LordosisParticipantStatus: PhysicianPosts: 1807Joined: 02/11/2019I appreciate you continuing that appropriate care. Sometimes if two physicians (including the patient’s PCP) tell them that there’s nothing to do for a certain set of symptoms besides supportive care then maybe they’ll realize the ED doc wasn’t a complete moron.Click to expand…
I agree. I hate when one doc throws another under the bus just to commiserate with patients. I think it is important to stand up for quality health care.
However I do occasionally find some strange or odd or even dangerous things other physicians do and I will tell the patient it is bad management.
“Never let your sense of morals prevent you from doing what is right.”SValleyMDParticipantStatus: PhysicianPosts: 462Joined: 05/12/2016
Lordosis – yep, it’s that tough scenario where u basically have to triage the chronic pts that don’t have much going on in order to have accessibility for the acutes/news that have something going on. I have a partner like you (based on your prior posts) that focused on his old patient panel and takes months to in to get seen. It’s hard to be both (take lots of time with each pt and have accessibility without utilizing mid levels ) so it’s kind of develop your own philosophy imo if u don’t have a ton of resources/support. Both can leave pts upset.July 9, 2019 at 8:13 am MST #228990IntensiveCareBearSpectatorStatus: PhysicianPosts: 235Joined: 12/22/2018
60min new patients and 30min estab? Unless you are a rare sub-specialist surgeon or a psych doing own therapy (and even if you are), you’d be belly up in private practice in less than a year. Wow. I say to ignore ratings (or buy/solicit them if private practice), but if you actually want to improve your patients’ happiness with their exp, that’s a noble goal…
My advice to young docs who need to do more in less time is to simply do much less “education” of patients. They don’t care. They don’t remember it. The few who are interested will ask. Give handouts from good sources if you wish. Just because you spent the better part of a decade studying and prioritize health does not mean they enjoy it. Don’t be myopic. By and large, they generally don’t care about their disease process or why/how the treatment will work (the ones who actually do care and learn are the same type who very seldom get sick, so you will rarely see them). Realize early that the folks you are seeing are primarily the ones who do NOT care much about health or prioritize it.
Besides, all that nonsense “education” time gets in the way of asking patients about their upcoming vaca or pop culture or their kids. Your outpt visits should generally be 80/20 social/medical talk… not the other way around. Inpatients or acute can still be roughly 50/50. This is the most common new doc mistake, bar none… they tend to make it 80/20 or even 90/10 medical/social. The more you know, the less you have to say. Think of one or two problems per visit and one or basic two solutions for each of them. Simplicity wins… Occam’s razor. Introduce yourself, ask a question, and do (or convincingly feign) active listening for 30-60sec or more by using head nods, making note, echoing, leading, etc without interrupting or jumping to conclusions. It doesn’t matter if the conclusions are right within a few seconds, still wait until the end of the visit to give them… pretend to spend at least token time and contemplate their issue. Act the part. That is solid gold to patients.
The physical exam builds rapport in and of itself… and it is a great time to socialize (since you should have gotten the dx or at least figured out what tests to order from the history and a quick glance in 90% of cases). The physical touch and proximity to patients is a real thing. How many people dislike their massage therapist or PT? Besides the costs, not many have complaints. I don’t care if it is a remnant from fictional Jeebus stories and the laying of hands, but I just know it works today. Animals use touch, and humans thrive on it also. Doing an exam builds rapport and trust in the doctor patient relationship. Patients enjoy the show. Entertain them. Even if the patient is from a very sex-negative culture, a minimal exam should be done. Fake a decent physical exam of some sort even if it is totally pointless since you already know the answer to their problem or the CT will provide the answer. Do it anyways. Do it every time. Try to actually do at least half the stuff you are going to say you did in the EMR. Take better care of your patients than your notes.
