“I am so lucky to spend so much time in doctors’ offices,” said no one ever. I, however, would actually allow this sentence to escape my lips without concern for sounding disingenuous or like a hypochondriac. My luck is twofold: 1) I am fortunate to have good genes. I have yet to frequent a physician’s office as a patient on more than a preventative basis, and typically enter the office through the employee entrance, there to help build things behind the scenes. 2) In this capacity, I, with great passion, help implement processes that improve patient experience, make staff more efficient and happier, and increase revenue for the doctor. This zeal, however, makes it excruciatingly difficult to not constantly evaluate a practice from the standpoint of a patient, when I happen to be there as such and be overcome with strong opinions on what I would do differently.
The following is an account of two recent doctor visits, and my unsolicited recommendations to the practices and physicians (whose names have been changed or omitted to protect the inefficient). Thank you for indulging me, as I’ve really needed to get all this off my (thankfully healthy) chest.
Concierge Medicine – Doctor Appointment 1
In my continued search for a primary care doctor that I was comfortable with (of the two previous, one nodded off during our visit, after keeping me waiting over two hours, repeatedly; the other immediately, even gleefully, recommended medication for numerous things I may not have needed, as my labs indicated I was in great health, before even bringing up lifestyle, diet, exercise, etc.), I got a wonderful recommendation from a trusted friend, also a physician. Upon arriving in the office, I realized he was part of a larger, branded group practice I’ll refer to as “Select Healthcare”. My interest piqued, I was anxious to learn more about their apparently multifaceted approach to preventive medicine, and even more curious if anyone was going to try to sell it to me. If we consider as readers that this practice has a large concierge medicine component, charging several thousand dollars per year, plus a variety of other tests and add-ons creating large billables, we can evaluate the appointment in relation to how well they achieved their goal of taking a regular patient and converting him into a true believer and buyer, as is the goal of any doctor looking to drive patient revenue, referrals, and retention.
First, let’s start with the nurse bringing me in for the standard weigh-in. I’m all for building rapport, in fact, it’s a requisite initial interaction with a patient to help them feel comfortable. But there is a big difference between what you should say to build rapport, and what you can get away with saying once you have a rapport built. Don’t get me wrong, the nurse was actually very nice and I think her heart was in the right place, but she took on a condescending-meets-flirty-meets-too-personal-given-we-just-met-even-though-we’re-in-a-doctor’s-office attitude. After my height: “wow, you’re taller than I thought, stand up straight next to me…” After my age, “wow, I thought you were a lot older.” She then pressed me about my marital status, relationship successes and woes, and sexual activity. She asked if circumcision was part of my surgical history. When she asked about drug use and I answered in the negative, her response was: “wow, perfect guy.” So we can almost agree on something…
Now, obviously, most of these questions are part of a routine list for any physical, which I am happy to answer honestly and comfortably without hesitation. And although the nurse did “insulate my objections” by letting me know she was about to ask some personal questions in advance, therefore reducing my urge to protest as I knew what was coming, she did not build the level of rapport first needed to make circumcision jokes nor suggest I looked older than I am. This part of the visit is clinical, let’s try to keep it that way.
Perhaps most importantly, she missed the opportunity to provide any information about the other services the practice offers and ask if I was interested. How am I to get more engaged in what the practice offers, let alone purchase things, if I don’t know about them?
She left the room, and I was relieved when the doctor came in, not only because of the aforementioned but because he was a joy. Friendly but reserved, measured and unrushed, happy to meet with me, and genuinely curious about my concerns and condition. Another nurse followed him in shortly thereafter simply to take notes in the system. Again, a simple “Susie’s going to be here just to take notes while we talk about your treatment” would have gone a long way to let me know who she is and put me at ease speaking about things in front of her, particularly for other people who are not yet used to the need for this position since the advent of EMR.
How about that multifaceted approach to preventive medicine I might be able to take advantage of? I didn’t hear anything about it until the doctor suggested I get an allergy test and consider the immunotherapy (which was a good thing because I learned the shocking fact that I am allergic to 56 of the 58 airborne and mold allergens tested for, when I considered myself asymptomatic). Apparently, Select Healthcare offers: concierge medicine, fitness and nutrition planning, a more comprehensive executive wellness system, and many other services that I might have been interested in, despite the out-of-pocket expense, had someone only taken the time to sit with me first to explain what was available and ask if I would like to proceed.
The Skinny on my Skin – Doctor Appointment 2
My next doctor visit, the following day, was to a dermatologist and didn’t unfold much differently. I expected a similar scenario, this time because I was visiting a well-known dermatologist, who also performs a lot of cosmetic treatments and procedures, merely for a standard full-body screening, plus some inquiry about cosmetic skincare. As we manage dermatologic practices here at YellowTelescope, I had a strong understanding of what to expect. What I didn’t expect was for the doctor to spend a ton of time in the screening, when he’s got more lucrative ways to spend his limited patient time.
After spending my time in the waiting room (twice as long as the previous visit) and filling out a wildly detailed questionnaire on an iPad, a nurse or patient coordinator, I assumed arrived in advance of the doctor. I thought, “finally someone trying to sell me something I’m hoping to buy!” Wrong again. Downright terse, she asked what I was there for. “Haven’t been to a derm in a long time, and I’d like to get a screening, have a couple of spots I want to make sure aren’t serious, and have some questions about cosmetic stuff.” She replied with, “OK, put on this gown and I’ll be back with the doctor.”
She missed the perfect opportunity to ask about my cosmetic concerns and provide potential solutions, then gauge my interest in having something done, or ready me to have it that day if possible, and prepare the doctor prior to him coming in on what I was interested in.
Instead, the doctor charged in the office. After a cursory handshake and introduction to the other doctor observing him on his rounds, he hurriedly reached his hands, which still smelled of the onions that accompanied whatever he last ate, toward my face and body for examination. Literally, two minutes later, he left assuring me I had nothing to worry about and to return on an annual basis for a screening. The nurse asked me to dress and be discharged.
As a last-ditch effort, I mentioned to the woman at the front desk that I had some questions about cosmetic procedures, and asked if I might speak with someone. I was handed a business card to call the office another time and ask for the cosmetic coordinator.
Now, some reading this are wondering what fault, if any, might be found in the preceding. Others recognize much could be improved upon or might even see the same challenges in their own practice. Still, others are shaking their heads in disbelief at how any practice could be successful at all given the missed opportunities. There may be no way to know if there is a lack of leadership, a bad manager, questionable employees, good intentions juxtaposed against a bad day, all or none of the above.
My humble but well-founded opinion after the better part of a decade helping doctors grow their practices is that the ultimate shortcomings of each practice lie in the basic need to have the right people in the office, and the right processes and techniques in place for those people to maximize patient engagement and satisfaction. While I have held this belief for years prior to these two doctor office visits, I still believe fully that every doctor’s office in America should have a patient coordinator seeing each patient before the doctor, taking the opportunity to discover the patient’s needs and interests, extolling the virtues of the practice and doctor, reviewing the services that are available including necessary details like recovery, results, and costs, and asking about interest in those services before relaying that information to the doctor to be more prepared when seeing the patient. This alone will lead to more satisfied patients, and more practice revenue.
While I saved thousands this month by not being sold something I already wanted, I also will have less lustrous skin, no on-demand concierge medicine, but will have fewer allergies (I moved forward with that treatment) and will continue to see who among Miami’s top doctors would like to take the money I hold up in the air, flapping in the wind in the coming year.
If your practice doesn’t have someone coordinating patients, or has someone who needs the formal training needed to truly excel in this role and take your practice to the next level, contact firstname.lastname@example.org for more information on how we can help.