The central relationship of healthcare - the doctor-patient relationship - is in tatters in many ways.  The invasion of the exam room by insurance company rules, malpractice threats, and the media barrage has made things increasingly uncomfortable.  But a good relationship is essential to really get/give good care.  Obviously there are two players in this drama, and both can undermine or help the relationship. So I am going to do a series on various aspects of the doctor/patient relationship and what each party can do to maximize its effectiveness.  The first area I will cover is availability.

Availability

To have a relationship, there has to be some interaction.  Doctors tend to view their own agendas over those of the patients, while the patients can demand things that are unreasonable.

The doctor has to accommodate patients - The patients want to see their doctor when they need to be seen.

  • Some problems can't wait. It is not reasonable to have to wait to be seen for a problem that needs immediate attention.  Most of my patients who need to be seen immediately are willing to wait longer for the ability to be seen.
  • Focus on the not-so-frequent fliers - I was taught very early in practice that the most important marketing I can do is to the patient who doesn't come in often.  "Frequent fliers" are much more forgiving and fewer in number than the patient who only calls when they need the doctor.  People don't schedule getting sick, so fitting into a rigid doctor schedule is not reasonable.
  • Remember whose visit it is - Doctors must understand that their existence is for the sake of patients; patients aren't there so doctors have a job.  This mindset will help a lot when it comes to flexibility.
  • Patients have jobs and other things to do - It is hard to take time off.  It is hard to drop everything for a 1PM visit - especially if you end up spending 3 hours in the office waiting to be seen.  Accommodating patients needs to be done wisely, as double and triple booking will penalize people with scheduled appointments.

The patient has to be reasonable - Patients sometimes forget that they are not the only person with needs.

  • "Urgent" problems should actually be urgent - It's one thing to have immediate access for acute problems like abdominal pain, ear infections, and broken limbs; it's another thing to demand immediate access for preventive care, routine follow-up appointments, etc.
  • Patience is important - Good doctors are in demand.  This becomes a bigger problem as a practice matures - the better the doctor, the more patients want to get in, the harder it is to get an appointment.
  • Accept alternatives - Refusing to see a PA or other doctor in the office for acute problems is another demand that makes things difficult.  This certainly can be abused by medical offices - scheduling so many patients that doctors simply aren't available.
  • You are not alone - Remember that docs have between 2000 and 5000 patients who have needs as well.  It's tricky balancing this - I have only limited slots for new patients because my established patients are my priority.
  • Your doctor has a life too - We get sick, we take vacations, and we have families.  Your life may revolve around your illness, but it is unreasonable to expect that your doctor's life does the same.

I have personally found that being available is good business.  We allow walk-in visits every day from 7:30-9 AM and 5:30-7 PM for acute problems only.  The visits must be about problems that can be cared for in 5 minutes.  Longer visits are scheduled later in the day.

I have also found that it is important to stand up to people who are unreasonable.  I need to set the expectation that if I am to respect their needs, then they must be willing to play by our rules.  It is very hard to run an office, but it gets much harder when patients are allowed to dictate what goes on.  There always has to be a balance.

In short, both sides must be reasonable.

12 Comments