Phone Tag, Fax Tag, and the Patients Caught Between

The patient described in this post is a composite drawn from two patients I have cared for. Identifying details have been changed or generalized to protect privacy. The frustrations described, however, are real — and recurring.

There is a kind of patient I have come to know well over the years. They have a clear pain problem. They have already done the work — the imaging, the visits, the diagnostic blocks — and they have shown me, more than once, that the planned procedure is going to help them. And then, before I can actually perform it, we run into a wall that has nothing to do with their pain or their diagnosis. The wall is paperwork.

I want to talk about that wall, because patients almost never see it from the inside, and the time it costs is real.

Why some procedures need clearance from someone else first

Before I perform certain interventional pain procedures, I sometimes need formal sign-off from another part of the medical system. The most common example, and the one I see most often, is a patient with a pacemaker.

A pacemaker is a small, implanted device that helps regulate the rhythm of the heart. When I plan a procedure that uses radiofrequency energy — the kind we use, for example, to quiet the small nerves that send pain signals from a worn-out joint in the neck or back — the energy from my equipment can interact with the device. It is usually manageable, often very simple, but it has to be coordinated. The patient’s cardiologist, or the team that manages the device, needs to weigh in. They tell us how the device should be set during the procedure. They tell us what to watch for. In some cases, they recommend that we have an anesthesiologist standing by, ready to support the patient if anything unexpected happens.

This is good medicine. It is exactly the level of caution I want around a patient I am responsible for. If you are reading this and you are a patient considering an interventional procedure of your own, this is the work that happens behind the scenes that you usually never see — clearances, sign-offs, written confirmations that we are proceeding the right way. I would not skip this step, and you should not want me to.

The frustrating part is not the requirement. The frustrating part is what happens when we try to actually obtain it.

What “phone tag” really looks like

In a lot of these cases, the office that needs to provide the clearance is not part of our practice and not part of our health system. It might be a large specialty group. It might be a multi-site cardiology practice. It might be the VA, or another federal or coverage-driven system where the path to a specific person is genuinely difficult to navigate. Each one has its own intake line, its own fax number, its own message routing. And in many of these systems, the person we actually need to speak with is two or three transfers away from the person who picks up the phone.

So we make the calls. My medical assistant makes the calls. We send faxes. We request callback fax numbers and send our own. We leave voicemails for staff we have never met, asking them to please pass along the request. We follow up a week later. Sometimes we follow up two weeks later.

And the patient is in the middle of all of it. Their primary doctor at one of these systems may have changed. Their records may not have followed them. Their memory of who they last saw may not be as sharp as it used to be — that is not unusual either, especially in older patients. So we are sometimes trying to reach an office for a clearance about a patient whose own care team within that office has shifted, and nobody we speak to is sure who is the right person to ask.

In the meantime, the patient waits. We have had to call patients the day before a planned procedure to let them know we cannot proceed, because the clearance has not arrived in time and we cannot safely accommodate them at the surgery center. That phone call is one of the worst parts of our work. They are kind about it, every time. They thank us for trying. They ask when we can put them back on the schedule. We tell them we are still working on it.

Why we still rely on phone and fax in 2026

A fair question I get from patients all the time: “Why are you still using fax machines?”

The honest answer is that there is no unified medical record in the United States. Not really. The VA runs its own electronic record system. Most hospitals run one of a handful of large vendors — Epic, Cerner, Meditech — and even hospitals using the same vendor are often not actually connected to each other in a way that lets information flow freely. Independent practices like ours run their own systems. Specialty groups run their own. None of these systems were designed to talk to each other, and the partial bridges that do exist are slow, incomplete, and often unreliable.

So when I need a clearance from a cardiologist who works inside a different system than ours, I cannot just send a message that lands in their inbox the way an email would. I cannot pull up their note on my screen the way I can pull up notes from inside our own practice. We are back to phones and faxes — not because that is the standard of modern communication, but because it is the lowest common denominator that every system still supports.

There is a second reason we use these channels, and it matters for your safety. We document everything. Every clearance, every confirmation, every “yes you may proceed” we receive from another office is recorded, dated, filed, and kept on the chart. If anything were ever to go wrong during a procedure, that paper trail is what protects you and what protects us. It tells the story of how the decision was made and who signed off. A verbal “go ahead” in a hallway is not enough; we need a written record. The fax confirmation, awkward as it is, gives us that.

This is also why, in most cases, the right communication is between our office and the other doctor’s office — not between you and them. You should not have to be the one carrying messages between systems that should be talking to each other. We try to keep you out of that loop on purpose. When we cannot, it is because the loop itself is broken — not because we are asking you to do our job.

What I want every patient to know

If you are about to undergo an interventional pain procedure, the part you do not see is sometimes the part that is hardest. We do not just need you to be ready. We need your other doctors to be ready. We need your insurance to be ready. We need your records to arrive, your clearances to be signed, your prior authorizations to come back. When any one of those pieces is delayed, the whole plan is delayed — even if everyone in our building is ready to go.

That is not an excuse. It is a description of the system we work inside.

When there is a delay in your care, it is almost never because your physician has stopped advocating for you. It is usually because the system around your care has more moving parts than any one office can fully control.

A few things you can do that genuinely help, on the edges. If you have multiple specialists, ask each of them whether they share records with the others, or whether you need to physically request a release. If you have a portal account with one of your other care systems, log in once in a while and look — sometimes records that have not arrived in our office are sitting there waiting to be released. Bring copies of recent imaging or clearance letters with you to your next visit. The more documentation you carry with you, the easier it is for us to keep the plan moving.

But I want to be clear about something, because it matters: the work of getting clearances signed and records moved between offices is our work, not yours. You should not be the one managing communication between two doctors’ offices. When we ask for help on the edges, it is because the system has failed to do that work invisibly — the way it should — not because we are handing the job to you.

We are not giving up

I have patients I have been trying to help for a long time. Some of them are still waiting. That is hard to write, and harder to sit with at the end of a clinic day.

But they keep coming back, and so do we. We keep calling, keep faxing, keep putting them back on the schedule when the clearances finally line up. They have been patient with us in a way I will not forget, and they deserve a team that matches their patience with persistence.

If your care has been caught in something similar — phone tag, fax tag, an outside office that will not call back — please know that we are still in your corner. The wait is not because anyone has forgotten you. We are still working on it. We will keep working on it.

That is the only promise I can really make in a system like this. But I will keep making it.