Every patient deserves your first-time energy

What do you think is the most common question that patients ask employees? Is it, "How long until I see the doctor?" or "Where's the bathroom?"

If you were asked those questions multiple times every day, at what point would you start to act frustrated with any patient who asked an employee that question?

Here's the point: The 50th person asking you where the bathroom is doesn't know they are the 50th person asking that same question. For them, it's the patient's first time asking, and your response should convey that it's the first time you've heard that question.

I have performed magic at trade show exhibitor spaces. One of the vendors hired me for three days, during which time I performed ten 20-minute shows a day – that's 30 shows!

After the final show, the vendor asked, "How is it that after doing all of those shows, you seem to be just as fresh and enthusiastic at the last show as the first show?" I answered, "I think about each audience. Everyone in the audience deserves my best effort and energy, as if each member of the audience were the first to see my performance. If I came off as bored or tired, I'd be letting them down, not to mention disappointing the vendor. So, even though I may have performed the same tricks and delivered the same lines supporting the vendor’s product for every show, each audience – even the 30th audience deserved my very best effort and energy as if it was the first performance.

Look at a server at a restaurant who recites the daily specials for the 12th time each night. Do you want to hear them deliver the menu with enthusiasm or with the boredom of the 12th repetition? If the server wants a good tip and the owner wants repeat business, then the server must be excited and enthusiastic with the presentation of the menu.

Baseball legend Joe DiMaggio understood this principle. His story is a perfect example of this concept. A reporter interviewed DiMaggio and asked why he played so hard for every game? He replied, "Because there might have been somebody in the stands today who'd never seen me play before and might never see me again."

If you have been to a Broadway Play, on the first night of a performance or the last show of their run, you will find that the energy level is the same. How do these performers generate the same enthusiasm eight days a week for three hours a show for hundreds of shows? I believe they envision each show as their first performance and want each audience to experience that same excitement and enjoyment.

I usually perform vasectomies on Friday afternoon. I find it a challenge to tell patients about the procedure, the post-operative instructions, and the potential complications multiple times each Friday afternoon. That discussion takes approximately 15 minutes. To make my same message fresh after preparing several patients , I made a video of that same discussion and ask each patient to watch the video either before coming to the office for the procedure or if they are in the office they see the video just before the procedure. Each video ends with the following message, “I hope you have found this video helpful regarding your vasectomy and I will provide you with a handout that summarizes what you need to know. If you have any questions, I will be in the room shortly to answer any additional questions you may have.” I also record in the EMR record that the patient saw the video and that I answered all his questions. I know this isn’t a perfect method of patient education, but it avoids me becoming stale after repeating the message multiple times.

I have a message on the wall of the before a procedure employee lounge where the employees enter each morning. The sign says, "You are going on stage. So go out there and light up the room." This is a reminder that the staff and the doctor have an opportunity to make each patient have a positive encounter with the practice. When we can do that, patients become raving fans and will tell their family and friends about their interactions with the staff and doctors.

Bottom Line: The best restaurant servers, athletes, trade show magicians, Broadway actors, and even doctors and medical staff understand that repetition is their challenge, not the patient's problem. Doctors and employees must find ways to keep their responses and reactions fresh, be it the first or thousandth time. This mindset transforms an ordinary patient experience into something extraordinary. Every patient deserves your first-time energy.

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Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.

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Acting classes may help physicians learn to show empathy

One of the keys to improving patient satisfaction is learning to show empathy, but this is not something that every doctor is naturally good at doing.


So how can physicians learn to demonstrate our feelings to our patients-that we care and understand their concerns? One way is by taking acting classes.

In fact, I’m firmly convinced that high school drama club taught me more interpersonal technique than anything I learned in my clinical skills medical school courses.

I’m not the only one who thinks so.

David A. Watson, MD, a family physician in West Virginia, attributes much of his success in the office to studying acting in high school and college. “I remember wanted to be an actor as early as kindergarten,” says Watson, who starred in his first school play in the fourth grade.

From that first play, Watson was hooked. He began writing and performing plays with a friend, and in high school he excelled in speech and oral interpretation classes. In college, he auditioned at open tryouts and was cast in a large role. Although he majored in English literature, Watson took many theater and acting classes, and after graduation he participated in community theater events.

Watson eventually decided to go to medical school. His career as a physician has limited his theatrical extracurricular activities, but he still uses his acting skills in the office every day.

“I remember the first time that I realized that I needed to use acting as a physician,” Watson says. “I was a young doctor, and I got my first complaint from a patient. My supervisor called me in to discuss it and said, ‘can’t you just pretend that you care?’ I was hurt! The truth is I did care-but the patient didn’t understand how I felt because I wasn’t communicating it effectively.”

Essentially, acting is communicating, explains Watson. “Acting is emoting-it doesn’t mean that you’re faking it. You’re simply putting out there how you feel.”

