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For Patient Satisfaction, Communication is Critical


When it comes to providing care and increasing patient satisfaction, time is not on anyone's side. As appointment times shrink, quality communication falls by the wayside, leading to loss of information and a fraying of the doctor-patient relationship.

Alecia Powell

When it comes to providing care and increasing patient satisfaction, time is not on anyone’s side. The median length for an office visit to a primary care physician is now just 15 minutes — five minutes shorter than most patients spend in the waiting room. Physicians don’t like the trend any more than their patients: on average, US physicians feel as if they have four minutes and 20 seconds less time than needed for office visits and physical exams.

While shorter visit times may boost productivity on paper, the looming time threat sets up inherent stress between the patient and the physician that is detrimental to patient experience and the overall physician-patient relationship. Physicians do not have the time to address every detail of a patient’s story and so fixate on one “chief complaint” — a big problem with patients with multiple chronic conditions. Though most physicians have their patients’ best interests at heart, studies have found that 54% of patient problems and 45% of concerns are never broached by physicians during an appointment, due in part to the time crunch.

The time pressure also leads to the dreaded “doorknob phenomenon,” which occurs when patients wait to express their true health concerns until the last minute of an appointment — literally as their hand is on the doorknob to leave. This all-too-common occurrence tacks on extra minutes to a scheduled appointment, causing physician schedules to run over and having a domino effect on the patients that follow. But the doorknob phenomenon could be avoided, simply by devoting more quality time per patient and communicating from the onset. A study from Family Medicine notes that patients are often interrupted by their physician within the first 12 seconds of their dialogue at the start of office visits.

With a stale attitude toward the routine appointment, it’s unsurprising that there is a direct correlation between a lack of communication and the patient’s outcomes and satisfaction. Communication failure causes approximately 70% of serious adverse health outcomes in hospitals and nationwide and 71% of patients cite poor relationships with their physician as a reason for malpractice claims.

How does communication failure cause serious adverse effects? The issue is information retention. After leaving an appointment, up to 80% of the information that patients receive from their physicians is forgotten immediately and nearly half that is retained is actually incorrect.

Clearly, focusing on how information is shared with patients has its benefits. Patient adherence to treatment plans is more than two times greater if a physician communicates well with a patient in the office. Not only does better communication help patients; it also can impact the bottom line. The Wall Street Journal reported that a group of nearly 450 hospitals adopted an active communications approach, which included a “teach back” strategy, asking patients to repeat care instructions back to the physician in their own words, and an additional overview from the physician about prescribed medications, explaining the purpose, proper dosage, and possible side effects. The result? In just nine months, they reduced readmissions by 8.4% — saving $870 million.

So how can you improve communications within your practice? Here are three considerations:

Speak your patient’s language: Recognize that medical terms that are easily understandable to you may sound like another language to your patients. Use the most accurate, yet clear, wording you can.

Confirm what was heard: As in the study cited above, asking the patient to recap instructions in their own words greatly increases understanding.

Take emotional impact into consideration: A Journal of Clinical Oncology study found that most people just diagnosed with cancer remembered less than half of what their doctor had told them. What’s even more interesting is that asking questions doesn’t necessarily mean understanding, since the study found those who asked the most questions at the time had poorer recall on what was said.

Rely on your staff to reinforce what was said. In many practices, nurses serve as excellent “translators.” Not only do they know the medical terminology, they can help put it into accessible, patient-friendly language. Additionally, they can often provide a more personal, less intimidating take on the patient’s situation. For example, is the patient financially stressed about medication prices or other costs? Is he good about taking medicine and following the care plan on his own, or does he need reminders? Does he/she have a caregiver nearby who can help? In the chronic care arena, some practices are now engaging external partners like SmartCCM who provide qualified healthcare professionals to serve as extensions to the practice, checking on patients through monthly phone calls and confirming compliance.

As the industry evolves to value-based care, placing the practice in the role of proactive manager, it’s imperative to open the lines of communications at both ends for the sake of your patient's health and your practice's.

Alecia Powell is Director of Operations at SmartCCM, a Dallas-based firm that specializes in providing third-party chronic care management services to help physicians increase practice profitability without the need for additional staffing or technology.

As Director of Operations, Alecia oversees daily activities that drive the business, including establishing financial goals, building the right teams, and monitoring the outcomes of each department. She is responsible for all of SmartCCM’s physician practice implementations, including partnering with physicians to develop protocols and best practices and ensuring patient satisfaction.

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