At the conclusion of the visit, always give tangible proof of the visit for the patient to take home. Give these “presents” (handout on condition, samples, your biz card, physical Rx med/DME/lab/imaging order of some sort… hand written or at least signed in front of them and personally handed to pt if at all possible). Even if it’s just OTC stuff or diet advice or etc, hand write it on Rx pad. Make it simple and quick and positive. Impart confidence to the patient and the impression that they are your top priority. That is how to be a good communicator. If there is no diagnosis or the complaint is nonsense, make something up that sounds medical. If you did your job, each patient should always be able to tell their spouse/kid/friend the next day what is wrong and what was recommended by the doc… that’s all. They only want those two things (diagnosis and solution… or at least understanding and improvement ideas), and all the rest of the visit should be friendly and positive filler convo that will have them saying how nice the doc was. No joke.
“The patient does not care about your science; what he wants to know is, can you cure him?”
“You must learn to talk clearly. The jargon of scientific terminology which rolls off your tongues is mental garbage.”
“Knowledge is a process of piling up facts; wisdom lies in their simplification.”
“The public blabbers about preventive medicine, but will neither appreciate nor pay for it. You get paid for what you cure.” -all by M. Fischer
…Dude, it all comes down to people skill. Study sales skills and customer service skill… make the visits all about the patient, not their disease or about you. Study Tony Robbins rapport videos. Patients will rate a total hack doc better than Mr. Brainiac, as long as his wait times are decent and he uses effective communication to make them feel good (rapport, humor, etc). They want to feel like a person and not just a number. If you are a cool person and they can glean by your eye contact and handshake that you are treating them like you would treat family, you win the game. They will accept that some things are not curable and that bad outcomes do occur, or you can direct and even encourage them to an appropriate board cert second opinion doc (very few will do it if you cultivated trust… the few who do are no problem). The only quote you really truly need to know in clinical medicine is this cliché yet perfect one:
“The art of medicine consists in amusing the patient while nature cures the disease. ” -Voltaire
…and yeah, many people like you until they see the bill. Some people will complain about waiting 30min for 10min or less of doc time. That is out of your control, esp if you work for a hospital or large group. Huge bills and short appointments are facts of life for ALL docs. People have come to expect that. Besides, when the docs you’re compared with (or at least should be!) are in the same clinic, the wait and phone and billing etc factors are the same anyways. They cancel out. Customer service from the doc’s personal charisma and communication skill are what will make or break your ratings… and probably your joy or misery with patient relations as well as your job satisfaction. It blows my mind how many patients and family members have told my nurses “I really like him” or “he’s really good” when I did basically nothing medically for them or even when I’d just finished giving them bad news. It gives testament to how dry or verbose or curt most of their other docs may have been.
Oh, lastly, have the confidence not to care much. It is just a job, not what defines you. If you are doing your best, that’s all you can do. Surveys are out of your control; the patient relations stuff should just be for your job/integrity satisfaction. Always be improving. Some patients (and people in general) are also just in a terrible mood (hopefully temporary), and they are the ones you hate to see on your rounds list or clinic schedule. You need to quickly triage these types fast as you enter the encounter (miserable overall, complaining about past docs, etc), temper your expectations yet give them the benefit of the doubt, finish up quick, move on quicker, and definitely don’t let them ruin your day. Discharge the especially malignant ones from your practice if you like (I sure do). Besides the over-“educating,” that mistake of letting grumpy patients or their doc image (ego?) or their medical outcomes or reviews ruin their mojo or consume too much time/energy is another pitfall many docs struggle with. Mood is not an imposition. You can’t save the world. Have a short term memory and have many other sources of self esteem besides medicine. GL
"Hmm, that sounds risky." - motto of the middle classEntrepreneurMDParticipantStatus: PhysicianPosts: 323Joined: 06/10/2019
Your employer is trying to optimize goodwill (reputation as a quantifiable asset) in case of a future sale of the business…
…or lower provider salaries if finances aren’t great.
