Phone Policy Update

We have witnessed a huge demand for our services in the past six months. The corresponding phone calls have risen to an unmanageable level.  After being gone for a week to a headache meeting we came back to 46 phone messages and another 15 came in as soon as the phones were turned on.  As usual, we had an overbooked schedule. In our typical day we start early in the morning and work late with no breaks. There is no time to sit and chat on the phone with anyone, unless we leave a patient, whom we care a great deal about, sitting in the room.

While phone calls are part of any medical practice, there are reasonable phone calls and those that seeking medical management by phone. The latter ones are inappropriate  because we cannot deliver a high standard of care when someone calls and ask for medical advise while we are sitting and listening to another patient.  I have updated our phone policy and will post it below. It tries to distinguish between what are appropriate and reasonable calls and what are medical management issues disguised as phone calls. Medical management can only be done with a high quality of care in the setting of a designated visit, either in person or a virtual visit.

 Phone Policy 

The charter and only goal of the Pacific Rim Headache center is to bring the highest standard of headache and face pain care to the greatest number of patients in the most compassionate setting. In recent months the demand for our services has grown exponentially as have the phone calls. We must enforce our telephone policy better to support our original mission.

A provider cannot provide the high standard of care that we offer when complex medical management is done over the phone for one patient while in the room with another and we are always in the room with patients. The purpose of this guide is to differentiate between reasonable communications and what constitutes medical management. Medical management requires a careful review of the patient’s record, written documentation of the entire conversation, review of the present and past medications, allergies, compatibility with new treatments and communication with a pharmacy. This takes at least 20-30 minutes of devoted time. Going forward, this can only be done in the setting of a scheduled personal or virtual appointment.

Customary Phone Calls and other Reasonable Communications:

  • To schedule or reschedule appointments.
  • To report side effects of treatment.
  • To go on to “plan B” treatment, which was established at the previous appointment.
  • To ask for refills. It is best to have your pharmacy request refills electronically as that saves several steps. We try very hard to give enough refills to last from one appointment to the next. We never make unnecessary appointments. If you choose not to keep the needed follow-up appointment, please do not ask for refills.
  • To ask about the results of a test we ordered.

Medical Management Issues that Always Requires an Appointment:

  • The program for prevention is not working or has stopped working. It takes at least three weeks of continuous use to determine if something is working.
  • You are in crisis with a bad headache and the home treatments are not working. You are welcome to make an acute treatment appointment at our office. If it is after hours you may go to an ER. On the next office visit we can address this failure and try to methodically create a better plan.
  • To discuss a new symptom always requires a new appointment.
  • To discuss something you have heard about headaches requires an appointment.
  • To complete FMLA, disability or other forms requires an appointment.

You can reach us at Phone: 360-588-1460 or e-mail: We take messages first come first serve and we do our best to get back as fast as we possibly can but it can take up to 48 hours depending on demand.