When employees walk away from the job

Guest Post
Melissa Young, MD


My practice has had a fairly stable staff for the last several years, but I’ve had my share of unpleasant employee exits.


There was one who gave notice but one day up and left without saying a word.


There was another who quit but claimed I fired her. We were on the phone with unemployment, and it was her turn to tell her side of the story. She started with, “Well, Dr. Young was in another one of her moods…” I listened in angry silence. When it was my turn, I was honestly confused and asked, “I just want to clarify, she gets to collect unemployment even if she has a new job?” I knew she did since she wrote “start new job” on her desk calendar and told another employee all about it. Needless to say, she was ineligible to collect.


And then there was the one who was technically employed for about a month but was only physically present for a week. Someone was always sick, had to go to the doctor, or the car broke down.


But even when employees don’t give you troubles like these, they can still cause headaches.


An acquaintance of mine recently had a long-time employee who just disappeared one day, along with hundreds of dollars in cash and a few items from the office. There was proof should she wish to prosecute, but it’s more than the theft. She feels betrayed and violated. Now that former employee wants her last paycheck. It is our understanding that, by law, she cannot withhold this from the employee.


Some people are telling her to send the check and let it all go. That it isn’t worth the hassle for a few hundred dollars. Then there are others who feel she should fight this on principal because the employee committed a crime and should be held accountable. That a police report should be filed. Some have suggested deducting the losses from her paycheck but as far as us non-lawyers can tell, that’s not legal.


Regardless of what is legal or what a lawyer might advise, she has still been hurt by this employee's actions. Those actions are likely to cause a ripple effect throughout the physician's exisiting and future relationships with co-workers and staff. The theft is more than a monetary loss. It's a violation of trust.


What can physicians do to protect themselves from theft in the office? A good background check and references are helpful prior to hiring. Establishing a system of checks and balances system for cash transactions at the front desk is also important. No one person should be solely responsible for all the financial transactions. Physicians may also consider investing in security cameras. If there are any valuables or controlled medications, a good inventory must be kept.


Most physicians in solo practices are so busy seeing patients and running the practice that they don’t have time to serve as human resource managers and security officers. But we must find time to take steps to prevent such events when we can. Otherwise, we will pay the price.

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How to improve interactions with special needs patients

At the age of five, my brother, Guy, ran into the street and was hit by a truck while flying a kite. He suffered a traumatic brain injury and remained at the cognitive level of a 5-year-old for the next 53 years.


Since then, I have been fortunate to work with those with special needs, volunteering locally every week and with Special Olympics. I have witnessed firsthand peoples’ struggle to communicate with those with special needs.


As a certified physician assistant (PA) specializing in neurosurgery, I work regularly with other medical providers and special needs patients. From my personal and professional experiences, I can offer five suggestions that may help clinicians provide the best quality care to those with disabilities.

Prepare for the encounter in advance by reviewing patients’ histories.

Being prepared is paramount to a successful encounter for both clinicians and patients. The complex challenges of those with special needs requires extra preparation and a thorough review of their history. For example, if the patient has a central nervous system deficit, flaccid paralysis, or spasticity is consistent with their baseline, we clinicians must understand these crucial parameters.


Also consider in advance who will chaperone the patients. Wherever patients reside, it is imperative that they be accompanied by a reliable caregiver who is familiar with their activities of daily living and physical, social, and intellectual norms versus a driver who transports patients to the clinic. In a perfect world, physicians could schedule a phone consult before a visit with a caregiver/family member to better understand how they can make the visit most comfortable for patients.

Assume patients with disabilities understand what is being said to them.

It is common for clinicians to be uncertain about how to communicate to the patients for fear they may not understand questions or comments.


In most circumstances, speak to patients with disabilities first, even if patients are nonverbal, visually impaired, and/or have a blunt affect. We do not know how patients interpret interactions. Many clinicians assume that if the patients cannot see or speak, they may not comprehend what is being said. The human mind/body is extraordinary and will elicit clues and sensory mechanisms. We should not underestimate their ability to understand. After speaking to patients, it is also vital that the caregiver/family member then share their insights and answer pertinent questions for clarification.


