Out of office, but never out of touch: Strengthening patient connections digitally

As physicians, we know that patient care doesn't stop when an appointment ends. In many ways, the work only begins once the patient leaves the exam room. The time we spend managing follow-up communication—after hours, on weekends, and even during our
much-needed vacations—is a significant part of modern medical practice.

When this communication chain breaks down, the consequences ripple through our practices - and sometimes, even our personal lives (hello, burnout). Despite our best efforts, it can be challenging to communicate with patients remotely.

The current landscape: Phones, portals and messaging tools galore

Theoretically, technology has made patient communication easier than ever, arming us with a host of tools at our fingertips. A recent survey from Sermo revealed that 92% of physicians use an EHR or patient portal to communicate with patients outside of the exam room, followed closely by phone calls at 80%, on-call service at 61%, and email at 36% - to name a few.

In reality, navigating multiple communication channels can become overwhelming quickly. Each platform brings its own strengths and limitations, and no single tool serves as a universal solution. Even when physicians take the time to master these technologies, patients may not be equally willing—or able—to embrace them. Outside the office, communication preferences can be as individual as personalities themselves, often shaped by demographic factors.

EHR portals: Secure but lacking patient adoption

The effectiveness of EHR portals is often limited by patient adoption rates, especially among older populations who may not be comfortable with the technology, as I know from my work with a largely middle-aged to geriatric population.

Another significant drawback is that portals often don’t work internationally, which poses a major hurdle. The same Sermo survey found that 31% of physicians report being unable to communicate effectively with patients when traveling abroad.

Phone calls: Familiar but frustrating

The telephone remains a staple of patient communication, but it’s far from efficient. How many times have you found yourself in a game of voicemail tag, without ever connecting? Or, you aren’t even able to leave the voicemail because the patient’s mailbox is full? An incredible 90% of physicians say they often or sometimes play phone tag with patients, with 27% noting that their patients simply never answer.

A separate Sermo survey of 50+ physicians highlighted our reliance on personal devices. When asked how they made follow-up calls recently, 78% say their mobile phones, compared to 62% who used office phones. This brings up another critical issue: privacy. Using our personal cell phones for patient calls blurs the line between our professional and private lives.

The internal medicine perspective: Unique communication hurdles

In my internal medicine practice, these out-of-office communication challenges are magnified. I'm not just communicating with a single patient; I often coordinate care with multiple family members or caregivers who are also involved in a patient’s life. A simple follow-up about a treatment plan can turn into a complex series of calls to ensure everyone is on the same page.

There are also situations involving sensitive topics—discussions about difficult diagnoses or chronic conditions—that are simply not suited for voicemail. Leaving a vague message can cause unnecessary anxiety, while leaving a detailed one is a breach of privacy.

My experiences aren’t unique to the specialty; many physicians have active caregivers involved in a patient’s care. As the Baby Boomer population ages, many adult children are finding themselves stepping into the role of managing a parent’s care. According to the U.S. Census Bureau, by 2030, all baby boomers will be older than 65. These adult children caregivers are critical to a successful treatment plan, but can be difficult to get on the phone.

Practical tips for smoother communication

• End each appointment with a new patient by asking, “How do you prefer to communicate outside of the exam room?”- While it might be frustrating to prioritize your patients' preferences over your own, in the long run, this could save you a lot of back-and-forth time. This can be a critical time-saver, especially when a patient has an ongoing condition that requires a lot of management. Each new patient (often with multiple co-morbidities or ongoing challenges from chronic conditions) is the start of a likely long-term relationship.
• Find out what time of day is best to communicate - Does the patient have a job where they can take a call in the middle of a workday? If not, could I send them a portal message during the day? And if there are more than one caregiver involved, such as two parents who might be separated, find out if they both want to be on the call.
• Emphasize being ready for a callback- Inform new patients (and remind those who are chronically hard to reach) to be ready for a call-back if they call the office. Be ready to pick up a call from the office number or another number you might not recognize. Emphasize that you understand it’s annoying to pick up unknown numbers and that we live in a culture of scanning calls due to the unprecedented volume of spam calls, but screening calls will just lead to a game of phone tag and ultimately a delay in care.
• Set expectations upfront & review out-of-office communication policies - New appointments can be overwhelming. We are asking the patient to digest a lot of new information. It’s unrealistic to also expect patients to remember the logistical operational policies of our practice at this time. A simple one-sheet highlighting what to anticipate from your practice when communicating outside of the office can do wonders. I like to emphasize typical response times, what to anticipate when calling off hours, that we will only call with an abnormal result, encourage downloading the portal app, and what to do in the case of an emergency.

As observed in the Sermo survey, phone calls are a top preferred method of communication. However, low pick-up rates can make this preferred method of communication ineffective. This is where patient dialer tools have emerged as a powerful solution for me personally. These tools, often included for free in memberships with platforms like Sermo and Doximity, are designed to address the specific pain points we face every day.

Here are a few practical benefits:

1. Protect your privacy: A key feature of these dialers is the ability to set a custom caller ID. You can make calls from your personal cell phone, but the patient sees your office number. This protects your personal number and helps maintain a healthy boundary between your work and your life. You can be at home or on vacation and still reach patients without compromising your privacy.
2. Eliminate international barriers: Some dialers also support international calling - a game-changer for physicians who travel a lot personally or for conferences. It ensures continuity of care for urgent matters without worrying about exorbitant fees or technical glitches. Many EHR systems also don’t work internationally, making it challenging to communicate with patients and their caregivers with chronic conditions.
3. Improve connection rates: When patients see a call coming from their doctor's office instead of an unknown or blocked number, they are more likely to answer. This small change can significantly reduce the time wasted playing phone tag.

The broader impact of better communication

Improving how we communicate with patients does more than save time. It streamlines daily operations, reduces delays and endless phone tag, and frees up valuable time for both physicians and staff. The result is a smoother-running practice, stronger patient trust, and potentially a meaningful reduction in burnout.

Ashish Rana is a member of the core faculty at ChristianaCare in Wilmington, Delaware, as well as a professor of medicine at Drexel University College of Medicine. He serves on the Sermo Medical Advisory Board.