At the point the Doctor doing is paperwork picked up his visit sheet and left the building! The other receptionist went to the back of the reception area and telephoned the Health Visitor who came and took the patients in the waiting room into her office.

All of a sudden was alone in the reception area with this young man – who was now getting more angry and aggressive. He was shouting that he needed to see a Doctor and NOW! He then went to rip the telephone off the wall shouting if he didn’t see a Doctor immediately he would go outside and throw himself in front of a car.

He started shouting that he needed to call his girlfriend but did not have any money. He then slammed into the telephone on the wall again.

At this point I had to do something – I was hoping that the other receptionist had gone to the Practice Managers office and they were phoning the police and the duty doctor on call that day. I hoped that no one else would come into the Surgery at that point.

But at this moment in time it was me and him, and I had to avoid any more damage or worse.

The only thing I felt I could do was talk to the young man.

In a firm but soft voice I asked him to come and talk to me – I was thankful for the high reception desk that was between the two of us.  I also stood back so he could not grab me over the desk.

I told him if he stopped I would let him use the reception telephone. He stopped and asked if I would let him use the phone.  I passed the phone over to him and he dialled his girlfriend.

He spoke to her and she obviously calmed him down. The call finished and he handed me back the telephone and said thank you! He was starting to calm down.

I asked him if he was ok. He started crying. He then poured out his troubles – he had been taking drugs and had been trying to come off them and was finding it very difficult. He had a young daughter who he was not allowed to see because of his drug habit and because of her he was trying to be drug free. He had a row with his girlfriend that same morning and she had told him that it was over between them. He had just come to the end of his tether.

He said that he had spoken to his social worker that morning and she was not of much help (I did not go into details) and he felt that everyone was against him, and he needed help. But no one was helping. He felt that he needed drugs to get him thorough this, but he was fighting against it – but said he didn’t know how much longer he could do so he said he was really struggling. He felt by threatening to throw himself under a car that someone might do something to help him. He said that he would do it if it  would get him the help he needed.

I actually started feeling sorry for this young man – he was screaming out for help – I admit not going the right way about it – but it was obvious that he was frightened and very confused at this point.

I started chatting to him (I cannot even remember what the conversation was now) but he seemed to calm right down. I stood there with him until the duty doctor came back and took him into his room.

The police arrived shortly afterwards and after speaking to the duty doctor decided they were not going to arrest the young man.

The doctor admitted the patient into the local drug rehab centre for 2 weeks – the doctor said that the young man was almost at breaking point.

After lunch all was calm and everything back to normal.

Then three weeks later I was out the back doing some admin work when one of my colleagues called me and said that there was a patient at the desk asking for me. I went up to the desk and there was the young man. He  said that he wanted to thank me for all my help when he was in last. He said that all he wanted was someone to listen to him and that I had been the first person to have done that. He apologised for the upset that he might have caused and promised that it would never happen again.

He went on to say that he had got fantastic help and support in the drug rehab centre and the doctor here in the Practice and for that he and his girlfriend were on great terms and he was in the process of agreeing access to seeing his daughter. He was one very happy man.

He then presented me with a box of chocolates.

Whenever that young man came into the surgery from that day on he was always pleasant, friendly and very polite.

Sometimes people just want to be listened to and not judged.

Of course it could have turned out a lot worse. Does your Practice have a protocol on dealing with such an incident? Have your Receptionist had training on dealing difficult situations?

Does your Reception desk have a panic button?

 

 

The Million Pound Cheque


Following on from my most recent blog re “The Urine Sample Pot” I have another story to share you will regarding the friendly GP – Dr Paul


I was in reception before morning surgery began opening the daily post.   In walks Dr Paul. He took his post out of his tray and started his daily signing of prescriptions, letters and other requests. The Practice Manager came along and asked him for a cheque that he was due to give to her. He got out his cheque book and wrote the check as requested.

I turned to him and asked while he was writing out cheques could he do one for me!! “No probs” was his reply – and duly wrote a cheque out to me – he wrote my full name on the cheque, dated and signed it and gave it to me.

The cheque was made out for one million pounds. We had a good laugh and I said that I probably would never have a cheque like this again and that I was going to frame it!!

A couple of weeks later I was working for the out of hours service and was working with a GP who happened to be a good friend of Dr Pauls, and was just as mad as he was.

I told him about the cheque and with a big grin and a twinkle in his eye said………right let’s get him!!

The out of ours GP took the cheque – and phoned me a couple of days later. He had arranged for his secretary to phone Dr Paul the following week – on the 1st April – April Fools Day.

Picture the moment – the secretary phones me and we had a chat – she was well and truly up for the joke as I put “the call” through to Dr Paul. I phoned him in his room – told him that I had his bank on the phone – he had a rep in his room with him at the time but was happy to take the call. Even better as the rep in there would be able to tell us his reaction.

I put the call through……………………….. About 4 minutes later all I hear is you bas***ds coming along the corridor – luckily there were not patients in the waiting room!!

Speaking to the rep later he said that we had well and truly had ‘got him’. His face was just a picture. The rep said that he had NEVER seen Dr Paul  lost for words. He certainly was on this occasion. All he kept saying to the caller on the end of the phone “this is a big mistake”.

Speaking to Dr Paul afterwards he said couldn’t believe that he had been well and truly caught. He said the call came through and the secretary made out that a cheque for a million pounds had been presented to the bank – and asked when he was going to put the funds into his account to cover this. He tried to explain that it was a joke and it shouldn’t have been banked. To which she replied “well Sir the cheque is dated and signed by you – is it not” to which he had to say yes!! The conversation went on and obviously the secretary was making life very difficult for him – she kept asking him difficult questions – until he heard the other Doctor in the background laughing!!! Game over.

He took it very well – relieved I think that this wasn’t really happening.

He came out into reception and gave me a friendly thump! The secretary on the other hand got a box of chocolates from him for the laugh!

I never got the cheque back – shame – as I said before – it probably will be the one and only time that I will ever get a cheque for one million pounds.