And indeed, a study from the American Psychological Association shows that teaching role-playing (or acting) can not only help medical students to appear empathetic but can create true empathy. This is important, because while most medical students start out with extremely high levels of empathy, the trauma of third year clinical rotations often causes those natural empathy levels to plummet. Just learning how to actin an empathetic way seems to counter this reduction in empathy. Another study corroborates this finding, showing that people who are naturally introverted are actually happier when they act, or pretend, to be extroverted.

So, let’s take a clue from Hollywood television drama and incorporate a bit of acting into our day-to-day profession, especially since when we are in front of patients, in a way we are “onstage.”

No one expects you to win an Oscar-but if you are having a bad day, you can use acting to put your own personal feelings and behaviors to the side to show your caring, competent, and compassionate qualities. It’s not so much “faking it” as learning to embody the characteristics that create a good bedside manner.

This is exactly what Watson does in the exam room, and he always starts by first asking himself: “Who is my character beyond ‘doctor?’” In other words, what kind of doctor does the patient hope to get?”

He says that you can figure this out by listening to the patient, who often tells you what they want directly- and keep in mind that patients tend to seek the qualities in doctors that they personally value or recognize in themselves. Just by paying attention to the patient, you can often determine what type of doctor they are looking for.

“Does the patient want knowledgeable, matter-of-fact, down-to-business doctor? Or is he looking for the folksy, old-time country doc? Some patients want a bit of hand-holding, while others are in search of the persuasive physician-‘help talk me into doing the right thing.’ And of course, there are patients who want the ‘customer is always right’ doctor.”

As a physician, it’s essential to ‘know your script’ before you go into the exam room. “The best advice I ever got was to know what you are going to say before you go into the room,” says Watson. “This doesn’t mean that you can’t change what you say as the visit evolves, but you should have a good idea of the message you want to communicate ahead of time.”

This is especially important during those frequently given spiels-the new diabetes lecture, why antibiotics don’t work for viruses, etc. “Even though you say it over and over again, it may be the first time the patient is hearing it. You have to say it each time like you’ve never said it before,” advises Watson. “And remember, there are no small roles, just small actors!”

So, how does a doctor without any acting experience learn how to embody a character in the exam room?

Take an acting workshop, find a community theater group online, or just get together with a friend or two to practice. Even just practicing in a mirror or videoing yourself can be helpful. “Getting feedback is essential,” says Watson. “And it doesn’t necessarily have to be dramatic acting-try a speech class or practice oral interpretation through a story or poetry reading.”

And who knows-you might just have fun doing it.

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Using natural language processing to improve prepayment reviews

Payers have traditionally relied on post-payment claims reviews to detect, prevent and correct fraud, waste and abuse, accurately facilitate claim payments and reimbursement, and ensure medical necessity of services delivered.

However, the post-payment review process can be lengthy, cumbersome, administratively inefficient, and result in provider abrasion. To overcome the drawbacks associated with post-payment reviews, payers have recently started implementing prepayment claim review programs that allow for prospective claim reviews, in which payers evaluate claims prior to rendering payment to providers.

While prepayment reviews are likely to provide greater savings, faster turnaround times and reduce provider abrasion, performing these audits accurately, consistently, and efficiently requires the utilization of technology that surfaces key information from patient records, enabling payers to determine the medical necessity of services that a patient received.

To this end, clinical natural language processing (NLP) technology has proven particularly valuable in enabling payers to read, extract, and produce clean information from unstructured data buried in the narrative sections of patient records. NLP organizes disparate, unstructured data into a comprehensive, longitudinal, and semantically interoperable patient record that captures all key health information, such as diagnoses, treatments, and care plans.

In addition, accurate claims routing and workflow plays an important role in increasing efficiency of claim reviews in a pre-pay environment. This includes document management, ensuring all pertinent information is present for a determination to be made, and a rules-driven dispatch to ensure claims are routed to an appropriately skilled auditor to optimize productivity.

Say goodbye to “pay-and-chase”
For some payers, the “pay-and-chase” post-payment review process has become deeply ingrained over many years. The process involves reviewing claims after payment, verifying whether the services described in those claims are medically justified for a given patient’s diagnosis, and then attempting to recover funds when overpayment has been identified.

This retrospective form of analysis requires a significant investment in resources for post-payment reviews and overpayment recovery efforts. In addition to the resources required to retrieve documentation from often disparate sources in a timely manner, the “pay-and-chase” process increases provider abrasion by retracting portions of prior payments which results in additional administrative overhead, detracting resources that are otherwise focused on patient care.



While post-payment reviews can negatively impact payer-provider relationships, the industry has found that “pre-submission notification,” a process in which payers alert providers of potential errors before the claim is submitted for payment, can result in goodwill from providers. By enabling providers to file more accurate claims, pre-submission notification helps reduce administrative burdens and lower costs, greatly reducing the negative experiences of providers.