I speak from personal experience. When I would escort my brother to a medical appointment, physicians would ask complicated questions directly to him, aware that he could not fully understand the question. However, he greatly appreciated that he was being spoken to directly. Guy would try to answer the questions as best he could. I would wait until Guy finished commenting, and then sensitively offer additional clarification to the questions.

Remember a disability is different than an illness.

While illness and disability can coexist, it is important to separate the disability from the acute care treatment plan. Patients and the caregiver/family member do not feel the disability needs a cure. Treating the disability as an illness inappropriately perpetuates the “sick” role and is ultimately disempowering for people who struggle with challenging conditions.

Allow additional time for visits.

Patients with disabilities need more of clinicians’ time than nondisabled patients because of their physical, communication, and cognitive barriers.


Patients with disabilities may need more time to express themselves, or they might use technological aids that delay the process. They may also need extra time dressing and undressing or require more time for clinicians to position and examine them.


When the family member/caregiver attends appointments, three-way conversations are more time-consuming. Patients with a cognitive disability require more detailed or simplified instructions and explanations. Some also require written material to support verbal directives.

Consider their vulnerabilities.

Patients with disabilities are more vulnerable to secondary complications, such as unattended minor infections that progress quickly to major infections. Patients with disabilities may also be economically vulnerable, age prematurely, or be at increased risk of physical, sexual or verbal abuse. Clinicians who look for these risk factors can offer a line of defense by recommending community resources or referrals.


Patients with disabilities afford us the chance for immense professional growth if we welcome the opportunity to remain clinically teachable and emotionally compassionate to those with special needs.

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What patients wish you said

Imagine you are a patient rather than a healthcare provider at your practice. Now, complete the following sentence: “I wish my healthcare team would communicate more clearly about…” What was your response?


Patients have strong feelings about what healthcare teams are and are not getting right when it comes to communicating with them. Understanding patients’ wishes helps healthcare teams create better care interactions and support patients both during and in-between appointments. Of course, knowing what patients expect when it comes to communicating about their healthcare can be challenging. But, when healthcare providers understand what patients want and expect from healthcare interactions, they can do a better job of creating healthcare experiences that satisfy patients.


West, a patient engagement communications provider, recently surveyed 1,036 adults and 317 healthcare providers in the United States to learn more about patients’ communication preferences. Survey findings identified 10 types of communication that patients say are important to them. Their communication wish list revolves around themes of prevention, disease management, and billing transparency.

Patients prioritize routine and preventive care outreach

Patients say they want more support from their healthcare providers between appointments so they can better manage their own health at home. West’s survey showed patients think it is important for providers to make communications more prevention focused by helping track lab results (77 percent); recommending and scheduling preventive tests and screenings (71 percent); sending text messages and participating in online chat sessions (60 percent); and using automated text, voice, and email reminders to encourage prevention and promote routine health management. Here’s a closer look at the prevention-focused communications patients want:


Updates about lab tests – Routine screenings and lab tests are an integral part of preventive care. Depending on the circumstances, waiting for lab results can range from mildly annoying to downright nerve-racking. It is not uncommon for patients to experience anxiety, worry, or fear when they are waiting to get their lab results. West survey data revealed nine in 10 providers (91 percent) agree that it is very or extremely important to communicate with patients about the status of their lab results. Healthcare providers can make the wait for test results less stressful by using their patient engagement technology to send patients messages so they know how and when test results can be retrieved.


Recommendations for preventive services – Patients rarely know when they are due for preventive exams or what screenings they need. Worse, many aren’t receiving guidance from their healthcare team. More than one in three patients (36 percent) report their healthcare team does not proactively recommend preventive screenings or they do a poor job communicating which preventive services are needed. Sending automated messages to let patients know they need to make an appointment for an annual exam or preventive screening, such as a mammogram or colorectal cancer screening, is simple and creates awareness about preventive care.


Text Messages – In the past seven years, patients’ interest in texting with providers has doubled. Texting is a widely popular form of communication, so providers shouldn’t be surprised that patients want healthcare professionals to text them. However, many providers have been slow to adopt texting. Nearly one-quarter (24 percent) of patients say they do not receive text messages from their healthcare team. Using patient engagement technology, providers can easily send patients mass or one-to-one text messages about routine care and prevention.


