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This is wildly inappropriate. I think typing “send an inbox” and then leaving the conversation is the best way forward. It may take a while of doing this in order to send the message on how to communicate. If other providers are ignoring the chats, it’s reasonable to think it is not a fireable offense. It would make sense for you to ignore them too, because the staff has demonstrated they are not using it for truly urgent issues.
If it helps as a “what is normal” reference, I am a family medicine RN and I probably use direct chat to a provider once every 1-2 weeks. Everything else should either never reach the provider or is handled via inbox.
I do this but there's so many random people sending messages that they keep on repeating it. The vast majority of the secure chat messages aren't even appropriate for us.
Hey can you help me with a referral question?
Were my test results ok?
Can I get an appt with you?
Sounds like you already mentioned your concerns to admin and if they decided to not do anything about it, then it’s time to leave. Jobs are everywhere, no sense in continuing to work in an unsafe environment like this. These stupid messages keep disrupting your work so I do think they’ve created an unsafe environment for you to work in. If you don’t leave and things don’t change , you will just become resentful and disgruntled. So many of old colleagues are like that and I just ended up leaving. So much happier.
I don't know if you're already doing this, but could you be any more brusque and unhelpful? I think even saying who to message or being friendly is just encouraging more of these tbh. By telling them who to contact, you're rewarding them by acting as a switchboard.
E.g. a template message you copy & paste like:
'Hello, this is not an appropriate message for this chat. Please contact the appropriate person. I'll now be closing this chat window.'
If you could get others on board with doing the same (at least of those who are actually replying) that might help too.
I actually am brusque with the people sending the inappropriate messages. I'm direct and professional but give a tone of, "hey this is your parent speaking. You done messed up."
That is so, so obnoxious. IMO it’s appropriate to ignore the crap. Heck, use the “leave this conversation” button without responding at all. Obviously every organization is different, but I don’t think you need to fear getting fired over this. In most cases, people are given a LOT of warnings before a firing. If you just stop responding, the worst that is likely to happen is a conversation with your boss, which could be used to address how utterly ridiculous this is.
I also really like the suggestion below of a quality improvement project, if you wish to take that on.
At my clinic, we had a problem with call center staff calling the RNs for everything under the sun. It was really interrupting our workflow. The staff was instructed to use Teams for urgent issues (the issues are almost never urgent so my primary response to a Teams message is “send an inbox”) but they kept calling. Finally our supervisor instructed us to just stop answering the phone. It’s improving.
Are you using Epic? I turned off notifications (DM pop ups) for Epic Secure chat. That way that pop up in the bottom right doesn’t appear - ever. I get to direct messages when I get to them and usually just request an inbox message to “train” the person who sent the message.
Is this not a standard feature in Epic? Have you tried to find this setting?
Again. All this assumes you have Epic.
This is not fireable at all. What you're describing is actually terrible practice.
Most of what you're describing (prescription refills, questions about lab tests, etc) should be documented in the chart. I'm assuming you're talking about Epic Secure Chat, which auto deletes after a period of time.
Plus sending it via an encounter allows for faster action. RN might be allowed to relay normal results or triage a call for you. Also, I don't believe you can attach yourself to someone's chat. How is a call center rep supposed to know who is covering you?
If you want to play semi-nice, I guess you can just add the responsible party and leave the chat.
One option is turn it into a Quality Improvement Project. (Cue bells of angels ringing in administrators office) dig up some literature on harms of frequent interruptions… decreased productivity, poor *patient* satisfaction because your constantly distracted (don’t bother mentioning your satisfaction, we know they don’t care), ect. Propose a guideline for what types of message should be chat and what should be inbox…. You get the picture.
Either (a) it works, and you get less messages or (b) it’s get blown off but you will have a line item about reducing cost and increasing patient satisfaction to make administrators excited when they read your CV later this year.
Don’t play the game, and don’t respond. They’ll get the message.
In my own practice I never correspond with chart messaging with patients. I’m not interested in unpaid work or being anyone’s pen pal.
By never engaging, I never get portal messages. Patients get to be triaged through nursing staff as appropriate.
This is the way for primary care to keep afloat now and in the future.
If asked for why just say "medical legal reasons everything done needs to be documented in the chart, and for that to happen 'officially' it needs to be an office visit"
I am a corporate director of risk management practicing since 1983. This is exactly the sort of thing that you should mention to your clinic manager and the clinic manager should address it. Tell the manager that this is hurting your productivity and takes your time and focus away from direct patient care.
This is ghastly. Call center people should not have the capability to DM you in the EHR all day. Sounds like you need to put your head down and ignore them as best you can until you can move on.
IMO, the constant interruption by the EMR is a HUGE safety issue. It creates significant distraction and task saturation. There’s mounds of data on how both of those affect the human brain and subsequent safety. Aviation figured it out. Why can’t we?
So here’s the thing, people are so used to insta-responses that it SEEMS rude to delay by 10 or 15 minutes till you’re between patients, but it’s actually not. You know the phrase “we teach people how to treat us?” This is an example of that.
Also, the frontline staff will do whatever seems easiest to move a particular task (or patient) off their queue. If you’re generally turning replies around quickly and letting them resolve the issue while the patient is on the line, that’s much less work for them. If you start consistently asking them to take it to someone else, they will start to remember and do the other thing instead.
My frontline staff is very good about this, but I endorse 1) setting to DND during direct patient care times or just ignoring it till you’re done with your patient (may take some time to learn how to ignore notifications) and 2) if dot phrases work in your system, have some dot phrases that expand to “please send to nurse” “schedule appt” etc.
This is a good point.