Separately, Medicare administrators have experienced success in moving away from a “pay-and-chase” approach to one that involves more upfront education and technology to predict improper payments. The U.S. Centers for Medicare and Medicaid Services (CMS) in 2021 reported its lowest-ever improper payment rate of 6.26%, a substantial improvement from 2014 when the figure stood at 14%.

How NLP helps
In the past, payers have depended on costly and time-consuming chart reviews to find and extract key unstructured data from patient records and claims. In recent years, however, NLP has played an increasingly important part in confirming payment integrity prior to payment.

By giving computers the ability to read, understand, and interpret clinical language, NLP extracts and organizes data from patients’ episodic health records, enabling payers to modernize chart review processes and eliminate antiquated and bloated workflows associated with manually reading a medical record. Leveraging NLP technology in audit workflow tools unlocks the key pieces of data buried in unstructured documents to empower more accurate automation of claims management. Organizing and presenting claim-specific data elements to auditors provides a rapid and efficient path to determination.

A significant advantage of NLP is that chart reviews can be performed just one time to extract all key patient data, as opposed to multiple reviews by multiple clinicians, researchers, or auditors who are all looking for different pieces of information. Further, NLP technology is a key component of interoperability between healthcare information systems, structuring and standardizing health information from a wide variety of sources including claims and patient charts.

In cases when payment integrity is in question, there is often a pattern of repeatability in the data, such as a large number of patients meeting the same prior authorization requirements. NLP helps payers detect these patterns that lack the natural variability found in legitimate patient records before claims are paid.

In the same respect, NLP can help payers spot unusual data that may be representative of fraud, such as expensive tests for which there is no medical necessity. With its ability to accurately analyze unstructured data to identify anomalies within records, NLP can quickly verify the presence, or lack of, substantiating data.

Post-payment claims reviews are a backward-looking process that should largely be confined to the healthcare industry’s past. In contrast, with prepayment reviews that leverage NLP to surface new insights from unstructured patient data, payers can improve the speed and accuracy of claims adjudication while cutting administrative costs. This ultimately improves a payer’s cash flow by saving millions of dollars from leaving the organization in the first place.

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The magic of 'I’m sorry'

Most fairy tales begin with “once upon a time.” There’s another fairy tale in the healthcare profession that once upon a time, the initials “M.D.” after your name indicated status, trust, and perfection. Most physicians appreciate that elevated status, infallibility, and blind trust by our patients in their physicians are long gone and are the stuff of fairy tales.

We believe that the Internet has leveled the playing field of knowledge between patients and physicians. Also, the media has highlighted the errors and mistakes and have hung out our dirty laundry for the public to see.

Then there is the Institute of Medicine’s study in 1999, which chronicled nearly 100,000 deaths\year because of medical errors. Certainly, we can’t overlook the legal profession constantly nipping at our heels, threatening litigation when the outcome is less than perfect.

What can we do? We can continue to assume a policy of denying and defending the situation when there is an undesirable outcome. Or we can adopt an apology policy.

Perhaps after reading this blog, you will understand that we are not perfect, nor are all our diagnoses, treatments, and recommendations. Perhaps an apology will mollify a patient having the knee-jerk reaction of considering litigation when things don’t turn out as planned.

“I’m sorry” is one of the most used phrases in any language. Most of us don’t think twice about offering an apology when we unintentionally bump into a stranger on the sidewalk. However, when we have made a medical mistake, the words seem to get stuck in our throats and become difficult or impossible to express.



We begin learning detachment the moment we begin our medical training. This is compounded by the fact that we have less time to spend with patients and are often wary of engaging our patients in honest, open dialogue. In addition, our malpractice insurers tell us that an apology might be interpreted as an admission of fault or negligence that could make defense difficult if the patient proceeds with a lawsuit.

The likelihood of being sued is significantly decreased as communication skills are increased.

Physicians with the best communication skills ask the patients more questions, encourage patients to talk about their feelings, use humor when appropriate, and educate patients about what to expect during their treatment. Those with enhanced communication skills spend just a few more minutes with their patients, about three minutes per visit, than those physicians who have been sued. A lawsuit decreases by 50% when an apology is offered, and the medical error is disclosed in a timely fashion.

How can we effectively apologize without admitting guilt or wrongdoing?

An authentic apology is heartfelt and driven by genuine regret or remorse. There are five reasons to consider an apology:

• Shows the patient you respect them
• Shows you are taking responsibility for the situation
• Demonstrates you care about the way the patient feels
• Demonstrates your empathy
• Results in dissipating anger

Patients want to know what happened, why it happened, how the problem or error will affect their health in the short and long term, what is being done to correct the problem, who will be responsible for the cost of the error or complication, and finally, what the doctor is doing to avoid this happening again.

Bottom Line: The take-home message: Perhaps when we are comfortable with the words “I’m sorry” and can say them easily and sincerely, we can expect better healthcare, increased job satisfaction, and lower malpractice premiums.

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