Health management advice – Patients welcome tips and information they can follow at home to maintain their health. A reminder to get 30 minutes of physical activity daily, recipes and healthy eating tips, or an invitation to join a smoking cessation program are just a few examples of the types of automated communications providers can send patients to encourage prevention and wellness. Although patients say they want to receive automated text messages, voicemails, or emails with prevention-themed advice, 21 percent of patients don’t currently receive these communications from their providers.

Disease management support is in demand

Approximately half of adults in the United States face the daily struggle of having to manage a chronic illness, and they don’t want to do it without help from their healthcare team. More than three in four chronic patients say it is very important for providers to give them personalized disease management recommendations based on their specific needs (78 percent) and help them understand their current and target health metrics (76 percent). Sixty-four percent of patients with a chronic illness want to receive medication reminders while 53 percent want providers to administer surveys or check-ins to monitor conditions, assess health risks, and help manage their chronic conditions. Here are examples of how providers can offer patients communication to support disease management:


Personalized recommendations – Nearly all (95 percent) healthcare providers agree it is important to give patients personalized—not generic—recommendations targeted to their conditions. Fortunately, sending disease-specific communications on a mass scale is easy for providers who leverage their patient engagement technology. For example, staff can send a series of emails with tips and information on lowering blood pressure to all of their patients who have been diagnosed with high

Information about health metrics and goals – For patients with chronic diseases, tracking health metrics is the first step to improving and maintaining health. Unfortunately, more than one-third (36 percent) of chronic patients say they don’t get enough information from their providers about health metrics. Patients want more frequent communication to help them understand what their health readings are, or should, be. After discussing health metrics during appointments, providers can follow up and send patients automated messages that clearly define goals for metrics like blood sugar, weight, or blood pressure. This guidance helps ensure patients know what range they need to work toward and whether they are within their target levels for optimal health.

Medication reminders – Patients with chronic diseases often rely on medication(s) to manage their health, but many struggle with adherence. Clear communication about medication can make a big impact. For example, automated reminder messages can help encourage patients to pick up and take prescribed medications. Medication adherence surveys can be used to identify medication issues, so providers can intervene when necessary.


Monitoring surveys – Patients with chronic diseases say they would prefer for their providers to proactively monitor their health and alert them of health risks. Survey check-ins give healthcare teams a way to do that. Teams can send patients automated messages with invitations to complete online surveys on their health. Surveys can be used to identify new and worsening symptoms. When survey data shows patients are struggling, providers can escalate cases and intervene to prevent avoidable issues.

Patients want better billing transparency

In addition to health and wellness themed outreach, patients expect providers to communicate about billing. Seventy-six percent of Americans want providers to give them an easy way to understand and pay for their medical bills. And 80 percent of patients say it is very important for healthcare providers to help them understand what is covered by insurance and how much they are responsible for paying. Here is a look at how healthcare teams can grant patients’ wishes for better communication about billing:


Manage expectations for insurance vs. patient responsibility – Not knowing what to expect when it comes to medical expenses is both common and frustrating for patients. Despite wanting to help patients understand what insurance covers, 35 percent of providers give their organization a poor grade for communicating about out-of-pocket expenses. A simple action like sending an automated message prior to appointments to let patients know they need to make a copayment helps manage expectations.


Make medical bills easy to understand and pay – Patients often receive little to no information about the cost of care until they open their healthcare bills. To eliminate confusion and encourage on-time payments, healthcare teams can begin communicating with patients about billing even before bills are mailed. For example, staff can send automated messages following appointments to let patients know what services they should expect to be billed for and when. Implementing automated reminders for upcoming payments is another easy way providers can improve communication about billing.


These 10 examples are easy ways for healthcare teams to drastically improve healthcare experiences for patients. Most providers have the necessary technology in place and are already using it to deliver communications like appointment reminders. By listening to what patients want and applying existing technology in new ways, healthcare teams can deliver more of the prevention, disease management, and billing information patients expect. In the process, providers can drive better healthcare interactions.