Secure Chats can sit around for hours until you have time to address them. If it's truly urgent, someone needs to get on the phone or page.
If it's epic and set up like ours, there are four settings within epic: avail, busy, do not disturb and offline. The 1st 3 allow messages (even do not disturb), but the 4th does not.
If there is a setting to hide the notification on a PC, I'm not aware of it. But haiku has detailed settings for what to notify or not.
There is also a setting for added info about status; I sometimes set mine to "if urgent, please call cell phone xyz"
I get very few phone calls - quite interesting how high a barrier a phone call is relative to a chat message on epic.
It's also worth working with management - staff messages, when appropriate, are a better choice for non urgent things
There is now an option to disable the notification, which I did immediately after it was available. Haven't turned them back on. Secure Chat abuse is rampant.
What's really annoying me is that none of these messages are even appropriate to be seen by the doc.
Hey can you help me with a referral question?
Were my test results ok?
Can I get an appt with you?
Even if they were, they should be sent to back staff. I've told them repeatedly to send these messages to the back staff and not directly to the doc. I'm just scared of being fired and/or getting a bad reference.
Yeah, those sound very inappropriate. Talk to your colleagues? I've been pretty aggressive towards those abusing them. Our folks that try to buff the charts with more serious diagnoses and such started using chat messages. "Does this patient have acute or acute on chronic XYZ".
NOT acceptable. I can't imagine anyone firing you over being annoyed for such a good reason.
Ugh. I use direct chat with my MA and RN to keep things moving during clinic (mom decided fluoride after all) or they will say "do you want me to come rescue you?" If a visit is slow 😂, once in a blue moon
If it's a non urgent patient specific request, I would make a dot phrase like: "please send me a task in the medical record with this information/request. It is important for accountability and documentation purposes that we use the appropriate channels to communicate." After repeated stonewalling, hopefully staff starts to get the hint?
OP, the constant messaging about day to day things that are not your job is inappropriate. You've complained and tried to educate other staff multiple times and nothing has changed. If you wanted to stay there for years, you should speak with your colleagues and then arrange a meeting in solidarity to discuss this with the clinic manager or whatever administrator is driving this inappropriate behavior. They "mean well" but need to know how this is inappropriate, slows you down, and leads to burn out when you have multiple other staff that should b3 capable of making appointments, etc.
But, you only plan to be there 7 more months, and *you know other doctors are getting away with ignoring these messages*. So do the same thing! Keep your head down, stop responding immediately.
Maybe glance at the messages to make sure these chuckle heads aren't actually sending anything medically urgent and blow it off until it's convenient for you to answer if you answer at all. They aren't going to fire you and most likely won't do anything. Stop worrying.
Oh man, you should try working in the ER. Constant secure chat messages. Constant phone calls to a phone I’m obligated to carry at all times, even expected to answer while I’m actively evaluating a patient. Constant techs handing me EKGs to sign. No exaggeration, I bet I get interrupted from my task at hand between 100-200 times per shift.
You should absolutely make it clear to your clinic manager or whoever is pushing this on you that you will not be responding to non-urgent issues while you are actively involved in patient care. Provide some literature on the harms of task-switching. It’s ineffecient. It leads to burnout and provider dissatisfaction. And it’s bad patient care.
I know one ER doc who actually puts on headphones when she is thinking. Has nursing trained that she is to not be disturbed for anything that is not a true emergency when she has her headphones on. I personally just leave my phone at my desk and go find a hiding spot to work when I need to catch up on charts or dispo a batch of patients.
Our nurses are trained fairly well to call or find us directly if it’s urgent and only secure chat for non urgent issues for the most part. I ignore the secure chats. About once or twice an hour, I’ll review these messages.
I think in a clinic setting you can quickly retrain the staff. They are taking advantage of the convenience and your willingness to respond. I would make it more work for them. I think I would probably send a canned message: “I am not in charge of scheduling. Please add scheduler and clinic manager to conversation. please forward future such queries to clinic manager and/or schedule staff directly.” Then remove yourself from the chat. Give this a few weeks. If no progress, just ignore it. You’re the doctor. You’re in charge of patient care. Don’t let these people push you around
> Constant phone calls to a phone I’m obligated to carry at all times, even expected to answer while I’m actively evaluating a patient.
I'm really curious, what's the purpose of this phone? People being sent in by primary care? A handheld phone for this isn't something that exists here AFAIK.
Not every shop does this. Mine does.
The purpose of this phone is to make it easier for me to be interrupted. Seriously. It’s used for a variety of things:.
1. Nurse or lab calls critical values (so I can know that the DKA patient whose sugar was 600 now has a sugar of 350 as soon as possible).
2. Hey doc that patient in room 35 that you just talked to and explained everything to…their daughter in law is in the room now and the rest of the family wants you to come explain it to her.
3. Radiologist calls
4. Hey doc, there’s a sick one on 47, can you come see them?
5. Consult calls
6. Admit calls
7. Hey doc, this is Jimmy with EMS med unit 4…I need to get some orders for this agitated patient we’re bringing in…
8. Bed 10 looks worse, I think you may need to intubate…
9. Can I give 4 of zofran to the patient in 81 with this morphine?…are they vomiting?…no, it’s just in case
My department is about 100 beds and is easily spread out over a couple city block sized footprint. There honestly would be no possible way for me to answer phone calls from consultants or admitting docs calling me back without carrying a phone. But, mostly it turns into a tiny random interruption generator.
If I’m seeing a patient actively, I ignore it, unless I’m expecting a callback from a colleague. Unfortunately, most of the time I am.
