Karen Smith, Receptionist: Dr. Diaz's office, this is Karen.
David Johnson: Karen, this is David Johnson. I'm a regular patient of Dr. Diaz.
Mr. Johnson: I woke up this morning feeling weak. I'm wondering if I could see Dr. Diaz
today?
Karen: Let's see. I'm sorry, Mr. Johnson, but our schedule's full today. I'll let his
nurse Renee know, and we'll get back in touch with you, okay?
Mr. Johnson: Okay. Please have her call me back as soon as you can, Karen.
Karen: Renee, David Johnson called for Dr. Diaz this morning. He said he woke up
feeling weak and wanted to see Dr. Diaz.
Our schedule's full this morning. Can I move Mr. O'Conner's checkup to next week and have
Mr. Johnson come in at 10?
Renee Jones, RN: So he says he's feeling weak. Did he say anything else?
Karen: Um. No.
Renee: So we don't know if he's feeling lightheaded, or if he's in any pain?
Karen: No, I didn't ask him anything like that.
Renee: Karen, how am I supposed to make decisions if I don't have enough information?
I've gotta go see my next patient. I have to deal with this later.
Karen: Renee, have you spoken to David Johnson yet? Do we need to follow up with
him?
Renee: Oh my gosh, I never called him back. Can I see that?
Karen: Here you go, Renee. I don't know him, but he did not sound good.
Renee: Dr. Diaz, do you have a moment? I need to run down some things with you.
Dr. Hector Diaz: Sure, Renee. But make it quick. There's a lot on my plate right
now.
Renee: Okay. First, can you sign these scripts?
Phyllis Mitchell wants you to refer her to an orthopedist for her shoulder pain.
Also, David Johnson called and said he woke up feeling weak. You remember who Mr. Johnson
is, don't you?
He's a 68-year-old with hypertension and hyperlipidemia.
We've had him on lisinopril 20mg daily for the last year now, and you added hydrochlorothiazide
25 mg per day three days ago.
He said he woke up this morning feeling weak. Do you think we should see him today?
Dr. Diaz: No, just tell him to stop taking the hydrochlorothiazide.
Renee: Dr. Diaz, I'm concerned about Mr. Johnson. I called and talked to him, and it
sounds like more than just weakness. He sounded anxious and said he feels like his heart's
beating out of his chest.
Dr. Diaz: You know, you may be right, Renee. Let's get him in today for an electrocardiogram
and a blood pressure check.
Renee: Okay, I'll call him right now, and I'll set up an electrocardiogram and a blood
pressure check. I'll bring that to you as soon as I have it. Thanks, Dr. Diaz.
That's right, Mr. Johnson. Dr. Diaz would like to see you today, so we can run an electrocardiogram
and check your blood pressure.
Mr. Johnson: Should I be concerned?
Renee: No, there's nothing to worry about. Dr. Diaz just wants to make sure that your
weakness is related to the new medication you're taking, and nothing else.
Mr. Johnson: I'll be right in. Thank you.
Renee: Okay, Mr. Johnson, we'll see you in about an hour.
Hey, Karen, if you have a minute, we should talk about a situation from yesterday.
Things didn't go as smoothly as we would've liked, and I feel some responsibility. So
let's think about what we can do to make it better.
Karen: Sure, Renee.
Renee: I was frustrated because the information you provided was incomplete, and not helpful.
Karen: I'm sorry about that, Renee
Renee: Well, I'm sorry that we haven't provided you with the training you need.
If we provide that for you, we'll all benefit.
Now, I know you're new here, so here's what would be helpful next time.
When a patient calls with a clinical concern, ask some general questions, like the ones
listed here.
They'll help us make sure the patient gets the right care.
Karen: Oh, this'll be a huge help.
Renee: Well, as you know, yesterday we were able to help Mr. Johnson quickly.
If we don't ask the right questions at the right time, we might not be able to help other
patients as quickly as we should.
I need you to speak up when things like this occur.
No one benefits if we don't speak up or address issues quickly.
So let's go through these questions. For example...
Dr. Diaz: Thanks, Renee, for getting lunch today.
Let's go over how things went over the last week.
The lab forgot to pick up the specimens, but Karen caught it in time for the courier to
deliver.
We had five no-shows last week, and Renee and I will be addressing that.
And oh, yeah, we've heard that David Johnson is home and resting comfortably.
We did a great job as a team with Mr. Johnson's case.
So, what do you think we did well, and how can we improve our communications?
Renee: Karen was very sensitive to Mr. Johnson's needs.
As usual, I was swamped, but she kept me on task by making sure I did my part to address
his issue.
Karen: I was concerned about Mr. Johnson, but I realized that I could have gotten more
information from him, too.
Renee: Precise communication is one part of it.
The other part is training, and that's my responsibility.
I hadn't given Karen the training on what to ask when people call with these issues.
We need to do a better job of orienting our new team members.
Karen: Well, I really appreciate our conversation last Wednesday. That was so helpful.
Dr. Diaz: I think we need to make sure that everyone's comfortable speaking up in
this practice. Getting those issues out of the way helps us focus on the real work here.
Karen: Like taking care of Mr. Johnson.
Dr. Diaz: We all need to speak up, just like Renee did. She challenged my orders and
helped me refocus on the issue.
I could've missed something if she hadn't.
We need to keep our communications open and continue working as a team, not just as individuals
working at the same place.
Now, how else can we accomplish this?