My last post was a rant about a patient that touched a nerve. I don't have many patients like this, but occasionally a person implies that I am greedy and/or insensitive. In the comments section, regular commenter Ken O pointed out that I am not the only one who works for a living (probably sounding real smart with his British accent). Many of my patients work as well. They have limited time off from work and so want to minimize any unnecessary visits to the doctor. I think a lot of physicians forget this. We think that the world revolves around our schedule and so make things much harder on our patients.
Compounding this is the nature of a doctor's office with the unpredictability of any given day. I may be right on time or I may be an hour behind. If the latter is true, the patient is forced to wait (often without explanation) until they get the "privilege" of the doctor's attention. And not all lateness is due to the nature of the practice of medicine; much of it is due to the poor way in which many (most) doctor's offices are run (occasionally even doctors writing blog posts?). Customer service is not something most medical offices are known for - mainly because they don't have to be well-run to stay in business.
This has had its effect on the public perception. A significant portion of the ill-will doctors get is because of this "center of the universe" mentality that does not take into account the patients' needs. It's really a contradiction, in that the whole reason for medicine in the first place is the patient, not the doctor.
When I first started in practice I was given some marketing advice: to make people loyal to you, make the cost of leaving your practice very high. In other words, make your service so good that people won't want to give up the benefits of your practice. I am happy to say that we have put this mindset into practice and have built a thriving practice with mostly happy patients. Here are some of the things we have done:
1. Remember the needs of the silent majority.
20% of the patients in a practice account for 80% of the visits. Many are the chronically ill, coming in to the office anywhere from 2 to 10 times per year. Others are people with a string of bad luck. Regardless, the majority of people don't get sick often, but when they do they don't want to wait 2 weeks to be seen. Convenience and accessibility is king for these people.
The way that we have addressed this need is to have a very generous walk-in policy. We have morning and afternoon walk-in clinics for acute illnesses. The morning clinic is from 7:30 to 9 AM, and the evening clinic is from 5:30 to 7 PM (6:30 in the summer). We don't allow well-visits (aside from sports physicals) or chronic problems to be seen in these clinics - a policy that is strictly enforced. The idea is to allow dependable access during times that are convenient to our patients. We also allow 4 work-in quick visits during the day with each doctor.
This has not only been incredibly popular with our patients (a huge source of word-of-mouth marketing), but it has been highly profitable as well. We are able to see most of these patients in 5 minutes, and do so with significantly reduced staff coverage (1 nurse and 1 front-desk person), so the income to overhead ratio is high.
It's a win-win. Patients are thrilled at the access and we are happy with the income. The only downside is that our providers and nurses are required to cover these clinics. We've done it for over 10 years, so nobody thinks much about this fact any more.
2. Allow Access
If there is an Achilles heel in our office (Achilles heal?) it is our phone system. I regularly have patients complain about them - either that they hate talking to a machine or that they don't get return calls. This has not fallen on deaf ears. I will chase down any complaint I hear and we have a long-term strategy to tackle this problem.
To deal with this we are going digital. Our patients soon will be able to request appointments and refills online. By the end of the year we hope to open up to medical questions as well. This is still not reimbursed, but the phones are not either, so if you don't get paid for a process you should do it as efficiently as possible to devote more time to things that are paid for.
I'll let you know how this does as things proceed.
3. Get the Right Mindset
From when I first started practicing medicine, we have tried to work our office in such a way that the patients' convenience was always considered. We are always looking at how we do things and trying to be as patient-centered as possible. I am always willing to check the ear of a brother or sister in the room. I never charge for it. The good-will generated from my willingness to flex will more than make up for it. If the child truly is sick and needs prescriptions, then I turn it into a real visit.
The same holds for refill requests for family members. Our EMR allows me to do this in 20 seconds and do so with proper documentation. The gratefulness of patients is worth those 20 seconds.
My adoption of a reasonable mindset has rubbed off on my staff, as they are not bound by rules for rules' sake but instead respond to reasonable requests.
4. Quality of Care Trumps All
While service is important, I am most concerned about giving good medical care. This means that if a visit takes more than the allotted time, I will not flinch. People get the time they need. This means that I will run late - quite late on some days; but over the course of time my patients have learned that I will never cheat them on time.
This mindset has not bogged us down, it has made our practice thrive. Our patients know we value their time but they also know we will do what we need to for them. I keep short appointment short (thinking of the patient's time) which allows me to spend more time when I need to.
5. Remember the Little Things.
Pediatricians need good stickers. Kids come to the office much better if there are "cool" stickers. This is really important. No joke. We also make sure we have good reading material in each room. I go to Borders and get discount books for each demographic we care for. I have often come into a room quickly only to have a person complain that they are just getting started in their reading.
I also incorporate humor in many of my visits. This probably doesn't shock people. I especially like to joke around with children, finding ways to tickle them or find absurd things in their ears. With adults, I am less silly, but maintain a relaxed demeanor. If I seem hurried, they will be less satisfied.
6. Don't be Vague
I do my best to make my instructions clear to my patients, but even so there are many times when people don't follow my instructions. Sometimes this is minor, but sometimes they don't stop a medication when the new one is started - a problem that can be very dangerous. To counter this problem, we've started giving written instructions at the end of each visit. The EMR allows this to happen easily, which is critical. Less confusion by the patients means better outcomes and less follow-up phone calls.
7. Follow the Rules.
The most popular post I ever did was the rules for doctors, and I still try to live by these. I also have some humorous guidelines posted for patients describing how to be a good patient in our practice.
No system is perfect, but it is very important to underline the fact that patients don't come to our office to give us something to do. They are not a source of income, our care for them is.
Thanks for the reminder, Ken.