Celebrating patients

7 missed opportunities Doctors can identify today that will make a dramatic impact on the rhythm of your day.

By Editor, Concierge Medicine Today

I expect too much of my Physician.

I ask too many questions.

I talk too much, and I consistently get in my head, worry, and overthink things.

Customer service and common-sense hospitality “stuff” really bug me in healthcare.

As a patient, I know how it feels to be passed off to a phone tree, an NP or PA in the practice, or thrown to the [metaphorical] wolves of the billing department.

I know what it feels like as a parent to have my son sit with a Doctor we hoped would be caring, cautious, and updated while you sit on the tip of the chair “concerned,” and in less than five minutes, they drop the standard abbreviations and acronyms and leave without the full story. Then, you find they are now giving more attention to the next chart down the hall, and the patient waiting in the exam room next door gets the laughter, time, and attention you had hoped for.

Patients know what caring, serving, and treating are within seconds. We feel your compassion and understand where this encounter will take us within a minute or two of your entering the exam room or us simply walking into the lobby.

You are known for something in your community.

Yelp! reviews and Google Reviews might tell us exactly "What you are known for ..."

As your practice grows “older” and perhaps your team gets “colder,” we'll pick up on trends in the reviews we read. Some are true. Some are not. We take the good with the bad. Some are informative and constructive and some are just plain rude.

We have identified seven "it" action items that might help you and your staff create those lasting impressions.

For starters, maybe it's a smile when you walk into the exam room. Perhaps you asked a patient,” How is school going this year?

There are a lot of missed opportunities that Doctors can find each day that can help "It" become tangible for your practice.

Identifying these "It" moments leads to growth. Growth is the bi-product of doing the right things, consistently.

Here are 7 missed opportunities Doctors can identify today that will make a dramatic impact on the rhythm of your day.

1. Be Aware of the climate you bring with you when you walk into the practice.

Author and Speaker Jeff Henderson says, "Every relationship has a climate—sunny, stormy, or even icy. And the current climate dictates the forecast. The problem is that many of us are unaware of the emotional climates we carry around with us. We affect the emotional climate [of the room] when we arrive home or step into a meeting at work. The truth for all of us is that at least one of our relationships could use climate change. And until the climate changes, the forecast will remain the same."

When you walk into an exam room, you bring a climate with you. When you walk in the back door of your practice and greet your staff first thing in the morning, you bring a climate with you.

Pro Tip! Try to start the day with your staff by giving them the courtesy of a meaningful morning greeting!

We all get stuck in our daily routines.

For example, what does your interaction with a staff member sound like if the first thing they do when they see you arrive at the practice is immediately jump into a problem?

These are challenging moments.

What about when you have a disagreement with your spouse in the morning before leaving for the hospital? How do those conversations dictate your mood and “climate” and, potentially, how do you greet the first patient of the day?

How we begin and end our days creates a natural rhythm in our lives.

The goal isn't perfection, it's progress.

If you don’t know how to do this, just start by greeting the first person you see in the practice by their first name, preferably.

Why is the "first name" important you ask?

Well, research says for example … Northwestern University found Doctors do not address patients by name in half of first-time visits, even though nearly all patients want this personal greeting, according to new research from Northwestern University's Feinberg School of Medicine.

“Greetings may seem a rather mundane part of physician-patient communication, but they create a first impression that can affect the chance of developing a therapeutic relationship,” said Gregory Makoul, lead investigator of the study, professor of medicine, and director of the Center for Communication and Medicine at the Feinberg School.

There has been little evidence to guide doctors about how they should greet patients or what patients actually expect. Makoul's study focused on finding out what patients think is an appropriate greeting. He also analyzed a sample of interactions between doctors and patients during first-time visits.

Makoul and his colleagues collected information from 415 phone surveys in which people were asked how they expect to be greeted by a doctor. Researchers also viewed and analyzed more than 120 videos of primary care visits in which the doctor and patient met for the first time.

