How We Are Designing a Medical Practice That Does Not Depend on the Telephone
- John Kim
- Aug 2
- 7 min read
Yoon Hang Kim, MD, MPH
Board-Certified in Preventive Medicine | Integrative & Functional Medicine Physician
Disclaimer: This article is for educational and informational purposes only and does not constitute medical advice, nor does it establish a physician-patient relationship. The communication systems described reflect one practice's approach and may not apply to all clinical settings. Always consult a qualified healthcare professional and ensure compliance with applicable federal and state regulations, including HIPAA, when designing clinical communication workflows.
For decades, the telephone has been one of the primary ways clients communicate with medical practices. It is also one of the least efficient.
Phone calls interrupt clinical work, require both parties to be available at the same moment, create opportunities for miscommunication, and often leave little or no documentation in the medical record. Voicemail adds another layer of delay, leading to repeated calls, missed connections, and frustration for everyone involved.
At www.directintegrativecare.com, our goal is not to become less accessible. Our goal is to build a clearer, more reliable, and more secure communication system. When every person knows exactly where to go and which channel to use, the telephone becomes largely unnecessary.
Different People Need Different Communication Pathways
One reason practice communication becomes difficult is that every message enters through the same channel.
A prospective client may call to ask about services. An established client may call with a medication question. Someone else may need a receipt, a scheduling change, or help accessing the portal. When all of these requests arrive through the telephone, they compete for the same limited attention.
A better system separates communication according to the person's relationship with the practice and the purpose of the message. Our communication pathway is designed around three primary groups:
Prospective clients
Existing clients
People with general administrative questions
Each group is directed to the channel best suited to its needs.
Prospective Clients Begin With the Website
People interested in becoming clients should begin at www.directintegrativecare.com. The website allows prospective clients to learn about the practice, understand the model of care, and determine whether the services appear appropriate for their needs. Those who wish to explore further can complete the Contact Us form.
This is more effective than beginning with an unscheduled telephone conversation. The form gives the practice the information needed to provide a consistent response and to guide the person toward the correct next step.
It also helps establish an important expectation: an initial inquiry is not the same as establishing a physician-patient relationship. Medical advice cannot be provided to individuals who are not clients of the practice. The website offers prospective clients an appropriate way to learn about the practice without creating confusion about whether individualized medical guidance is being offered.
What Happens After a Missed Call?
When a telephone call is not answered, the caller receives an automatic text message directing them to the correct starting point. A typical response reads:
“Sorry we missed your call. If you are interested in becoming a client of Yoon Hang Kim, MD, please visit www.directintegrativecare.com and complete the Contact Us form to begin the process.”
This response does more than acknowledge the missed call. It immediately gives the caller a clear action to take, so there is no need to leave multiple voicemails or keep calling in hopes of reaching someone. The process can move forward even when the physician or staff is seeing clients, completing documentation, or working outside normal administrative hours.
Existing Clients Use Secure EHR Messaging
Once someone becomes an established client, client-specific communication should occur through the secure messaging system within the electronic health record. Our practice uses Practice Better for secure messaging, forms, scheduling, and other elements of the care process.
Secure messaging offers several important advantages. It protects privacy. It keeps communication connected to the client's medical information. It creates a written record of the question and the response. And it allows the physician to review the message at an appropriate time, rather than being interrupted during another client's visit.
This is especially important for communication involving:
Symptoms or changes in condition
Medication questions
Prescription concerns
Laboratory results
Treatment responses and adverse effects
Follow-up questions and other client-specific clinical information
Secure messaging does not mean that every medical problem can be resolved through a message. Some concerns require a scheduled telephone, video, or in-person evaluation. The purpose of secure messaging is to ensure that communication begins in the correct place and can be properly documented and triaged.
Not Every Communication Method Is Clinically Equivalent
The method of communication directly affects how much information a clinician can obtain.
A text message provides a limited amount of information. A telephone conversation provides more, because the clinician can ask follow-up questions and hear the client's tone, breathing, speech pattern, and level of distress. Video generally provides more than telephone, because visual observation becomes possible. An in-person evaluation typically provides the greatest amount of clinical information, since it may include a physical examination, vital signs, direct observation, and immediate testing.
Communication should therefore follow a practical hierarchy:
Text or secure message — appropriate for straightforward updates or administrative questions.
Telephone — appropriate when a real-time conversation is needed.
Video — necessary when visual assessment would improve the evaluation.
In-person or emergency care — required when the concern cannot be safely evaluated remotely.