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How to make sure you’re worth the wait

Spending the past two months in and out of countless medical appointments with an ill relative has given me an entirely new perspective about what waiting for doctors feels like. I wish I had better news for you, but the experience hasn’t always been great. And I’m not even the patient.


Physicians are busy people, so staying on top of things can be challenging. No matter how skilled you are at time management, realistic scheduling, and organizational protocols within your practice, it’s pretty much expected that patients are still going to have to wait to see you.

And that wait is getting longer. For a variety of reasons, including a shortage of doctors, fluctuations in the availability of health care insurance, and an aging population, wait times are on the uptick.

According to a September 2017 survey from Merritt Hawkins, the wait time for a new patient appointment with a physician for a non-urgent visit has increased by 30 percent since 2014 in the 15 major metropolitan areas studied.

Increasing wait times add to the pressure of doctors who are already delayed. There are two orbs to every hourglass, though, and the sands of time weigh just as heavily on patients as they do on overwhelmed physicians. Patients, too, are busy people. And the inconvenience of waiting to see a medical practitioner can add more than frustration to their hectic lives. It can also add severity to their illness or injury.

The fact is, most doctors these days are in a Catch-22 situation. They simultaneously face a steady stream of patients and a seriously stressed system. And, like the sand grains in an hourglass, sooner or later something’s going to get clogged. In the case of a medical practice, that something is efficiency.

Knowing that people are lining up to see you is a given. The question is, are you worth the wait?

Here are six things you can do to enhance the experience patients have when they arrive to see you.

1. Create a pleasant waiting area. The initial thing your patients feel when they enter your door is your practice’s ambience. Tattered furniture, faded paint, and outdated reading material leave a less than stellar first impression. Sprucing up your waiting room needn’t cost a lot of time or money, and the investment will be appreciated. Replace scruffy chairs, freshen up the walls, stream some music or video, and subscribe to a variety of contemporary publications that are of interest to all populations. The family member I accompanied to myriad appointments, a male, said at more than one medical office, “I wish they had something to read other than old cooking, decorating, and gossip magazines!”

2. Provide realistic updates. Ask your receptionist to keep patients and/or their advocates updated about delays and schedule changes. Provide as much lead-time as possible to notify them about unforeseen cancellations or appointment changes. If you’re running more than 30-minutes behind, consider having a staff member call or text patients with an update so they can amend their plans. Yes, it sounds labor intensive, but it’s also respectful. And for those who are already in your waiting room, make sure someone updates them with accurate wait times. This will allow them to take care of details like changing their pick-up time if they’ve been dropped off, alerting others they’ll be late for their next meeting, or adding time to their parking in a paid lot.

3. Review the chart before you enter the examination room. Take a moment to familiarize yourself with the patients’ complaint, referral note, or history before you walk in the door. Naturally, you’ll determine both subjective and objective perspectives of their presenting condition during your assessment and examination. But having them sit there watching you read can cause an uncomfortable gap in the relationship. Briefly reviewing their chart in advance of entering the room enables you to start the conversation at a more informed level. It also ensures that when you greet your patients you’ll be making solid eye contact with them rather than with the paper or device in your hand.

4. Be patient. Most of us feel harried when we’re hurried. That sensation is contagious. When you’re feeling rushed, so will your patients. One of the ways hurrying rears its head is through impatience, often manifested by interrupting, finishing people’s sentences, sighing, or ceasing to listen. Avoid these pitfalls by taking a deep breath and imagining the person in front of you is one of your own loved ones. How would you want them to be treated and spoken to? Keeping that image in the back of your mind will help you find the patience to hear people out.

5. Confirm their comprehension. A lot of patients will smile and nod during medical conversations, even when they don’t have a clue about what you’re saying. And if they do understand what you’ve told them, they can easily forget the details when they leave. Clarify that they have a firm grasp of all diagnoses, test results, and next steps. If you have any written materials or website recommendations as a backup, share them or write a quick note in lay terms that they can refer to. Increasingly, patients are recording medical conversations.Think about setting policies regarding this growing trend so you’re not caught off guard when it happens in your practice.