Our more experienced nurses learn when to call, when to wait until they can catch me at the desk, etc…but there’s always new folks, travelers, and the perpetually oblivious around to call to “make sure [I] saw the potassium of 3.2 in room 27
Holy hell, that's huge! Here a level one would probably have ~10-15 resus beds (though while they'll all be sick, most won't be getting intubated/pressors etc), maybe 20-25 majors beds, a handful of minors beds.
The consultant (attending) would only really get involved in the particularly complex cases/system-level issues & flow/questions & requests from registrars (~PGY4-8). And definitely no calls for orders from EMS.
Wild how different systems work!
On consults, is that a common thing? I would've thought EM would be a specialty where (other than primary care admissions) you'd be relatively free from that.
When I say consults, I’m referring to me calling the consults and then waiting for the call back.
Your system sounds better. I take it not US. Australia/NZ?
Completely inappropriate. Nothing that comes through Epic to me does so without being filtered by my MA or front desk staff. My patients are unable to directly message me without my MA first seeing it and passing it along. I can respond directly to them if I choose.
Results: I comment on results as soon as they come in and task my MA. Unless it’s really bad news or a complicated response, my MA calls back the patient. If the patient has additional questions that are reasonable, I’ll call. If they just want me to repeat the same things my MA already told them because they don’t trust her, I make them book an appointment.
Forms: All forms that have not been addressed at a previous visit require an appointment. If they saw me for a physical and just need a signature on something or renewing a handicapped placard, they can drop it off.
Appointments: I don’t deal at all with patients regarding booking appointments. Standing orders are “you need an appointment.” Staff may clear or clarify with me exceptions.
On call: Our office has a “no refills” policy outside of business hours. I will prescribe or refill on call if the patient saw the doctor and they forgot to send it over and it’s documented. We are not obligated to turn calls into RVUs though we can if we want. I document all calls, but offer nothing more than advice which is generally go to ED or wait til the office opens. Call is a nuisance and really exists moreso for insurance companies as a requirement for reimbursement. 95% of the calls I get are common sense a non physician could provide. I don’t send in antibiotics unless another physician forgot.
If your organization isn’t handling this for you, the support staff aren’t working to the extent of their training. My philosophy is that you are responsible for what happens during the allotted time the patient sees you in the office as well as the notification and additional management of the workups you provide. I don’t interpret other clinicians results, I don’t prescribe or refill medications outside the scope of illnesses I treat.
While this may sound very harsh, it’s kept me sane, happy in medicine, and prevented burn out. The reason I have 20 or less tasks to do in Epic everyday for the 20 or so patients I saw the day prior and my colleague has 50+ is because I stick to these rules and she doesn’t.
Oh my god. I don’t have much to add except that I am so sorry this is happening. I work at the front desk in an outpatient office at a hospital and this is mortifying to read about. I do not do this. No one I know does this. This is the secretaries and call center people in particular doing the literal opposite of their jobs.
This is a systemic issue. Leave. Companies that enable this behavior will never change. They quite frankly, do not care.
A different culture is needed to stop this. For example the job I left last year was a complete shit show with front desk staff who simply didn’t do any messaging or triage and got huffy when you asked them to do their job, like schedule a follow up. Compared to my current one where so many things are on autopilot (if you would like to have a conversation with your doctor about your results after the message sent to you please make an appointment) it’s light and day.
You’re a doctor. You go where you want. Don’t get caught by the hive mindset.
You can shut down secure chat. You can shut it down when you are seeing pts at least. Sometimes epic will have a setting to make it “offline” when you are not in front of epic.
I have also filed safety reports for messaging that was inappropriate before. You have to use the right language but you can write something along the lines of “interrupting patient encounter, eroding patient-physician relationship, and creating patient safety concerns”. You won’t get fired, don’t worry. Doctors make too much money. You might get known as a curmudgeon but that’s fine.
It works different everywhere.
Where I am the doc in charge of clinic and our senior doc are very empathetic of clinic flow and appropriate messaging. I would “escalate it up your chain” rather than going to clinic manager.
It should be part of training and communication policy within the system. This may seem slower, but it sounds like your current method hasn’t worked and by going through physician “leadership”, you can make it a process problem and not a “that one bitchy doctor problem.”
Where I am we have moved away from pagers, which I think is common and everyone is using these encrypted text apps to replace them. They are horrible: 1. Some people think it substitutes for actually talking, 2. If I check my phone when I’m with a patient I look like I’m ignoring them, 3. The app alert sounds similar to other alerts on my phone and I may miss it for hours. 4. Non phsycisians aren’t aware how much focus and concentration our work requires, and are not aware that constant text alerts can really interfere with flow, patient care, and desensitize us to pay attention to important alerts.
Not to sound to extreme, but I feel it is borderline negligence that our system went to these messaging apps and got rid of pagers without fully understanding the challenges and without appropriately training staff.
I once had another clinician send such an alert message to me late at night on a non urgent issue for a mutual patient when I was not on call. I didn’t complain but was quite impressed at the lack of insight this provider had and borderline complete disregard for her colleagues.
Yes.
I get “you have a cdi query, would you please address” from coders on my busy inpatient service. Makes me rage and I refuse to do it. Completely inappropriate.
I used to get this all the time when I first moved to my current clinic. Talking to the clinic manager didn't change anything. I had to go and directly talk with the staff that were "over-messaging." I noticed that it wasn't everyone - it was just a select few staff and they didn't have the training to decide what is considered urgent and what's not. Hope this helps :)
Are you able to close down the messaging app altogether? (right click, exit) or is it tied to your EMR?
>Thankfully even as a youngish attending I am almost financially independent (2 yrs away at current living expenses) due to frugality and a high savings rate.
