Memo From The Editor

See two fewer patients

Marianne Dekker Mattera

W hen we came up with the concept for this issue's cover, gas prices—like malpractice insurance premiums—were soaring, with no ceiling in sight. As I write this memo, gas has actually come down a few cents. Would that I could say the same about malpractice premiums!

They were pretty stable for most of the '90s, so I suppose we were due for an increase. But that's small comfort to those who face premiums twice the size they were last year, or even to those who face the 8 percent rise that is the lowest hike predicted this year.

Aside from lobbying state legislatures for some form of tort relief, there's not much doctors can do about rising premiums but pay them. What you must do, though, is make your practice as low-risk as possible.

The best way to do that is by building the best rapport you can with your patients. You've gotten this advice over and over from risk management consultants and in the pages of this magazine and others. But it's more important now than ever.

That's because the relationship between doctor and patient is more tenuous than it's ever been. Patients hold their loyalty to a physician only as long as he's on their insurance plan's panel. If the physician drops out or the patient changes plans, it's on to another doctor.

And doctors, faced with lower reimbursement and pressure to keep costs down, squeeze more and more patients into each day. That means giving up the precious extra minutes it takes to build a relationship—the time needed to ask a patient how her spouse is or to express sympathy when a relative has died, or even to ask if there's anything else bothering her.

Then there are the extra minutes it takes to listen to the answers if you do ask those questions. And believe me, patients know when you're not listening. If they miss it at the moment, they'll pick up on it at the next visit when you forget to ask about that other problem or ask again about something the patient has already answered.

If you think the risk of not paying attention is blown out of proportion, consider the results of a recently released study of state employees in Massachusetts: Researchers found declines of 10 to 15 percent in patients' satisfaction with the interactions they have with their physicians, with the way their doctors communicate information, and in the overall trust they have in their physicians.

Lots of things that will help build good patient relations don't require you to do anything more than making sure you have a friendly and efficient office staff:

• Put in policies and procedures that mandate courteous, prompt attention to patient requests.

• Make sure phone calls are returned promptly. My husband's still waiting for a call back from his internist's office three weeks after the answering service promised one. Should he have called back himself? Of course, but not all patients do what they should do, and believe me, he doesn't think he's the one at fault.

• Set up procedures so that patients who've been referred to a specialist get a call to confirm that they've actually made the appointment. And follow up with test results.

There are two things you must do personally, though. You must truly care about your patients, and you must let that caring show in every encounter with them.

If you have to see two fewer patients every day in order to make the time to be caring, then so be it. The money you lose from those two encounters will be far less than the increased malpractice premiums you'll have to pay after one of your patients sues the doctor who didn't really care about her.

 

Marianne Mattera. Memo from the Editor: See two fewer patients. Medical Economics 2001;13:4.