The last words you should say to any patient

"Could I borrow a few bucks from you? You see, I lost a lot of money at the racetrack and I need to pay my bookie.”

“Gee you’re cute. Are you seeing anyone these days? How about we go for drinks after this?”

“Sorry I’m running a little late today. How about we skip the physical exam so I can get back on track with my next patient?”

Just to make it clear; you should never, EVER talk with a patient like this. Not to the family member who accompanies the patient, nor the home health aide. Not even the Portuguese interpreter translating for you. Never cross this line. Otherwise, you will bring the doctor-patient relationship to a very bad place.

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However, if you are looking to stir things up a little, and change the character of your interaction with your patients, you may want to try what I did. And it starts with just two little words-that is, the last words you must say to each and every patient. Let me explain.

It all started two years ago. I was (and still am) part of a large multispecialty group practice. Our group prided itself on being forward thinking and ahead of the curve. We routinely emailed our patients. We had a division dedicated to population health and recently, one for telemedicine. We are now even trialing apps to improve patient access and care.

The one area where we have been frustratingly mediocre has been with our patient satisfaction scores. We do have certain providers who are “rock gods” in the pantheon of patient satisfaction, but most in our group hover around the 50th percentile. Since we strive to be the best in all we do, it was time to set our sights on improving this metric.

Next: Two simple words

We have tried a whole host of methods to improve patient satisfaction scores. Financial incentives and dis-incentives. Lauding the top performers on our intranet, and embarrassing the bottom feeders. Nothing worked. Well, nothing until we retained a consulting firm who taught us about AIDET®.

Now, the acronym AIDET® is not a secret. I encourage all of you to Google it and read more. But the quick–and-dirty description of AIDET® is that it stands for the action words that comprise the patient visit from start to finish: Acknowledge (the patient and associated family in the room); Introduce (yourself and tell your role and credentials); Describe (what you are going to); Explain (what you did, and what will happen next); and lastly Thank (say thank you). Pretty simple, right?

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Of course the consultant reviewed more than just AIDET®, but the amount of pages I’d need to describe the entire process would have a greater BMI than Harrison’s Principles of Internal Medicine. For the purpose of this essay, I’ll focus on AIDET®.

I thought most of it sounded like common sense, stuff I was already doing. But our group had paid good money for a consultant to teach us all the mystical ways of AIDET®, so I tried to drink the Kool-Aid with the rest of my colleagues. While everyone else began to incorporate this new dogma into our practice, I continued in my old ways. And then a funny thing happened.

After years of mediocrity, our scores for The Patient Experience (as we now called it) began to inch upwards. We started at the 50th percentile. Six months later we shot up to the 60th percentile, and a year later, the 70th percentile. Two years into AIDET®, our average patient satisfaction scores topped the 82nd percentile.

It was a modern rags-to-riches story. My colleagues were always good, caring men and women, dedicated to the health of their patients. But now the patients seemed to be uniformly thrilled with us. Every doc saw his or her score increase. Well, almost every one. My score remained frustratingly flat during this time.

Now, my scores were always good. I was solidly in the top quartile of docs. But now that the majority of my colleagues were at eighty-two, seventy-five started to smell like last week’s laundry. I had to be missing something. But I had convinced myself I was already doing it all. I was polite and friendly, caring and thorough. I never rushed. I remembered details about my patients’ jobs, hobbies and families. I was doing everything I was supposed to in this new world of AIDET®. Or almost everything.

Next: Do I really have to thank the patient?

Do I really have to thank the patient? I was helping them. Weren’t they supposed to thank me for the pill, or inhaler, or test, or$procedure that I prescribed? Well I supposed I could give it a try.

As I tied up the loose ends during a new consult, I tossed in this comment as I stood to shake the patient’s hand. “Thanks for coming in to see me on this problem. I will do my best for you.” The patient did a double take, and then replied, “You’re welcome, doctor. And thank you, too.” I saw him smiling as he left my exam room and walked down the hall. He seemed touched that I would thank him. I decided to try it again.

“Thanks for taking your medicine; I knew it would help you to feel better.”

“Thanks for coming in to see me for your check-up,” I said to a little child. “See you again in six months.” “Thanks for continuing to work with me on this tough problem; we’ll get to the bottom of things soon.”

And so on and so on. And you know what? It worked. My patients seemed happier. I believed they knew I cared about them, but now they also knew that I appreciated them. Patients have so many options in healthcare; we physicians need to be aware of that. When they choose to come to see us, we should be grateful for it.

The next quarter I was surprised-no, shocked-to see my patient satisfaction score creep up 10 points. And the next quarter, I reached the Holy Grail of the Patient Experience: the 90th percentile.

Now, I was not some grade–grubbing pre-med who needed an “A” in every class to feel good about myself. I was happy because I knew I had made a deeper connection to more of my patients. I knew this in my heart months ago; as I noted the smile each patient bore on his or her face when leaving my exam room. But it was nice to see the score as an objective measurement of that fact.

To paraphrase Abraham Lincoln, you can please all of the patients some of the time, and some of them all of the time. But you can’t please all of the patients all of the time. But you can try to thank all of them, all of the time, for coming to see you.

One last thing: Thanks for reading my essay. Hopefully it will allow you to connect with your patients on a deeper level and vault your practice to the top of the patient satisfaction food chain.

Joseph Sidari, MD is an otolaryngologist in Worcester, Massachusetts