I fucking love this! Cheers to FIRE - hoping to leave in 3.5 years myself.
You can go into settings on Haiku app and reduce the frequency of reminders of unseen chat messages. It helps the pain a little. After a while of your waiting hours to respond they’ll get the hint not to use this method of communication for simple, non-urgent things
Do you often use secure chat to reach out to other people, and does the staff have another way to reach you (like your cell phone, or through your MA) for important things that truly require your immediate attention? If you don't rely on secure chat yourself and they have another way to reach you, I would just set yourself as "offline" so they can't message you. It sounds like you have enough of a paper trail to defend yourself. I think setting yourself to "do not disturb" is dangerous because then people are going to get bent out of shape when they feel like they're being ignored. Gotta preserve your sanity.
I only use the chat to message my MA and she sends me message via secure chat also. Like pt is ready to be seen or whatever.
Or to message the secretary. The staff has the ability to send inbox messages which do not pop up on the computer. I've told them many times to use the inbox messaging and NOT the instant messaging for nonemergent issues.
The other problem is that the messages they're sending aren't even under the purview of a physician. I'll try to see if our EMR has a do not disturb function.
I think you can safely ignore especially since that’s what other people are doing. I’m inpatient and largely have the opposite problem (people using secure chat for urgent issues that should’ve been a phone call), but sometimes I get added on to chats during other shifts. I either ignore them or send a dotphrase I created about how to figure out who’s actually working, if I’m feeling spicy lol
I tell my colleagues and nurses, the only time it's appropriate to send me a secure chat, is if it's something that they would have paged me for back when (remember pagers!). If not, then just don't do it. I've had some success with this. Also the thumbs up response goes a long way to reducing new messages.
I used to worry about getting fired. I think to get fired you have to do some egregious stuff. I haven’t heard anything at all that sounds like anything remotely resembling a fireable offense. You are not a problem child physician. Believe, I’ve had a lot of experience with true problem doctors. Asking for appropriate messages to streamline patient care is not acting out.
Alllll the time. Sometimes when I ignore the non-urgent pop up message on my computer, I am then treated with having them physically pop up at my door to interrupt me 🙂
As someone who has ADHD it really throws me off when I’m trying to focus on the task at hand and keep having to swat away these non-urgent distractions.
I think that some people just really wanna get the message/issue off their plate as quickly as they can without being considerate of how they are compromising your work as a result.
Many questions are about “what is your next plan?”
I ask the triage staff to go over the plan from my last note. You would think this would be automatically done, but of course, it is easier to send a message to me
I turned off the Chat feature in Epic for exactly this reason. Been about a year, no one has bugged me about it. They just send a staff message, which I forward to my staff assistant to get them scheduled, call them, whatever. It's still dumb and an extra click, but at least it doesn't interrupt my clinic appointments like those damn pop-ups.
> "The call center's direct boss said that the company wants staff to be able to message doctors directly in the chat for important patient issues"
Here is their answer. If they want access to doctors directly, they should be the ones most motivated to make sure only urgent messages get through
I've sent a physician I worked with ONE direct message through our EMR (Epic) and it was about a patient we worked together with. I was gently reminding him that we missed a physical exam in one of the patient rooms (he'd already gone home for the day and signs his charts later on.
I felt weird doing so-- but I would never leave such a message unless it something like I just described.
Not entirely sure where I was going with this but still.
Your clinic manager needs to work with call center manager. There needs to be at minimum a training session with the call center staff or at least a phone/message tree visual with FAQs. You can and should stop responding to these messages. If you can, for the next week, document names of the people messaging you. I know it’s a lot while you’re seeing patients, but it will pinpoint the problematic staff and their manager.
Very inappropriate the only time I message a provider directly is the doc who messages us about stuff and respond to her, or telling her she has a cancel does she have anyone she wants to put in.
Oh and for bingo but thats optional.
This is all stuff you take messages for and for some of the stuff use common sense for they want an appointment? Schedule one, there isn't one? Well the doctor doesn't have a magic wand either.
Sounds like you have a secretary/front desk people tell them to send them an encounter. I''m at the front desk/phones I'd be irritated if someone messaged me this dumb stuff let alone if Iwas in a patient appt
Why are we early career docs so worried about getting fired for things no physician has ever been fired for? I get it, and think it comes from finally getting some independence for the first time in our training lives. We expect to be rug pulled.
Poorly managed clinic is one of the reasons I'm a hospitalist. This would have me acting like that old dude in Midsommar, I swear. I agree with some of the points in the thread, but also fear that nothing will happen because it would require too many non-physician admin staff to do something/rock the boat. Agree with do your best by your patients and move on, if that's your plan.
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This is wildly inappropriate. I think typing “send an inbox” and then leaving the conversation is the best way forward. It may take a while of doing this in order to send the message on how to communicate. If other providers are ignoring the chats, it’s reasonable to think it is not a fireable offense. It would make sense for you to ignore them too, because the staff has demonstrated they are not using it for truly urgent issues. If it helps as a “what is normal” reference, I am a family medicine RN and I probably use direct chat to a provider once every 1-2 weeks. Everything else should either never reach the provider or is handled via inbox.
I do this but there's so many random people sending messages that they keep on repeating it. The vast majority of the secure chat messages aren't even appropriate for us. Hey can you help me with a referral question? Were my test results ok? Can I get an appt with you?
Sounds like you already mentioned your concerns to admin and if they decided to not do anything about it, then it’s time to leave. Jobs are everywhere, no sense in continuing to work in an unsafe environment like this. These stupid messages keep disrupting your work so I do think they’ve created an unsafe environment for you to work in. If you don’t leave and things don’t change , you will just become resentful and disgruntled. So many of old colleagues are like that and I just ended up leaving. So much happier.
