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Managing Patient Expectations:
The Art of Finding & Keeping Loyal
Patients | 281 pages | ISBN:
0-7879-4158-1| Published by Jossey-Bass
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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 surgeon
arranges for his patients to speak with
former patients who have undergone the plastic 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.
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