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Firmness, tact can reduce disruptions caused by cell phone use

A column about keeping your practice in good health

By Victoria Stagg Elliott is a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009. Posted Oct. 25, 2010.

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Cell phones have become both the bane and boon of modern life. Experts say medical practices need policies to make it less likely that a patient taking a call during an office visit will throw a physician's schedule off track, or that text messages and Facebook postings will distract employees.

"It's an issue of respect," said Jennifer Souders, administrator of Hilltop Family Physicians in Parker, Colo. "Patients should give undivided attention to physicians or staff. Staff should be giving undivided attention to patients."

And, no, a sign saying "Please turn off your cell phone" is not enough.

"I have seen practices post signs," said Rosemarie Nelson, a consultant with the Medical Group Management Assn. "I think space in the waiting room can be put to better use."

Experts suggest that staff tell patients that cell phones need to be turned off or silenced, either during check-in or when directing patients into exam rooms.

"If you say it to people, they will understand," Nelson said.

If the phone still rings, or if a patient is on the phone during a visit, a physician can ask him or her to put it away. Practice management consultants suggest that what is actually said should reflect a physician's style and balance the need to maintain the focus of the visit with the fact that patients may change doctors if the situation is not handled well.

"You don't want to be too abrupt," Nelson said. "Everyone can create their own little shtick. I suggest: 'Are you ready for me, or do we need to reschedule?' "

Though cell phones may have some benefits to medicine and patient health, their use in a medical office often presents a challenge. Research suggests that photos taken by the devices can aid in the diagnosis and treatment of minor wounds. Public health agencies have long been sending various messages by text.

"I think almost every day we have a patient using a cell phone," said Alvia Siddiqi, MD, a family physician with Alexian Brothers Medical Group in Elk Grove Village, Ill., and a member of the board of directors of the Illinois Academy of Family Physicians. "We have to get them off the cell phone and directed toward the office visit. They need to truly be there for the visit and not feel like they are being pulled in different directions."

Her practice does not have signs posted. Nurses and other office staff usually tell patients to turn off their cell phones.

Limited cell phone use

Some practices have developed policies allowing patients limited use of cell phones in the office, in part to improve customer service but also in recognition of the increasing presence of cell phones in daily life.

Connecticut Family Orthopedics, a nine-physician practice in Danbury and Ridgefield, has signs asking patients to turn off their cell phones. If patients receive a call in the waiting room, they are instructed to take the call outside. If a staff member calls their names and they have not returned, the physician takes the next available patient.

"If you are a patient and you take a phone call and have to leave the building, we will not chase after you. [We will] take the next person," said Gabe Carubia, the group's practice administrator.

If a patient takes a call while in an exam room, a physician will move on to the next available patient, returning when others have been cared for and the call has been finished. "They don't hang out and wait. There is no time for that," said Carubia, president of the Connecticut chapter of the MGMA, who was speaking personally and not for the association.

The policy accommodates patients who need to take calls, but it still keeps the medical practice moving.

Some cell phone conversations that interrupt a visit may be urgent. Patients rarely complain if this means a visit is later than originally scheduled and usually are amenable to the explanation that the physician or other clinician did not want to interrupt the call.

"Sometimes patients have to take a call, and we understand," Carubia said. "We consider our patients customers, and you have to pay attention to customer service or the patient will go to the next practice. If there's a question of why a physician left the room, they say, 'You answered a call. I didn't want to interrupt you. Let's pick up where we left off.' "

Staff policy is different

Medical practice managers say, however, that policies for staffers need to be far less accommodating. Text messages, social media postings and cell phone calls can distract from work tasks. In addition, patients may be turned off by staffers who are paying attention to mobile devices rather than patients.

To address this, many practices say staffers may take cell phone calls or use other tools on handheld devices only during breaks. At other times, the devices should be turned off or silenced because even the vibrate setting can be distracting.

Some ask their staffers not to bring their cell phones into the building, because a flash of light indicating a call or a message can take the focus away from the job at hand.

"I take a hard line with my staff and ask them to leave the phone in the car," Carubia said. "If your child or somebody else needs to call, they can call the main line [of the practice]."

Victoria Stagg Elliott is a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009.

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