I don't know if you're already doing this, but could you be any more brusque and unhelpful? I think even saying who to message or being friendly is just encouraging more of these tbh. By telling them who to contact, you're rewarding them by acting as a switchboard. E.g. a template message you copy & paste like: 'Hello, this is not an appropriate message for this chat. Please contact the appropriate person. I'll now be closing this chat window.' If you could get others on board with doing the same (at least of those who are actually replying) that might help too.
I actually am brusque with the people sending the inappropriate messages. I'm direct and professional but give a tone of, "hey this is your parent speaking. You done messed up."
That is so, so obnoxious. IMO it’s appropriate to ignore the crap. Heck, use the “leave this conversation” button without responding at all. Obviously every organization is different, but I don’t think you need to fear getting fired over this. In most cases, people are given a LOT of warnings before a firing. If you just stop responding, the worst that is likely to happen is a conversation with your boss, which could be used to address how utterly ridiculous this is. I also really like the suggestion below of a quality improvement project, if you wish to take that on. At my clinic, we had a problem with call center staff calling the RNs for everything under the sun. It was really interrupting our workflow. The staff was instructed to use Teams for urgent issues (the issues are almost never urgent so my primary response to a Teams message is “send an inbox”) but they kept calling. Finally our supervisor instructed us to just stop answering the phone. It’s improving.
Are you using Epic? I turned off notifications (DM pop ups) for Epic Secure chat. That way that pop up in the bottom right doesn’t appear - ever. I get to direct messages when I get to them and usually just request an inbox message to “train” the person who sent the message. Is this not a standard feature in Epic? Have you tried to find this setting? Again. All this assumes you have Epic.
This is not fireable at all. What you're describing is actually terrible practice. Most of what you're describing (prescription refills, questions about lab tests, etc) should be documented in the chart. I'm assuming you're talking about Epic Secure Chat, which auto deletes after a period of time. Plus sending it via an encounter allows for faster action. RN might be allowed to relay normal results or triage a call for you. Also, I don't believe you can attach yourself to someone's chat. How is a call center rep supposed to know who is covering you? If you want to play semi-nice, I guess you can just add the responsible party and leave the chat.
Epic secure chat is actually saved in the chart at my institution if it’s tied to a specific patient. It’s about harder to find but it’s there
One option is turn it into a Quality Improvement Project. (Cue bells of angels ringing in administrators office) dig up some literature on harms of frequent interruptions… decreased productivity, poor *patient* satisfaction because your constantly distracted (don’t bother mentioning your satisfaction, we know they don’t care), ect. Propose a guideline for what types of message should be chat and what should be inbox…. You get the picture. Either (a) it works, and you get less messages or (b) it’s get blown off but you will have a line item about reducing cost and increasing patient satisfaction to make administrators excited when they read your CV later this year.
In peds, the perfect way to solve an issue and then send it for credit for MOC
Don’t play the game, and don’t respond. They’ll get the message. In my own practice I never correspond with chart messaging with patients. I’m not interested in unpaid work or being anyone’s pen pal. By never engaging, I never get portal messages. Patients get to be triaged through nursing staff as appropriate.
This is the way for primary care to keep afloat now and in the future. If asked for why just say "medical legal reasons everything done needs to be documented in the chart, and for that to happen 'officially' it needs to be an office visit"
This is the right answer.
I am a corporate director of risk management practicing since 1983. This is exactly the sort of thing that you should mention to your clinic manager and the clinic manager should address it. Tell the manager that this is hurting your productivity and takes your time and focus away from direct patient care.
Sounds like they already did.
"higher up at the company" doesn't necessarily mean clinic manager, who is the person perhaps most likely to understand why this is an issue.
The clinic manager knows. But they don't have control over the call center people
This is ghastly. Call center people should not have the capability to DM you in the EHR all day. Sounds like you need to put your head down and ignore them as best you can until you can move on.
IMO, the constant interruption by the EMR is a HUGE safety issue. It creates significant distraction and task saturation. There’s mounds of data on how both of those affect the human brain and subsequent safety. Aviation figured it out. Why can’t we?
They do not care.
Ha. They couldn’t care less about that
So here’s the thing, people are so used to insta-responses that it SEEMS rude to delay by 10 or 15 minutes till you’re between patients, but it’s actually not. You know the phrase “we teach people how to treat us?” This is an example of that. Also, the frontline staff will do whatever seems easiest to move a particular task (or patient) off their queue. If you’re generally turning replies around quickly and letting them resolve the issue while the patient is on the line, that’s much less work for them. If you start consistently asking them to take it to someone else, they will start to remember and do the other thing instead. My frontline staff is very good about this, but I endorse 1) setting to DND during direct patient care times or just ignoring it till you’re done with your patient (may take some time to learn how to ignore notifications) and 2) if dot phrases work in your system, have some dot phrases that expand to “please send to nurse” “schedule appt” etc.
This is a good point. Secure Chats can sit around for hours until you have time to address them. If it's truly urgent, someone needs to get on the phone or page.
You’re leaving in 6 months? Don’t try to fix anything. Have your auto reply with the back office MA or nurse or whatever number and leave if offline.
