Do UC the Doc or the Soup Nazi?

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Technology can lower costs and increase productivity; though sometimes neither. My first telecom job involved auto attendants; initially they did both. But somewhere along the line they became more focused on cost savings. Instead of simply routing calls; they attempted to service calls with various degrees of success and coronaries. I am going to try to keep this post UC focused and constructive, but there is a rant in here trying to get out.

Unified Communications was a term created to add some intelligence to voice processing. One goal might be to increase the productivity of first contacts. You hear this one frequently associated with presence. Another goal could be to treat calls with more intelligence or context. Whatever the goal, the barriers are less frequently the technologies. The bigger challenge is more likely the culture of the organization or industry. This brings me to the local medical practitioner.

Recently, I had to call my doctor’s office. They were supposed to order a new blood test, but didn’t. Anything I don’t have to do 8-5 I do later in the day. So I called my Doc after hours with the intent of leaving a reminder voice mail. I called the office number and got this familiar medical greeting: “If this is an emergency, hang up and dial 9-1-1”. Before getting into broader UC, let me just rant about this ridiculous and ubiquitous medical greeting.

First off, it seems cluetard stupid to me; a bit like preschool. “When done with the paste, but the lid back on.” If anyone thinks that that a doctor that can’t make it on-time to an appointment booked two months in advance is going to respond to an emergency faster than the 9-1-1 infrastructure, then they deserve a lesson in Darwinism. The whole message smells like lawsuit defense – “Your honor, I’m sorry the patient died while on hold, but we did say to dial 9-1-1”. But it isn’t even good lawsuit protection because the instructions are flawed. They should state “If this is an emergency, hang-up, lift the receiver again, wait for dial-tone, and then dial 9-1-1”. Or, “hang-up, dial 9-1-1 and press send”, or “hang-up, dial 9, 9-1-1″. Really, to be safe, it should state Press 1 if you are dialing from a cell phone, 2 from an analog land-line, and 3 from an office PBX”, and then provide the correct instructions. But even that is flawed because someone could say they followed the instructions and just hung-up not realizing that more steps followed.

So the 9-1-1 instructions bothered me, but didn’t frustrate me. That came next when the greeting stated that I needed to call during normal office hours and can’t leave a message. Basically the whole greeting said go away. If it was an emergency go away, if was regarding prescriptions go away, if it was for anything else- go away. Do you remember Major Major from Catch-22? “With a little ingenuity and vision, he had made it all but impossible for anyone in the squadron to talk to him.”

Unified communications has come so far. Unified Messaging, presence, mobility, APIs, FMC – all in the spirit of making communications more efficient and adaptive to our work styles. But the basic medical office still uses human gate keepers to prevent communications. We have gone from house calls to totally impersonal communication. Remember, all I wanted to do was to leave a reminder message. Now I need to waste my time to make a second call during the day, go through a gate keeper to get a message to a PA, so they can call me back with instructions. Yes, I am calling for UC medical reform with a public option for better service.

It seems to me that the medical community has placed too much value on protecting the doctor from patients. Doctors are the exact opposite of realtors which are happy to give you every possible number where they might be reachable. Doctors hide – they hide behind their own office staff and then hide behind answering services when the staff goes home. The whole thing reminds me of the Soup Nazi episode:

JERRY: The main thing is to keep the line moving.

GEORGE: All right. So, you hold out your money, speak your soup in a loud,

clear voice, step to the left and receive.

JERRY: Right. It’s very important not to embellish on your order. No

extraneous comments. No questions. No compliments.


Most discussions around UC in medical offices tend to focus on things like automatic appointment reminder calls, tele-medicine, or other measures to increase productivity and/or profits. I want to start the discussion using UC to improve doctor/patient care. Other professions, say lawyers and CPAs, are much better at this than doctors. I can call both my lawyer or my CPA and talk to them. If they are unavailable, I can leave a direct personal message. Get this, I can even book an appointment for a conference call. They understand my time is valuable too; and appropriately invoice me for their time. Why can’t doctors deal with this concept?

Doctors needs to use their gate-keepers to process the messages; not prevent them. The technology can be a huge boon to service – not just profit. I had a doctor (went out of business) that had just started embracing email. He encouraged me to take my blood pressure in those free machines when I shopped and to email the results from my phone so they could update my records. Great idea. Takes a minute; and when I see the doc annually; he can see my scores over time instead of just that day.

Doctors, particularly in private practice, are under considerable pressure to see more patients. Here is an idea, use the darn phone! Even video calls are pretty easy thanks to iChat, AIM, and Skype; easier than in the corporate space. Not all appointments require a visit or expensive equipment. A typical medical appointment lasts about 15 minutes, but consumes close to 90 minutes of time. UC discussions always include business processes, but sometimes those processes are flawed (like too much gate keeping). How about using UC to increase answering the phone and reducing communication attempts. How about sending email reminders about calendar appointments or even sending an Outlook or Google calendar appointment by email.

There is lots of talk about using UC for productivity gains – things like screen pops and automatic appointment reminder calls (post at UC Strategies). At Astricon, they demonstrated a method to use the IVR to read a practice calendar and initiate reminder calls. UC technologies are enabling things like centralized appointment scheduling and hot-desking, but the conversation is about productivity and profitability. I want it to shift to improved care.

Dave Michels