6. Honor your commitments. Patients will take you at your word. If you say you’ll follow up in two weeks, do it. If you promise to send a referral letter that day, send it. And if you ask a patient to book an appointment the following week, make sure you’re going to be in town. While time flies by for you, it can stand still for your patients. That’s why it’s so critical that you do what you say, when you say you’ll do it.

So many giant leaps have been made in modern medicine, but decreased wait times isn’t among them…yet. You can make a difference, though. By following these guidelines, rather than testing your patients’ patience, you’ll honor them by making the wait worthwhile.

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A model for positive connections

When you interact with others (staff, patients, colleagues, and family), how do you make people feel? Do they feel you have their best interest at heart?


While your medical knowledge and expertise are necessary ingredients to your success as a physician, how you interact with others is a critical but often overlooked factor. That’s because how we make people feel directly impacts the outcome of those interactions. It’s important to focus on mitigating threat that can cause people to distance themselves physically or emotionally and maximizing reward.

Many of my past articles have focused on the importance of understanding some basic brain dynamics and translating that into practical behaviors and communication strategies. Now let’s turn that into practice.

CONNECT© is a brain-based model I developed to help my clients incorporate brain friendly strategies into everyday interactions. The CONNECT model shows how to communicate in a way that creates a reward state through the release of chemicals such as dopamine, serotonin, oxytocin, and endorphins. When people feel threatened, their amygdala—the part of the brain responsible for the fight or flight response—is activated. The more threatened people feel, the less they are able to leverage their pre-frontal cortex, and the more avoidant they become.

Here are seven ways to improve interactions with others.

C = Consistency. Predictability is something the brain craves. When the brain encounters something it is has expected, it is very rewarding. Change is inherently threatening to the brain, so be mindful of providing people with adequate information and lead time so they can be better prepared. Be clear on expectations so people know what you want and/or are asking of them.

O = Ownership. Being told what to do triggers a negative response. But if people feel they have a choice and that they are given some autonomy, they can be motivated to act. Find opportunities to let others feel a sense of control. For example, let them decide how to do something or make a decision. Tell people more of the what than the how.

N = Novelty. While change is inherently threatening and boredom shuts down creativity and motivation, a state of curiosity is rewarding. Novelty and challenge create a reward state in the brain that causes people to feel intrinsically motivated, making it more likely that they will want to achieve their goals. Interestingly, our brains like to fill in gaps. We can help create a state of curiosity if we provide partial positive information, such as: “Did you know there are steps you can take to improve your blood pressure?” Asking open-ended questions is another way to encourage others to consider possibilities.

N = Need to Know. When people understand the meaning, purpose, and/or significance of their actions, they become more rewarding. The brain searches for meaning every time we encounter something new. If you ask patients or staff to do something but they don’t understand the “why,” that can trigger a threat state. Helping them establish challenging and meaningful goals they can see themselves making progress towards is highly motivating. It is a critical factor affecting job satisfaction and positive affect at work.

E = Equity. Not everything is equal, but perceptions of inequity trigger the disgust center of the brain and make it difficult to focus. People want to feel that things are fair—providing explanations about how you arrive at decisions and holding everyone to the same expectations goes a long towards creating perceptions of equity. Additionally, when people feel that their social “status” is less than that of others (we frequently, and often unconsciously, compare ourselves to others), it can trigger a threat response. Be careful to avoid making comparisons between people, such as staff.

C = Confidence. Feeling a sense of competency and capability enhances self-esteem, which creates a reward state in the brain. Situations that lower our self-esteem and confidence trigger a threat response. Help boost self-confidence by providing adequate training and instruction, by acknowledging what people are doing right (rather than focusing more on what they do wrong), and asking what they need to be successful.

T= Trust. As part of its focus on survival, the brain has evolved to quickly form in-groups (you are part of my tribe and therefore, you are safe) and out-groups (you represent a potential danger). These in and out-groups are formed easily and can lead to problems with collaboration and cooperation. One of the best ways to create a greater sense of in-group (trust) is to help people connect to their common goal (such as providing the best care we can for our patients).

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