The Executive Suite: Would you go to a doctor like you?

Neil Baum, MD

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Several years ago, I was more than 45 minutes late to see a patient who was also a good friend. When I entered the exam room, he was livid and said, "Neil, would you go to a physician like you?" Not getting the drift of his question, I asked him, "What do you mean?"

He said, "Would you go to a doctor who keeps a patient waiting for 45 minutes for a routine appointment?" I said that I wouldn't like to wait for the doctor. He told me that he didn't appreciate it either and that he wanted a copy of his records and would take his urologic care elsewhere with a doctor who respected his time. No matter how many apologies I offered and promises not to be late again, his mind was made up, and he left the practice for a new physician.

I was devastated and decided that I would not let this happen again and was going to develop a patient-centric practice.

I began by developing moments of truth (MOT) analysis. The first moment of truth is not when the doctor is eyeball-to-eyeball with the patient. I identified interactions between the practice and our patients. I tried to make those interactions as positive as possible for the patients.

Instead, the first MOT is usually the telephone.

We now have a script on each phone that asks the receptionist to smile and be enthusiastic as the smile can be heard on the other end of the line. We have a small mirror in front of the phone to encourage the receptionist to smile. Now the receptionist can receive feedback that they are smiling. That is where most patients develop their first impression of the practice.

The receptionist identifies the practice and then gives their name as there should be no anonymity. Each caller wants to know to whom they are speaking. Finally, the receptionist tries to personalize the call by using the caller's name several times during the conversation. After all, the most important word in the human language to us is the sound of our own name.

Direct the patient to the practice website. The website contains a map with directions to the office, suggestions for parking, and information about the physicians.

The receptionist emphasizes the importance of the patient obtaining authorization from their PCP, and failure to have this authorization will significantly delay their visit to the office. The receptionist tries to find out the purpose of the visit and will suggest that the patient review the educational material on the website related to why the patient is seeking an appointment.

For example, suppose the patient is referred by a PCP for an elevated PSA level. In that case, we include information about PSA testing, which also discusses free\total PSA and an explanation and indications for an ultrasound and prostate biopsy. Now the patient is educated about their problem before their visit.

To streamline the visit, the receptionist suggests that the patient complete the demographic information and the health questionnaire before coming to the office. This avoids the patient spending 20-30 minutes to complete those forms and impacting the schedule. Patients are told that completing the forms in the comfort of their homes will facilitate their visit and make it possible for the doctor to see them at their appointment.

The receptionist informs the patient about their responsibility of paying a co-pay and that they will be responsible for the entire bill if they have not met their deductible. This avoids the sticker shock when the patient receives a large bill when they complete the doctor-patient encounter.

Finally, the website mentions what instructions are necessary for their first visit. For example, if the patient will be asked to provide a urine specimen upon arrival in the office, they should consume extra fluids to facilitate this lab test. This avoids the typical scenario of patients going to the restroom before they come and having to wait 20-30 minutes for them to hydrate to provide the specimen.

The next MOT is the time spent in the reception area (not the waiting room) and the time in the exam room waiting for the physician. We have tried to reduce time in the reception area by engaging the patient in the exam room before the medical assistant or physician enters the room. New patients taken to the exam room will watch a 5-7-minute video of the practice that introduces the doctor and the office staff. This way, the patient meets the physician and other staff members involved in their care.

Finally, we suggest closing the loop and surveying the patient after leaving the office. This is important to understand the patient experience and identify any problems that occurred and provide you with an opportunity to correct them so that you can have continuous improvement and increase patient satisfaction. This improves your online reputation if the patient goes to review sites and comments on their experience with your practice.

Bottom line: I find it interesting that the Golden Rule that was given to us more than 2000 years ago still applies to today's healthcare delivery. We all need to answer the question, "Would we like to be treated by someone the way we are treating our patients?" If the answer is no, we make the changes to give each patient a positive health care experience…or the same experience we would like to have when we require healthcare.