The study, published June 11 in the Archives of Internal Medicine, reported that 78 percent of survey respondents wanted the physician to shake their hands. Nearly all patients wanted to be greeted by name, including 50 percent by their first name, 17 percent by their last name and 24 percent by both their first and last name. Most patients, about 56 percent, wanted physicians to introduce themselves using first and last names, while 33 percent expected last name and 7 percent expected first name.

Makoul's research team found a striking difference between expectations voiced in the phone surveys and the actual interaction between doctors and patients in the videos. While 83 percent of doctors shook hands in the videos, only half addressed the patient by name.

Source: Many Doctors Don't Use Patients' Names on First Visit; June 26, 2007 | by Marla Paul

To layer more onto the case for support of our topic here on the importance of Doctors greeting Patients, an interview with Ritz-Carlton's former CEO, Horst Schulze in Chief Executive said "We taught our employees no matter what you do, when a guest comes within 10 feet, you look up and greet that guest. If the guest needs help, no matter what you’re doing you help. That’s a culture of ours. That’s what we do. That works in every country. If a guest asks for directions, don’t point. Take them there. That was appreciated ..."

Ricco de Blank, CEO of Sun Hung Kai [Hotel] Properties, which owns Hong Kong’s Four Seasons, Ritz-Carlton, and W hotels, said the following when it comes to customer greetings, first-time interactions, and first-name service.

At Ritz-Carlton, every employee from vice presidents to busboys carried a small folded paper brochure called the “Credo,” a Schulze version of the Ten Commandments, dealing with everything from how to give guests directions to the elevator to treating fellow employees. From the Capella Canon, Number 8 on the expanded 24-point list reads, “Always recognize guests. Interrupt whatever activity you are doing when a guest is within 3 meters (12 feet), greet them with a smile, and offer assistance.”

2. Stay On Time Within 5 minutes and Apologize If You're Late.

"Behind schedule."

These are the two dreaded words of each Physician's day.

It's tough.

You never quite know when the wave will hit you.

It's a complex race to the finish. It's the unnecessary friction you swim against, and it's an annoyance to Patients.

Over time, it widens the gap between you and the Patient.

You're doing your best just to keep up.

Number 18 on the Capella Canon we mentioned above is, “The suggested hours of operation are guidelines, not limitations for satisfying individual guest desires and preference.”

Most medical offices in primary care and family medicine are 9-5 with after-hours and urgent care services built in. Understandable.

Sadly, when you walk into the exam room 45 minutes after you were supposed to, there's not a lot of grace. There's no reason not to address the elephant in the room [eg. you're late]. Most physicians are in such a hurry that they skip over the apology for their lateness and move right into addressing the issue in the room.

The gap widens even further.

Why?

Lack of relationship to be blunt.

Welcoming the Patient by their first name vs. just diving straight into the issue may save time, but it costs you eventually.

Neither side likes this rushed visit.

So how late or how late is too late?

A study done at San Francisco State University found that about 20% of the U.S. population is chronically late–but it’s not because they don’t value others’ time. [But] It’s more complicated than that, says lead researcher Diana DeLonzor.

“Repetitive lateness is more often related to personality characteristics such as anxiety or a penchant for thrill-seeking,” she says. “Some people are drawn to the adrenaline rush of that last-minute sprint to the finish line, while others receive an ego boost from over-scheduling and filling each moment with activity.”

Author Charles Dickens once said, "I never could have done what I have done without the habits of punctuality, order, and diligence, without the determination to concentrate myself on one subject at a time."

DeLonzor says that 45% of everything we do on a daily basis is automatic: “Our lives are filled with habits–from the way you brush teeth to how you get dressed and leave for work,” she says, adding that they’re necessary. “If we didn’t do things automatically, it would take us forever to get through our day.”

The habits of people who are always on time are highly structured. They analyze their daily activities, set routines, and stick to them on a regular basis. Chronically, late people, however, don’t have structure and often fall on the attention deficit disorder spectrum, says DeLonzor.

“Instead of thinking about why their routines don’t work and trying something different next time, chronically late people simply hope that tomorrow will be better,” DeLonzor adds.

