Medical Care
The Impact of Call Centers on American Medicine: A Call to Action
2024-12-09
When it comes to primary care, the role of the support staff is often overlooked. In a typical primary care clinic, I once cared for a panel of patients. I naively believed I could handle it all by myself. But in reality, Sandra, a seasoned medical assistant, and Linda, the secretary managing our schedules, were crucial in providing comprehensive care.
Why Their Presence Matters
These two individuals knew the patients well. If a patient needed an urgent appointment, Sandra would squeeze them in. For a refill, Linda would try to get it processed without a visit. They also knew how to provide words of reassurance when I wasn't available. They had a deep understanding of the patients and their problems, which allowed them to triage effectively. Linda, in particular, knew how to get a hold of patients. For example, when calling Ruby, she knew to call her daughter Dee as Ruby was older and blind and uncomfortable answering the phone.In the past, there were more Sandras and Lindas in American medicine. But now, they seem to be in short supply. Instead, there are more administrative staff, but they are misdeployed. The trend is to centralize call center operations for efficiency, but this comes at a cost.When you call a big healthcare system or medical group these days, you're more likely to reach a low-cost centralized call center rather than the front office. These call center agents may be good at scheduling within the system's limits, but they lack the personal connection to provide immediate assistance. They can't get a hold of you or your family easily, and they don't know your doctor. This leads to a game of human ping-pong, with calls and emails going back and forth without a satisfactory resolution.A few months ago, a colleague's mother faced a similar situation. She needed to see her orthopedic surgeon urgently but left several messages with the call center, which went unanswered. She was told to go to the emergency room for her problem, which was confusion about pre-operative instructions. Eventually, she cheated and used the doctor's option on the call-center menu to reach her surgeon's office. This shows the inefficiencies and inconveniences caused by call center centralization.The call center gurus and health system process engineers may claim that the issues are with the processes following centralization. But this is incorrect. Centralized call centers undermine the well-coordinated team sport that is healthcare. They break up the personal connections between patients and staff and erode the quality of service. True great medical care depends on deep human connection at every level.Physicians at numerous US health systems and medical groups have provided significant input into this article, highlighting the importance of restoring the role of the Lindas and Sandras in American medicine.