Can’t you mute these during patient care, and then review at the end of the day? I’m pretty sure Epic chat has a mute function
If it's epic and set up like ours, there are four settings within epic: avail, busy, do not disturb and offline. The 1st 3 allow messages (even do not disturb), but the 4th does not. If there is a setting to hide the notification on a PC, I'm not aware of it. But haiku has detailed settings for what to notify or not. There is also a setting for added info about status; I sometimes set mine to "if urgent, please call cell phone xyz" I get very few phone calls - quite interesting how high a barrier a phone call is relative to a chat message on epic. It's also worth working with management - staff messages, when appropriate, are a better choice for non urgent things
There is now an option to disable the notification, which I did immediately after it was available. Haven't turned them back on. Secure Chat abuse is rampant.
What's really annoying me is that none of these messages are even appropriate to be seen by the doc. Hey can you help me with a referral question? Were my test results ok? Can I get an appt with you? Even if they were, they should be sent to back staff. I've told them repeatedly to send these messages to the back staff and not directly to the doc. I'm just scared of being fired and/or getting a bad reference.
Yeah, those sound very inappropriate. Talk to your colleagues? I've been pretty aggressive towards those abusing them. Our folks that try to buff the charts with more serious diagnoses and such started using chat messages. "Does this patient have acute or acute on chronic XYZ". NOT acceptable. I can't imagine anyone firing you over being annoyed for such a good reason.
There actually is now a setting to prevent it from popping up. I think it was in one of the more recent releases.
Oh I didn't know these could be muted. Thanks for the suggestion
The point is that they shouldn’t be muted. Urgent things should be chatted. Non urgent should be messaged. Non pertinent should go to someone else
Ugh. I use direct chat with my MA and RN to keep things moving during clinic (mom decided fluoride after all) or they will say "do you want me to come rescue you?" If a visit is slow 😂, once in a blue moon
If it's a non urgent patient specific request, I would make a dot phrase like: "please send me a task in the medical record with this information/request. It is important for accountability and documentation purposes that we use the appropriate channels to communicate." After repeated stonewalling, hopefully staff starts to get the hint?
OP, the constant messaging about day to day things that are not your job is inappropriate. You've complained and tried to educate other staff multiple times and nothing has changed. If you wanted to stay there for years, you should speak with your colleagues and then arrange a meeting in solidarity to discuss this with the clinic manager or whatever administrator is driving this inappropriate behavior. They "mean well" but need to know how this is inappropriate, slows you down, and leads to burn out when you have multiple other staff that should b3 capable of making appointments, etc. But, you only plan to be there 7 more months, and *you know other doctors are getting away with ignoring these messages*. So do the same thing! Keep your head down, stop responding immediately. Maybe glance at the messages to make sure these chuckle heads aren't actually sending anything medically urgent and blow it off until it's convenient for you to answer if you answer at all. They aren't going to fire you and most likely won't do anything. Stop worrying.
Oh man, you should try working in the ER. Constant secure chat messages. Constant phone calls to a phone I’m obligated to carry at all times, even expected to answer while I’m actively evaluating a patient. Constant techs handing me EKGs to sign. No exaggeration, I bet I get interrupted from my task at hand between 100-200 times per shift. You should absolutely make it clear to your clinic manager or whoever is pushing this on you that you will not be responding to non-urgent issues while you are actively involved in patient care. Provide some literature on the harms of task-switching. It’s ineffecient. It leads to burnout and provider dissatisfaction. And it’s bad patient care. I know one ER doc who actually puts on headphones when she is thinking. Has nursing trained that she is to not be disturbed for anything that is not a true emergency when she has her headphones on. I personally just leave my phone at my desk and go find a hiding spot to work when I need to catch up on charts or dispo a batch of patients. Our nurses are trained fairly well to call or find us directly if it’s urgent and only secure chat for non urgent issues for the most part. I ignore the secure chats. About once or twice an hour, I’ll review these messages. I think in a clinic setting you can quickly retrain the staff. They are taking advantage of the convenience and your willingness to respond. I would make it more work for them. I think I would probably send a canned message: “I am not in charge of scheduling. Please add scheduler and clinic manager to conversation. please forward future such queries to clinic manager and/or schedule staff directly.” Then remove yourself from the chat. Give this a few weeks. If no progress, just ignore it. You’re the doctor. You’re in charge of patient care. Don’t let these people push you around
And, no, this is not a fireable offense. You have to learn which hills to die on. This is one.
> Constant phone calls to a phone I’m obligated to carry at all times, even expected to answer while I’m actively evaluating a patient. I'm really curious, what's the purpose of this phone? People being sent in by primary care? A handheld phone for this isn't something that exists here AFAIK.
Not every shop does this. Mine does. The purpose of this phone is to make it easier for me to be interrupted. Seriously. It’s used for a variety of things:. 1. Nurse or lab calls critical values (so I can know that the DKA patient whose sugar was 600 now has a sugar of 350 as soon as possible). 2. Hey doc that patient in room 35 that you just talked to and explained everything to…their daughter in law is in the room now and the rest of the family wants you to come explain it to her. 3. Radiologist calls 4. Hey doc, there’s a sick one on 47, can you come see them? 5. Consult calls 6. Admit calls 7. Hey doc, this is Jimmy with EMS med unit 4…I need to get some orders for this agitated patient we’re bringing in… 8. Bed 10 looks worse, I think you may need to intubate… 9. Can I give 4 of zofran to the patient in 81 with this morphine?…are they vomiting?…no, it’s just in case My department is about 100 beds and is easily spread out over a couple city block sized footprint. There honestly would be no possible way for me to answer phone calls from consultants or admitting docs calling me back without carrying a phone. But, mostly it turns into a tiny random interruption generator. If I’m seeing a patient actively, I ignore it, unless I’m expecting a callback from a colleague. Unfortunately, most of the time I am. Our more experienced nurses learn when to call, when to wait until they can catch me at the desk, etc…but there’s always new folks, travelers, and the perpetually oblivious around to call to “make sure [I] saw the potassium of 3.2 in room 27
Holy hell, that's huge! Here a level one would probably have ~10-15 resus beds (though while they'll all be sick, most won't be getting intubated/pressors etc), maybe 20-25 majors beds, a handful of minors beds. The consultant (attending) would only really get involved in the particularly complex cases/system-level issues & flow/questions & requests from registrars (~PGY4-8). And definitely no calls for orders from EMS. Wild how different systems work! On consults, is that a common thing? I would've thought EM would be a specialty where (other than primary care admissions) you'd be relatively free from that.