To become punctual, DeLonzor suggests putting more routines and structure into your life. For example, do everything you can to prepare for the morning the night before.

FOR PATIENTS, according to Esquire Magazine,

DOCTOR’S APPOINTMENTS

You are always encouraged to show up fifteen minutes before your appointment time, so that you can take that filthy clipboard with the Lyrica-logo pen attached and fill out a million forms. But, especially while you’re young and your medical issues are relatively few, it turns out you can do that pretty quickly. Then you’re stuck on a leather couch watching House Hunters International until fifteen minutes after your appointment time. Nuts to that. You can push it a little bit here. Time spent in a doctor’s office is time spent contemplating your mortality, and it behooves you to minimize it.

THE RIGHT TIME IS FIVE MINUTES BEFORE THE SCHEDULED TIME, JUST IN CASE THERE’S SOME WEIRD ISSUE WITH YOUR INSURANCE.

“We must not be distracted from the four supreme objectives of any organization that wants to succeed: 1.​ Keep the customer. 2.​ Get new customers. 3.​ Encourage the customers to spend as much as possible!—but without sabotaging Objective Number One. 4.​ In all of the above, keep working toward more and more efficiency.”― Horst Schulze, Excellence Wins: A No-Nonsense Guide to Becoming the Best in a World of Compromise

One final thought from a Physician on this topic when she told me … "Years ago, I once had a patient send me a bill for her time as I was running 90 minutes late. That's the day I thought long and hard about my schedule made some leadership changes and shifts in my practice, and told myself, 'Never again.' Honestly, I was more ashamed than angry. She was right. I had disrespected her time. I valued my time as more important than hers and it was a chronic condition. As I said earlier, I’m occasionally late when I walk into the exam room. Sometimes, a true emergency happens, or an outlier event transpires. When it does happen, I try to give a very detailed account of why I was late to every Patient for the rest of the day, apologize profusely, asking forgiveness ... which, by the way, not many Doctors do, and that's the key ingredient to the process. Without it, you just piss people off. I then make sure the other person knows I'm sorry and that I take their time very seriously, and assure them it won’t happen again."

Timeliness is hard. Timeliness is good and the good stuff is always hard.

The goal isn't perfection. The goal is progress.

RELATED STORY
The Etiquette Rules of Being on Time

3. Look For Everyday Moment to Express Your Gratitude To Your Staff and Patients.

If you see your staff do something out of the ordinary and kind to a patient or coworker, acknowledge it.

Handwritten notes haven't gone out of style.

Saying something right then is also good. Don’t stop there.

People need to know their Physician is paying attention. Whether it’s a colleague or a patient, we want to know you care.

We need to know you’re watching.

It doesn’t have to be some grand gesture, just something unexpected.

If you really want to surprise a coworker, for example, write them a note at the end of the day. Handwrite the envelope and address it to their home.

Sure, you could leave it on their keyboard or their chair for them to find the next morning. That’s nice but mailing it to them directly to find a few days later is even better. It informs the receiver that you thought about them and cared enough to take 90 seconds out of your busy day to acknowledge only their actions.

This can apply to your spouse. He/she is your cheerleader. In some ways, they are a vital component of a Doctor's office. They’ve helped you with your career choices, and whether they work in the practice or not, they deserve some recognition, too!

Often, we hear from Physicians about how their spouses sacrificed to help them become who they are today. Finding a quiet moment to write them a note that rewards them with a gift of gratitude is priceless.

“Notice what your wife does regularly for you and take a moment to say thank you for it,” said one psychologist we spoke to recently about implementing a gratitude system in a medical practice. I noticed something the other day. I made dinner (which I probably do about once a week) and when we sat down to eat, my kids said, ‘Thanks, Mom; this was great.' It made me feel good. But you know what? I make dinner the other six nights a week and no one ever says 'thank you' or even acknowledges it."

Your spouse, your coworkers, and your patients may get the best part of you eight to twelve hours of every day. It's important to recognize what others do regularly for you and thank them for it the other 12 hours, too!

Just a thought.