Problem is there are a lot of interactions outside of your control that may even go into a review of you directly. If a patient has a bad interaction with reception or nursing, they may give a lower review across the board.
When adhering to standard of care and it is unsatisfactory from the patient perspective, quality care is viewed as a lack of regard (think antibiotics, pediatric vaccination policies, work leave/disability paperwork, etc.)
Lots of problem with customer reviews in healthcare.q-schoolParticipantStatus: PhysicianPosts: 2629Joined: 05/07/2017
trust me on this-those things are a mixed blessing at best.
i’ve consistently been a high scorer since they started, and after they started publishing these things, all the ahem high maintenance patients demand to see you. they don’t follow your instructions and start yelling at you because the therapy isn’t working fast enough. they hear what they want to hear and then claim you told them different things.
your own nurse wants to slit your throat when you start having sizeable collections because they occupy a disproportionate amount of their time as well. your partners are only too happy for you to see these patients. they start telling them anything, don’t worry dr q-school will be back next week and he will take care of you. depending on how you get paid, it may reduce your own productivity.
don’t get me started.nolamd84ParticipantStatus: PhysicianPosts: 86Joined: 01/08/2016
I could not agree with @intensivecarebear more.YkcorParticipantStatus: PhysicianPosts: 88Joined: 01/02/2019
I don’t look at them(patient satification ratings) and I don’t care. At end of day I’ve done my best and tried to treat each patient like I would like myself or my family treated.ACNModeratorStatus: PhysicianPosts: 628Joined: 01/08/2016
I give out review cards to all the patients who come back postop and say they love their surgery and all their pain is gone. I also tell them to give me 20 stars out of 5 😂
If you're ever having a bad day, just remember in 1976 Ronald Wayne sold his 10% stake in Apple for $2,300.HankModeratorStatus: AttorneyPosts: 1394Joined: 03/27/2017
Press Ganey is a load of crap. If 10% of your compensation is based on PG or other patient “satisfaction” scores, consider the job offer to be for 90% of the stated amount of compensation.
Patients don’t want to be told that they need to run more miles and drink fewer Big Gulps. As empathetic and caring as you possibly might be, you won’t win any points for telling patients what they truly need to hear.
Sometimes people don’t want that which they most desperately need.IntensiveCareBearSpectatorStatus: PhysicianPosts: 235Joined: 12/22/2018
…Patients don’t want to be told that they need to run more miles and drink fewer Big Gulps. As empathetic and caring as you possibly might be, you won’t win any points for telling patients what they truly need to hear.
Sometimes people don’t want that which they most desperately need.Click to expand…
Of course they don’t want it. Nobody wants to be told that their way of thinking is incorrect. It’s a good thing that the tough love is not our job. The vast majority of adult patients already missed the boat on that long ago.
If you want to educate people, write books or raise your kids or be a teacher. With adults, all you can do is hope they develop the interest in the topic/goal themselves (and support it with good info links/handouts). They didn’t ask for a nutrition counselor or a personal trainer; they made an appointment with a doc and are typically paying good money for it.
Docs are mechanics… pure and simple. Patients are there for a fix, not to get educated. We go painfully wrong thinking we are or can become much more. The education, philosophy, etc needs to be done in your spare time. Patients and admins simply want you to quickly and efficiently contemplate, understand, and fix the medical problem… preferably with as much entertainment value as possible in the process. Few people would like a guy who fixed their engine perfectly but lectured them on how they’ve neglected oil changes and used the wrong parts or fluids. The beloved ones just fix the engine and make social small talk in the process and let the oil change reminder sticker do the talking. If asked, they can probably recommend a great website or book to learn car maintenance.
