The Successful
Office Practice The key elements
of happy, thriving practices by Susan Keane Baker
Many malpractice claims
involve incidences where the patient was
correct but not believed or was incorrect
and harshly "proven wrong." Errors
occur when someone knows something but fails
to tell someone else. Mutually respectful
relationships can prevent these claim igniters.
The successful practice invests time in
building positive relationships so that,
in the event of unmet expectations –
for example, an adverse outcome – the
physician is not required to establish rapport
in the most trying of circumstances.
The successful office
practice understands "anxiety of
the uninitiated." Physicians and
staff members are keenly aware that all
patients are anxious and that new patients
have additional anxiety because they don’t
know what to expect. Lou Holtz, the former
Notre Dame coach, said that at the start
of any relationship, a person has three
questions: 1) Can I trust you? 2) Are you
good at what you say you will do?"
and 3) Will you care about me? The successful
office practice answers these questions
in part by being fanatical about patient
confidentiality; by being credible, reliable
and responsive to patients; and by developing
the kind of rapport that assures a patient
that he is not just a sick sack of enzymes.
The successful office practice seeks to
build rapport with every patient. Strategies
for building rapport include finding something
in common with a patient and finding out
what’s important to a patient. To discover
what’s important to someone, watch
how he or she spends discretionary time
and income. What people spend their extra
time and money on – grandchildren,
gardening, gambling, etc. – is a topic
that you can introduce quickly and effectively.
It’s of little use to talk about last
night’s sporting event if your patient
doesn’t follow sports. Keeping a note
on your patients’ important interests
helps you recall them later. A Pennsylvania
physician told me that he always made a
note of the last thing a patient said as
he or she was leaving the office. Commenting
on that topic at the next visit helped develop
rapport and a sense of continuity in his
physician-patient relationships. Even simple
statements that take little time or effort
can build rapport. When a patient calls
to cancel an appointment because her child
is ill, it takes little time to say: "I
hope Bobby is feeling better." A nurse
told me that when she was pregnant with
her first child, she called several ob/gyn
practices to make "get acquainted"
appointments. At the end of the first call,
the receptionist said "Be sure to bring
your insurance card with you." At the
end of the call to the second practice,
the receptionist said, "Be sure to
bring your insurance card with you, and
congratulations." The nurse said that
her decision was made on the basis of those
two words "and congratulations"
and that she has referred at least a dozen
other women to the practice.
The successful office
practice achieves a balance of consistency
and flexibility that provides patients
with the security of predictability and
the comfort of knowing that their individual
preferences will be identified and considered.
One way to achieve the balance is to make
service as consistent as possible, while
at the same time, customizing interactions
with patients. Flexibility is important
to patients, particularly those who feel
alienated in impersonal relationships with
large organizations, such as insurance companies
and healthcare systems.
Physicians and staff
members in successful office practices are
more conscientious about using their knowledge
of patient relations and customer service
to their advantage. Because common knowledge
is not common practice, it’s what differentiates
them from others providing the same services.
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