Excerpts
from
Managing Patient Expectations
by Susan Keane Baker
On best practices:
Some of a physician’s greatest insights result from her experience as a patient. The Irish have a saying, "The wearer best knows where the shoe pinches." Whenever you or one of your staff members are patients at another practice or organization, evaluate the quality of service and follow-up attention you receive before, during and after your visit. How soon do you receive test results and how are they communicated? How is billing handled?
On patient education:
Patients are often adamant that the only people who can understand them are others who are experiencing or have experienced the same suffering. One orthopedic surgeon arranges for his patients to speak with former patients who have undergone the surgery being considered. He tries to match patients by age and interest. After surgery, patients have the opportunity to help future patients in the same way.On coping with angry patients:
It is tempting to mirror the angry patient or to vent your own frustrations. At L.L. Bean, employees are taught that no one ever wins an argument with a customer. If you are prone to argue, remind yourself that you don’t want to say anything that you will regret later. Consider how effective getting angry has been for you in the past. Whenever possible, delay any emotional response to the angry patient for a few moments or as long as it takes you to be calm.On building loyal relationships:
Be clear about who will do what next. If you say "Your test results will be back in a week," you leave the patient wondering whether you will call him or should he call you. Be specific about what you will do after visits and what your patient should do. When you are letting your patient know what will happen next, weave "for you" into your explanation. This strategy is an easy habit to develop. "I think we should do this test for you first." The use of "for you" subtly but effectively reminds the patient that he is your focus and priority.
On former patients:
If you walked into your office tomorrow and discovered that a $3000 computer was missing, how much time and effort would you devote to finding out how that loss occurred? Well, you have patients worth ten and a hundred times that who are walking out your door forever. How much time and effort are you devoting to those losses? There is no need to guess why patients left, when you can ask them. Former patients possess valuable information about flaws in your practice and the appeal of your competitors. Although it may be too late to fix a situation for a patient who has left, the information you receive may motivate you to take focused action to make improvements in your practice.
On achieving quick rapport with patients:
Know what’s important to your patient. If you are not sure, ask about or observe how your patient spends his discretionary time and money. What people spend their extra time and money on, whether it is gardening, gambling, or grandchildren, is what matters to them. You can use those subjects to make quick connections with patients.
On inspiring patient loyalty:
One physician told me that the most successful patient relations strategy he ever adopted was to record the last thing his patient told him as he was leaving the visit. He would then mention that subject at the beginning of the next visit. It didn’t matter what it was; his patients were flattered that he remembered.
On expectations and satisfaction:
Our satisfaction with most encounters, medical or otherwise, often depends on whether or not our expectations are met. The purpose of managing expectations is to have as little discrepancy as possible between patients’ expectations and their actual experience. Maintaining a balance of consistency and flexibility provides patients with the security of predictability and the comfort of knowing that they are cared for as individuals, not as symptoms or disease categories. One way to maintain this balance is to make your service as consistent as possible while at the same time customizing the interactions you have with patients.On staff strategies:
Employees need to know that their abilities and loyalties are appreciated. When was the last time you recognized a staff member? Never? Are you quick to criticize when people do a poor job and prone to take them for granted when things go smoothly? It’s critically important to acknowledge the contributions of your staff. Bob Hope was once asked why he didn’t retire and go fishing. "Because fish don’t applaud," he replied. Positive reinforcement is the key to changing an existing behavior, teaching a new one, or enhancing the positive attitudes and behaviors that already exist. A sincere compliment costs nothing, takes little time, and is often long remembered by the recipient. Don’t let opportunities for recognition pass you by.
On difficult patients:
Let the difficult patient overhear you saying something nice about him. Or if this fails, let him hear you saying something especially nice about some other physician… Difficult patients can be viewed as opportunities, because there is no competition for them. The difficult patient can help you improve your skills with other patients and may force you to make improvements in your style or practice that you might not otherwise recognize the need for.On listening to patients:
In the early stages of illness or the physician-patient relationship, patients often know the detailed circumstances of their illness better than you can. Understanding the complexity of the patient’s story is important if you do not want to miss information that will prevent you from oversimplifying the story to meet your presumed diagnosis. One specialist told me that he could diagnose a given condition within sixty seconds of meeting a patient. When he made those instant diagnoses, he found that patients felt obligated to tell their story several times, to make sure he really understood them. Or, they sought a second opinion. He learned that when he listened to their stories and asked several questions and then made the diagnosis, his patients felt far more confident about his diagnostic skills.
On encouraging patient follow-through
Ask your patient, "If you were the only person in the world who could solve this problem, what would you do?" He may present you with an acceptable plan and will be more likely to comply with it because he feels a sense of ownership of the idea. Treatment plans should be realistic from the patient’s point of view whenever possible. Praise the patient for his decision and express confidence in his ability to follow through with his plan.
On preventing adverse outcomes:
Watch for the red flag. Recognize that a red flag is waving whenever a patient returns with the same acute problem. Do not allow your earlier assumptions to govern your thoughts and actions. Listen as though you were hearing the patient’s story for the first time. Learn from the tragic experiences of others. Whenever a catastrophic event occurs in medicine, one of these two questions is often raised, "Why didn’t someone just ask the patient?" or "Why didn’t we listen to the patient?" When patients give you a warning, take it… The patient who feels comfortable questioning why a medication looks different or why the technician is preparing to draw blood from the "wrong" arm is helping you prevent a possible adverse event.
Published by Jossey-Bass ISBN 0-7879-4158-1