[The story you are about to hear is true. The names have been changed to protect the guilty.]

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The Case of "The Toxic Telephone"

By Lynn Homisak, PRT

This article was reprinted with permission from Podiatry Management Magazine


This is the City...San Antonio...DEEP in the heart of Texas. Centrally located between the east and west US coasts, it is a place where the words "River Walk" have never painted a more magical, impressionable image in one's mind and where the myth and legend of the iconic Alamo constitutes the most celebrated military engagement in Texas history. SOS rode slowly into town, our computers on our backs, to visit with one of San Antonio's finest podiatrists...Dr. David Crockett. Dr. Crockett built himself quite an excellent reputation in the San Antonio area over the past 32 years. His name was legend; known by all for his clinical expertise and also for his warm and friendly nature. Unfortunately, what he was also becoming known for was his "rude and disrespectful receptionist" who did not share his welcoming personality. It wasn't until after one of his patients shared with him her recent telephone experience with his receptionist that he called us in. And it wasn't until we called the office and got a taste of the receptionist's reception ourselves that we agreed to investigate further. Turns out, he had no idea that his callers were being mistreated although he confided in us that "come to think of it" his patient numbers were slipping recently. Until now, he couldn't put his finger on why; blaming it on the current economy, but it was all too familiar to us - another case of the toxic telephone; a product of unskilled telephone etiquette and behavior. We grabbed our notebooks and stepped into the front desk area, where we were certain we would capture some hard clues that would surely uncover this mystery. We waited for the phone to ring and once it did...sure enough, we got an earful of evidence.

Dr. Crockett's receptionist, Toni, answered. We listened in as the the crimes unfolded...

"Hello? Oh, hi ... Yes, this is Dr. Crockett's office. No, wait Mrs. Sparks," she said. "Calm down. Did you or did you not say you wanted the orthotics? What made you think you can take them and then not pay for them? No, I never said that. I don't know why they rejected the claim. Don't blame me...I called your insurance and they told me they'd pay, so how is this my fault? No. No. That's not true. There's nothing I can do at this point. Wait, my other phone is ringing...hold on a sec..." Without waiting for a response, Toni placed this patient on hold to answer another incoming call and proceeded to tend to the second phone call, leaving Mrs. Sparks "hanging..." It was apparent she was in no rush to get back.

We were flabbergasted. This was just ONE phone call but in a matter of THREE minutes, TEN unnecessary crimes were committed. 1- Toni did not identify the office or herself upon answering, 2- No smile (hard to sound warm and welcoming without that smile!); 3- Was confrontational and argumentative; 4- Accusatory; 5- Defensive; 6-Did not offer any help or solution; 7-Did not empathize with Mrs. Sparks's situation; 8- Did not wait for permission before automatically placing her on hold; 9- Informed the caller she'd be on hold for "just a sec"; 10-Did not follow proper call priority by taking the second call, placing the second caller on hold and going back to Mrs. Sparks's call. After all was said and done, the biggest crime of all was that the patient was not "still hanging" when Toni finally made her way back to her and likely would also not return to the office as a result of the way she was treated. It was clear that Ms. Toni needed an important lesson in telephone etiquette and we deduced that in order to make any kind of breakthrough, we decided to start from scratch.

Aside from some very basic rules like answering calls promptly (within 2-3 rings) and projecting a tone that is enthusiastic, natural, attentive and respectful; Toni was taught that she should always first identify herself as well as the practice or doctor name. Then, during the course of the phone conversation, she was told that these additional rules of telephone appropriateness must absolutely apply:

  • When dealing with a problem, remain calm; don't raise your voice. This will only make the situation worse. If you feel like your "hot buttons" have been pressed, offer to call the patient back in a few minutes, so that you can compose yourself, collect your thoughts, review their account and continue the conversation without taking things personally.
  • Always be courteous; remember your manners. "Please" and "Thank you" never get old.
  • Be Tactful. Don't lecture, accuse or blame the caller ("You should have...") In fact, beware of starting your sentences with "you" as this, in and of itself, can be provoking.
  • Don't be confrontational ("That is not true") or diminish their problem. Regardless of how inconsequential it may appear to you...it is never trivial to them.
  • Refrain from saying..."I don't know." Say instead... "That's a good/fair question...let me find out for you." Be willing to help them solve their problem. Offer to do what you can to remedy the situation. Toni could have turned "There is nothing I can do at this point" around by re-framing it into what she COULD do. For example, saying "I will send in an appeal to your insurance company with the name of the person I spoke with who said your coverage provides for custom made orthotics and see if we can't get them to reconsider your claim" is something that would have appeased the patient.
  • Listen! Give your caller your undivided attention. Allow them to vent. Empathize and acknowledge their feelings. You can be sensitive, even if you may not agree with them. Don't be afraid to apologize and mean it, even if it isn't your fault..."I'm sorry this has happened, Mrs. Sparks."
  • Accept responsibility and if you do offer to help, always follow through or you will jeopardize your (and the practice's) credibility.
  • Avoid using harsh and unhelpful words like "NO!" The word "no" represents the ultimate rejection and only leaves the caller more frustrated. Find a way to state the situation positively.
  • "Hold on for a sec..."? Seriously...just pressing the hold button takes a second. Anything more than that takes time. Be honest, not unrealistic. If you expect you cannot get back to someone in a reasonable amount of time (a couple of minutes), then offer to call them back at their convenience.
  • Always ask for the caller's permission before placing them on hold and remember that call priority applies when answering multiple lines. Check back with the caller every 15-30 seconds so that they do not feel forgotten or arrange for a call back if the caller must hold for more than a couple of minutes. When returning to your caller, always thank them for waiting.
  • At the end of your conversation, thank your caller for calling and invite them to call again.
  • NEVER hang up the phone before your caller does. Just saying "goodbye" does not necessarily mean the conversation has ended.

First Impressions are Lasting Ones. The phone is many times your patient's first contact with your practice and if used properly, it can open opportunities for you to shine and build rapport with your caller. If not, it can destroy the relationship. Once you have their attention, aroused their interest and curiosity and gained their participation, the impact you make is within your control. Like any other tool we operate, however, before it can be handled with any skill, it requires proper training. Toni was not permitted to take phone calls until she proved she was capable of doing so. We first required she answer the phone professionally, "Good morning/afternoon/evening, Dr. Crockett's office, Toni speaking, can I help you?" and then role-played several difficult situations with her - from angry patients to overly-talkative, aggressive, passive and inquisitive ones until we were satisfied with her responses.

Unfortunately, answering the telephone is so much a routine, that we can sometimes take it for granted. Qualities such as friendliness, positive attitude, helpfulness, voice clarity and inflection, good listening skills, confidence and empathy all require constant conscious effort, and when Toni learned to deliver them naturally, she used them to convey believability to her callers. She also made a point of ending her calls on an UP note because like the "PS" of a letter...people remember what they hear last.

Finally, we left her with this closing lesson. As sure as you REMEMBER THE ALAMO...REMEMBER TO SMILE! There is no better way to communicate a positive attitude and energy to your patient than a smile and even though they cannot see it, they can hear it in your voice. Try it yourself...smile big and say "Have a rotten day!" It still sounds positive. We put a permanent smile button on Toni's phone to remind her to smile every time she picks up the phone to speak.

We officially left the San Antonio crime scene, but our follow up is critical to our success. After returning to our headquarters, we called Dr. Crockett's office anonymously to hear our training in action...and we got our answer. This time, WE smiled when we heard a pleasant voice on the other end of the phone say, "Dr. Crockett's office, Toni speaking, can I help you?" Wow...nothing "phoney" about Toni in San Antonio now... and the legend of Dr. Crockett continues!