You want to follow “How to Win Friends and Influence People” to wow the patients… not write the sequel “How to Make Enemies and Alienate People” (summary = give unsolicited advice, break rapport). The docs with the consistently worst reviews and worst rep may or may not get good outcomes or make quality dx and Rx decisions, but they and/or their staff are generally just poor at social interaction. They come off as aloof and preachy, possibly curt and disinterested. They consistently break rapport when they never built up the trust (since appts are far too short to really do that). They are the opposite of what people say about charismatic guys in general: “listens well,” “understands me,” and “makes me feel like the only person in the room/ his top priority,” etc. You can’t just use ‘tough love’ and say things that patients find offensive; that is tough even if it came from a long time trusted friend or relative. To try that as a doc who barely knows the person is a fool’s errand (unless you are on straight salary and trying to thin out your patient load).
Be a friendly mechanic with good outcomes… that’s the best we can do. If they ask, give hints and encouragement tactfully… with their success/improvement/benefit as the clear stated goal. To try to frighten adults with scare tactics or evidence stats is generally ill advised. These are not little kids. A quick story (the way religion and ancient society typically teaches) about a patient who neglected their health or expressing genuine concern for the patient having a bad outcome or asking questions to have them think of how they are treating their body is less threatening… but will still fracture rapport a bit… so you need to repair it quick afterwards by beefing up their confidence as you conclude the interaction. It’s like when Patrick Swayze teaches his bouncers in Road House… “be nice” is all really you have to know.
"Hmm, that sounds risky." - motto of the middle classJackmommaParticipantStatus: PhysicianPosts: 37Joined: 01/26/2016
i would honestly consider telling patients especially the ones you have good rapport with to (1) fill out the survey if you get it. your strongest supporters may not even be submitting
(2) don’t be afraid to tell the patients something like “hey if you get a survey and you liked what we did please fill in with ALL 10’s” , especially since these crappy surveys often 4/5 or 8/10 as actually “fail”!
To be honest with you this is what they tell me at the Lexus dealership when I come in for servicing. I’m pretty sure their pay is tied to satisfaction and they have zero shame letting their customers know they need their help.HandFellowParticipantStatus: PhysicianPosts: 198Joined: 01/18/2016
In residency, the nurses used to wear buttons on their scrubs that said, “8s don’t count” or something like that. I think part of that was to remind people that they were aiming for excellent, 10/10 care, but the other part was to remind patients that when they got their surveys to give them 10s.
I agree with the above. Don’t waste tons of time with patients giving them information they don’t ask for. I always ask my patients if they have any other questions. If they ask them, I answer them. But I certainly don’t tell them everything they need to know on the topic. If you have some things you think they should know, give them a handout or a website. Once all their questions are answered, tell them about the survey and as others have mentioned, tell them to give you 20 out of 5.LordosisParticipantStatus: PhysicianPosts: 1807Joined: 02/11/2019
Half the complaints on the survey are about the survey.
Survey is too long
You asked this question already
I filled out this already
Most people who have time to fill this out are crotchety old people
“Never let your sense of morals prevent you from doing what is right.”pulmdocParticipantStatus: PhysicianPosts: 434Joined: 09/19/2016
Press Ganey is bull**** data for the simple fact that it is a pass/fail questionaire disguised as a 5 point scale. People think you did a fine, unmemorable job? 4/5 means you stink 🙄🙄
I have always scored highest in my group, and the reason is simple. At the end of the visit, I “anchor” them mentally by saying something along the lines of “your satisfaction is important, and you’ll get a survey soon from us about your experience. if there’s something that would keep you from giving me all 5’s, please let me know now.” this both lets them know that 5’s are the expectation, and if they have a legit complaint I can address it, and if they say no, they may feel ashamed to give me 3’s and 4’s afterwards if they didnt speak up about something that bothered them.TimParticipantStatus: AccountantPosts: 3030Joined: 09/18/2018
Dang. I’m so sorry. I thought the enlightened organizations were simply looking for constructive feedback. I mean, nobody is perfect. I wish they would stop the shock treatments for 3’s. Disgusting.July 16, 2019 at 5:26 pm MST #231097