Good to Great Patients

Yesterday I discussed the articles appearing of late that looked at physician-patient communication, or lack thereof. Some of this was generated by the video from the Agency for Healthcare Research and Quality to help consumer be better prepared for a visit with their doctor.

Yesterday, I wrote about some of the respective complaints from patients and doctors. Physicians can take steps to address many of the patient’s issues, as well as their own, which will lead to more satisfied physicians and patients, better care and better outcomes. Let’s look at these complaints and how to address them:

      Patients complain that:

·        have to wait too long in the doctor’s waiting room when they have an appointment;

Look at your actual schedule – are you scheduling more patients than you can handle? What can you do to improve your support functions to free up exam rooms faster? Don’t speed up your time – speed up the time around actual patient visits.

·        can’t schedule an appointment within a week, sometimes within a month;

Are you carrying too many patients? Should you be holding more appointments aside for patients where time is a consideration?

·        don’t get enough face time with the doctor during the appointment;

Slow down a bit, take the time the patient needs, and help the patient prepare (see below).

·        don’t get prompt test results from the doctor’s office;

Look at using online services, telephone inbox services (you record a brief report, the patient calls in and retrieves using a prearranged passcode.

·        don’t get prompt responses to their phone calls to the doctor’s office. 

Return all calls within 24 hours, set aside time and perhaps specific staff to return all calls.

Doctors complain that patients . . .

·        wait too long before seeking an appointment;

Do patients understand when to call for common problems? I’ve heard patients decide that they as much as you, saying, “what’s the doctor going to do? All he’s going to do is tell me to xxx”.  A doctor’s visit is expensive – can you give the patient any guidance as to when to call, and some of the options to help them.

·        are reluctant to completely and candidly discuss their symptoms;

This is a tough one. Maybe some of it is tied to feeling rushed. Maybe you can do the interview differently – perhaps prompt them by asking about specific issues that patients seem reluctant to discuss.

·        request unnecessary tests or prescriptions due to something they read or saw on TV or the Internet;

Also a tough one. Use your web site to post information that addresses the “cure du jour” and other relevant health information.

·        do not follow the doctors’ instructions and prescriptions for treatment;

A very tough one. We are seeing some automated reminder services being set up to remind people to take their medicine, for example. One option may be an automated reminder letter or email that goes out for more important diagnostic testing. The letter would be a reminder to get the test done, for example, and thank people if they have already taken care of it, and ask patients to call the office if there is anything they would like to discuss.

Sometimes money is in issue, particularly for drugs, but it applies to other costly services. Review the discussion you have with patients, and give them some handouts that, we hope, they will read (or someone will). Your discussion should emphasize the benefits of your instructions – what are you looking to learn, how will the treatment help the patient? In other words – what’s in it for them?

·        ask doctors to misrepresent to insurance companies, seeking unwarranted reimbursement;
I recall seeing at least one practice where there was a letter handed to all new patients telling them upfront that the physicians would do not misrepresent or otherwise disguise what was done. You can be empathetic and encouraging, but be firm. It happens – suggest that they call their HR department, congressman or the health insurer itself.

·        are not truthful in giving symptoms, in describing their actions that may have aggravated their condition and in claiming to have complied with doctor instructions. 

Probably one we’re not going to win. If another family member is present, include them in the conversation. Perhaps a brief discussion of the potential side effects or damage if a patient isn’t truthful, such as in their alcohol consumption. If anyone has any ideas – please share!

We can’t solve all complaints – but there are complaints that interfere in the efficiency and effectiveness of the practice, and the effectiveness and efficiency of the physician’s work. These are the issues where practices can make a difference, and where good business practices impact and support clinical care.