A well-designed system does not treat all concerns as though they can be handled through the same medium. It matches the concern to the channel that can evaluate it safely.
Email and Spruce Have a Limited Role
Email and Spruce may still be useful for general administrative communication, but they should not be the primary channels for established client care. They may be appropriate for issues such as:
General practice information
Nonclinical administrative coordination
Basic scheduling assistance
Technical problems accessing the portal
Documents that cannot be transmitted through the preferred system
Medical questions and client-specific treatment discussions, however, should move to secure EHR messaging whenever possible. Maintaining this distinction prevents important clinical information from becoming scattered across multiple platforms.
Onboarding Should Teach the Communication System
Communication expectations should be established before the first appointment, not after a problem occurs. A structured onboarding process includes:
Review of the practice and membership model
Completion of the appropriate agreement
Submission of payment
Creation of the Practice Better account
Completion and electronic signature of required forms
Verification of identity and state of residence
Scheduling of the initial video appointment
Education about secure messaging and communication policies
By the time of the initial appointment, the client understands how to contact the practice, where to send clinical questions, and which types of concerns require a scheduled visit. This reduces confusion and prevents clients from defaulting to repeated phone calls.
Meet-and-Greet Options Should Be Clearly Defined
Some prospective clients want an opportunity to learn more before enrolling. Rather than handling these inquiries through open-ended telephone calls, the practice offers clearly defined options — for example, a brief telephone meet-and-greet during designated hours, or a longer paid video meeting for someone who wants a more detailed discussion.
These conversations are intended to help a prospective client understand the practice. They are not substitutes for a medical evaluation and do not establish a physician-patient relationship unless the formal onboarding process is completed. Defined options protect the physician's time while giving prospective clients an appropriate opportunity to make an informed decision.
Communication as a Healing Partnership
This system is not only about efficiency. It reflects a conviction about what the healing relationship requires. In a membership-based practice, the relationship between physician and client is a partnership — a healing partnership, a term I use deliberately, because it implies mutual responsibility. I commit to availability, thoroughness, and the kind of unhurried attention that insurance-based models rarely permit. In return, I ask clients to communicate consistently, honestly, and through the channels designed to support that communication.
I have learned this lesson through experience. Early in my practice, a client became non-responsive. I reached out through the portal, secure email, and secure text — more than three times. The experience taught me that silence is not neutral in a healing relationship; when communication stops, the partnership stops functioning, even if the membership technically continues. Since then, I communicate clearly that persistent non-communication, after documented outreach through multiple channels, may result in discharge from the practice. This is not a punitive measure. It is a reflection of what this model requires to work.
Clear Boundaries Improve Access
Practice boundaries are sometimes mistaken for barriers. In reality, unclear systems create the greatest barriers of all.
When clients do not know which number to call, where to send a message, whether an email was received, or how long a response may take, they often contact the practice through several channels at once. The same message arrives by voicemail, text, email, Spruce, and the portal. This does not improve access. It creates duplication, increases the chance that communication is missed, and takes time away from care.
A clearly designed system gives each person one appropriate next step. Prospective clients use the website. Established clients use secure messaging. Administrative matters use the appropriate administrative channel. Urgent problems receive urgent evaluation. Emergencies are directed to 911 or the nearest emergency department.
The Goal Is Not Less Communication
The goal is better communication. A modern medical practice should not require clients to call repeatedly and wait for someone to answer. It should provide a predictable pathway that works even when the physician is caring for another client. A well-designed communication system can:
Reduce interruptions
Improve documentation
Protect client privacy
Decrease duplicated messages
Clarify client expectations
Support appropriate clinical triage
Allow staff to work more efficiently
Preserve physician attention for client care
The telephone may remain available for selected situations, but it no longer needs to be the center of the practice. When the website, secure EHR, scheduling system, automated responses, and onboarding process work together, communication becomes more organized and more responsive.
The result is not an impersonal practice. It is a practice in which clients know exactly how to reach the right person, through the right channel, at the right time — reachable in the right ways.
About Dr. Kim
Dr. Yoon Hang "John" Kim is a board-certified physician with over 20 years of clinical experience. He completed an Osher Fellowship at the University of Arizona under Dr. Andrew Weil and holds certifications in preventive medicine, medical acupuncture, and integrative/holistic medicine. He specializes in low dose naltrexone (LDN), autoimmune conditions, chronic pain, integrative oncology, fibromyalgia, chronic fatigue syndrome, mast cell activation syndrome, and mold-related illness. He is the author of three books and more than 20 published articles.
Professional: www.yoonhangkim.com
Clinical: www.directintegrativecare.com
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