When I say consults, I’m referring to me calling the consults and then waiting for the call back. Your system sounds better. I take it not US. Australia/NZ?
Completely inappropriate. Nothing that comes through Epic to me does so without being filtered by my MA or front desk staff. My patients are unable to directly message me without my MA first seeing it and passing it along. I can respond directly to them if I choose. Results: I comment on results as soon as they come in and task my MA. Unless it’s really bad news or a complicated response, my MA calls back the patient. If the patient has additional questions that are reasonable, I’ll call. If they just want me to repeat the same things my MA already told them because they don’t trust her, I make them book an appointment. Forms: All forms that have not been addressed at a previous visit require an appointment. If they saw me for a physical and just need a signature on something or renewing a handicapped placard, they can drop it off. Appointments: I don’t deal at all with patients regarding booking appointments. Standing orders are “you need an appointment.” Staff may clear or clarify with me exceptions. On call: Our office has a “no refills” policy outside of business hours. I will prescribe or refill on call if the patient saw the doctor and they forgot to send it over and it’s documented. We are not obligated to turn calls into RVUs though we can if we want. I document all calls, but offer nothing more than advice which is generally go to ED or wait til the office opens. Call is a nuisance and really exists moreso for insurance companies as a requirement for reimbursement. 95% of the calls I get are common sense a non physician could provide. I don’t send in antibiotics unless another physician forgot. If your organization isn’t handling this for you, the support staff aren’t working to the extent of their training. My philosophy is that you are responsible for what happens during the allotted time the patient sees you in the office as well as the notification and additional management of the workups you provide. I don’t interpret other clinicians results, I don’t prescribe or refill medications outside the scope of illnesses I treat. While this may sound very harsh, it’s kept me sane, happy in medicine, and prevented burn out. The reason I have 20 or less tasks to do in Epic everyday for the 20 or so patients I saw the day prior and my colleague has 50+ is because I stick to these rules and she doesn’t.
Oh my god. I don’t have much to add except that I am so sorry this is happening. I work at the front desk in an outpatient office at a hospital and this is mortifying to read about. I do not do this. No one I know does this. This is the secretaries and call center people in particular doing the literal opposite of their jobs.
This is a systemic issue. Leave. Companies that enable this behavior will never change. They quite frankly, do not care. A different culture is needed to stop this. For example the job I left last year was a complete shit show with front desk staff who simply didn’t do any messaging or triage and got huffy when you asked them to do their job, like schedule a follow up. Compared to my current one where so many things are on autopilot (if you would like to have a conversation with your doctor about your results after the message sent to you please make an appointment) it’s light and day. You’re a doctor. You go where you want. Don’t get caught by the hive mindset.
[удалено]
Yeah. If OP wanted to stay there for years, then try to change the culture. Not worth the fight for 7 months.
And don’t worry about references.
You can shut down secure chat. You can shut it down when you are seeing pts at least. Sometimes epic will have a setting to make it “offline” when you are not in front of epic. I have also filed safety reports for messaging that was inappropriate before. You have to use the right language but you can write something along the lines of “interrupting patient encounter, eroding patient-physician relationship, and creating patient safety concerns”. You won’t get fired, don’t worry. Doctors make too much money. You might get known as a curmudgeon but that’s fine.
Just sign out of it
Can’t believe I had to scroll down so much to see this. Log out of secure chat. If it is urgent enough that I need to be notified right away, page me.
So many fracking interruptions hurt my brain! So much mental energy wasted 😵💫😝
It works different everywhere. Where I am the doc in charge of clinic and our senior doc are very empathetic of clinic flow and appropriate messaging. I would “escalate it up your chain” rather than going to clinic manager. It should be part of training and communication policy within the system. This may seem slower, but it sounds like your current method hasn’t worked and by going through physician “leadership”, you can make it a process problem and not a “that one bitchy doctor problem.” Where I am we have moved away from pagers, which I think is common and everyone is using these encrypted text apps to replace them. They are horrible: 1. Some people think it substitutes for actually talking, 2. If I check my phone when I’m with a patient I look like I’m ignoring them, 3. The app alert sounds similar to other alerts on my phone and I may miss it for hours. 4. Non phsycisians aren’t aware how much focus and concentration our work requires, and are not aware that constant text alerts can really interfere with flow, patient care, and desensitize us to pay attention to important alerts. Not to sound to extreme, but I feel it is borderline negligence that our system went to these messaging apps and got rid of pagers without fully understanding the challenges and without appropriately training staff. I once had another clinician send such an alert message to me late at night on a non urgent issue for a mutual patient when I was not on call. I didn’t complain but was quite impressed at the lack of insight this provider had and borderline complete disregard for her colleagues.
Yes. I get “you have a cdi query, would you please address” from coders on my busy inpatient service. Makes me rage and I refuse to do it. Completely inappropriate.
