Office visits may be short nowadays, but they don't need to be impersonal. The author shares techniques that work in his practice
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Office visits may be short nowadays, but they don't need to be impersonal. The author shares techniques that work in his practice.
Not too long ago, a routine patient visit might have lasted a comfortable 30 minutes. In today's managed care environment, Darwinian forces have driven down the average visit in my practice to 10 minutes. Factor in overbookings and urgent walk-ins, and 10 minutes can shrink to seven.
Is it possible to spend only seven to 10 minutes with a patient and expect her to leave satisfied? The answer is Yes. But accomplishing this requires a conscious effort on your part.
Before you go into the exam room, take a few seconds to refresh your memory about the patient you're about to see. She wants you to connect with her as a person in need of help, rather than as a "chief complaint" filling another slot on the schedule.
Is this the patient's first visit? If it's an established patient, when was she last seen? Are there follow-up issues you need to address?
Use this information to make sure that the first sentence you utter upon entering the room is tailored to the patient. For example, "Hello, Mrs. Brown. Welcome to the group. I understand that this is your first visit." Or "Hi, Mr. Wallace. I haven't seen you in three months. I noticed that you missed an appointment." Patients immediately sense familiarity and concern from you, which puts them at ease.
During those few seconds before you enter the exam room, also familiarize yourself with the results of any tests the patient had. Patients often complain that physicians are ill-prepared to discuss these results. Here's a typical scene: The doctor strolls in; the worried patient reminds him of a barium enema that had been done the previous week; the doctor begins leisurely flipping through the chart to find the results. The patient is left with the impression that his doctor is unorganized and uncaring.
Keep a running list of personal notes in the chart regarding the patient and his family. Some of my notes: "patient has 25 grandchildren," "local golf amateur," and "has a daughter in medical school." When I meet with the patient, I say, "How is your daughter doing in medical school?"
Patients' eyes light up. She's surprised that I recalled a passing comment made during the last visit, and pleased that I care enough to ask. This personalized approach makes the patient feel as if she belongs to our group. Along with a nice feeling comes patient loyaltywell worth the extra time invested.
An additional benefit: By getting to know my patients better, I like them more. So rather than sighing on my way in to see the tenth URI of the day, I smile as I anticipate a conversation with a patient who helped engineer the Apollo space program, and who glows brightly each time I ask about it.
Ultimately, this makes me a better physician, since it's easier to generate sincere concern and care for a person than it is for a disease entity.
What if you enter an exam room only to find a patient who's irate because he had to endure a prolonged wait? The battle to keep this patient satisfied may already be lost before you utter your first word. But, there are ways to improve such situations in the future. First, make sure that your staff keeps patients informed of what the expected wait may be. Then, as soon as you enter the exam room, you should apologize. In my experience, these two approaches mollify most patients.
While I'm examining the patient, I make a conscious effort not to appear busy or overwhelmedeven when that's exactly the case. Patients are sensitive to body language: They notice when you take their history while standing, fail to make eye contact, hasten through patient instructions, or spend most of your time writing in the chart. All this leaves the impression that you're more interested in exiting the exam room than in treating the patient.
It doesn't take much time to avoid this pitfall. For instance, just sitting down requires no more time at all and can make a substantial difference. It implies that you're ready to focus your attention on the patient's complaints. It also puts you at eye level with the patient, which makes him more comfortable and more likely to be communicative. Many physicians just don't understand how intimidating it can be to have a towering white coat looming overhead.
It's especially important to engage patients with frequent eye contact. If you don't, it's impossible to convey your attention, let alone your concern and empathy. For this reason, I make a concerted effort to avoid charting in the exam room: It diminishes eye contact, and tends to disengage me from the patient both physically and mentally.
How do you deal with the patient who dutifully shows up with a prepared list of complaints? If you review the list beforehand and limit the discussion to the most important issues, you risk alienating the patient: What's important to you isn't necessarily what's most important to him. For example, a patient who is to be worked-up for chest pain may leave dismayed because you failed to do anything for his painful ingrown toenail.
So, after I review the list myself, I ask the patient to select the complaint that's most pressing to him. I make sure to address thisalong with the other issues I feel are important.
Giving instructionsabout a disease, test, diet, medication, or procedureis one of the most time-consuming activities of the office visit, so it's one area that's commonly truncated. A patient-pleaser: Use informative patient handouts. Not only do they save you a lot of time, but they're well-received. Patients can review the information carefully at their leisure.
The way you exit the exam room leaves a lasting impression on patients. When you turn on your heels and walk out abruptly, or rely on the nursing staff to discharge patients, you leave a sense of unfinished business.
I take a few seconds with each patient to shake his hand, and thank him. If it's a new patient, I also hand him a business card. I occasionally ask whether the patient has any questions, but that approach has its drawbacks when I'm on a tight schedule. The patient may bring up tangential complaints or ask general questions not pertinent to the reason for his visit. When that happens, I end up cutting him off, or giving his questions short shrift. So I typically end the visit by reminding the patient that he can call the office if he has any additional questions.
Don't forget that patient satisfaction isn't the doctor's task alone. A single rude employee can quickly undo your efforts. That's why I recommend that staff members receive ongoing formal training in interacting with patients. It might even be worthwhile to hire a professional organization to provide the training. Track how well you're doing with an informal questionnaire that asks patients how satisfied they are with the practice.
The results can be of tremendous value in identifying inadequacies. Addressing these will inevitably strengthen your practice and allow you to better compete in the medical marketplace.
Wernher Ovalle. Get personal in seven minutes? Sure you can. Medical Economics 2002;10:69.