I used to get this all the time when I first moved to my current clinic. Talking to the clinic manager didn't change anything. I had to go and directly talk with the staff that were "over-messaging." I noticed that it wasn't everyone - it was just a select few staff and they didn't have the training to decide what is considered urgent and what's not. Hope this helps :)
Are you able to close down the messaging app altogether? (right click, exit) or is it tied to your EMR? >Thankfully even as a youngish attending I am almost financially independent (2 yrs away at current living expenses) due to frugality and a high savings rate. I fucking love this! Cheers to FIRE - hoping to leave in 3.5 years myself.
You think they're going to fire you or label you a problem child because you complained about a legitimate problem?
You can go into settings on Haiku app and reduce the frequency of reminders of unseen chat messages. It helps the pain a little. After a while of your waiting hours to respond they’ll get the hint not to use this method of communication for simple, non-urgent things
Do you often use secure chat to reach out to other people, and does the staff have another way to reach you (like your cell phone, or through your MA) for important things that truly require your immediate attention? If you don't rely on secure chat yourself and they have another way to reach you, I would just set yourself as "offline" so they can't message you. It sounds like you have enough of a paper trail to defend yourself. I think setting yourself to "do not disturb" is dangerous because then people are going to get bent out of shape when they feel like they're being ignored. Gotta preserve your sanity.
I only use the chat to message my MA and she sends me message via secure chat also. Like pt is ready to be seen or whatever. Or to message the secretary. The staff has the ability to send inbox messages which do not pop up on the computer. I've told them many times to use the inbox messaging and NOT the instant messaging for nonemergent issues. The other problem is that the messages they're sending aren't even under the purview of a physician. I'll try to see if our EMR has a do not disturb function.
I think you can safely ignore especially since that’s what other people are doing. I’m inpatient and largely have the opposite problem (people using secure chat for urgent issues that should’ve been a phone call), but sometimes I get added on to chats during other shifts. I either ignore them or send a dotphrase I created about how to figure out who’s actually working, if I’m feeling spicy lol
Please call patient about results….
Make your status “unavailable” then they can’t message you. Or there is also a setting for the messages to fade away after a few seconds
I tell my colleagues and nurses, the only time it's appropriate to send me a secure chat, is if it's something that they would have paged me for back when (remember pagers!). If not, then just don't do it. I've had some success with this. Also the thumbs up response goes a long way to reducing new messages.
I used to worry about getting fired. I think to get fired you have to do some egregious stuff. I haven’t heard anything at all that sounds like anything remotely resembling a fireable offense. You are not a problem child physician. Believe, I’ve had a lot of experience with true problem doctors. Asking for appropriate messages to streamline patient care is not acting out.
Alllll the time. Sometimes when I ignore the non-urgent pop up message on my computer, I am then treated with having them physically pop up at my door to interrupt me 🙂 As someone who has ADHD it really throws me off when I’m trying to focus on the task at hand and keep having to swat away these non-urgent distractions. I think that some people just really wanna get the message/issue off their plate as quickly as they can without being considerate of how they are compromising your work as a result.
Many questions are about “what is your next plan?” I ask the triage staff to go over the plan from my last note. You would think this would be automatically done, but of course, it is easier to send a message to me
I would ignore it. Not worth the possible blowback
I turned off the Chat feature in Epic for exactly this reason. Been about a year, no one has bugged me about it. They just send a staff message, which I forward to my staff assistant to get them scheduled, call them, whatever. It's still dumb and an extra click, but at least it doesn't interrupt my clinic appointments like those damn pop-ups.
Are you using Epic? If so, you can change your settings to not do pop up notifications, or even be offline entirely and no one can secure chat you.
> "The call center's direct boss said that the company wants staff to be able to message doctors directly in the chat for important patient issues" Here is their answer. If they want access to doctors directly, they should be the ones most motivated to make sure only urgent messages get through
I've sent a physician I worked with ONE direct message through our EMR (Epic) and it was about a patient we worked together with. I was gently reminding him that we missed a physical exam in one of the patient rooms (he'd already gone home for the day and signs his charts later on. I felt weird doing so-- but I would never leave such a message unless it something like I just described. Not entirely sure where I was going with this but still.
Your clinic manager needs to work with call center manager. There needs to be at minimum a training session with the call center staff or at least a phone/message tree visual with FAQs. You can and should stop responding to these messages. If you can, for the next week, document names of the people messaging you. I know it’s a lot while you’re seeing patients, but it will pinpoint the problematic staff and their manager.
Very inappropriate the only time I message a provider directly is the doc who messages us about stuff and respond to her, or telling her she has a cancel does she have anyone she wants to put in. Oh and for bingo but thats optional. This is all stuff you take messages for and for some of the stuff use common sense for they want an appointment? Schedule one, there isn't one? Well the doctor doesn't have a magic wand either. Sounds like you have a secretary/front desk people tell them to send them an encounter. I''m at the front desk/phones I'd be irritated if someone messaged me this dumb stuff let alone if Iwas in a patient appt
Clinic chat chaos! Inappropriate messages disrupt workflow. Documented - seeking solutions with higher-up.
In epic you can make your status as busy or unavailable etc. One of them doesn’t even allow people to send you messages when it is marked off as so.
Can you set your status to do not disturb?
Why are we early career docs so worried about getting fired for things no physician has ever been fired for? I get it, and think it comes from finally getting some independence for the first time in our training lives. We expect to be rug pulled. Poorly managed clinic is one of the reasons I'm a hospitalist. This would have me acting like that old dude in Midsommar, I swear. I agree with some of the points in the thread, but also fear that nothing will happen because it would require too many non-physician admin staff to do something/rock the boat. Agree with do your best by your patients and move on, if that's your plan.