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  • Zzyzx Zzyzx 
    Participant
    Status: Physician
    Posts: 200
    Joined: 09/24/2018

    We do patient satisfaction surveys like most others.  I am trying to actually use them to improve my patient care.  What my real question here is;

    How do you say no nicely.

    Click to expand…

    Are your survey results saying that you are saying no in a non-empathetic way?  Or are they saying something else?

    https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2664068

    Jerant and colleagues1 demonstrate the extent to which the latter may be true. Reviewing 1319 outpatient visits to 56 family physicians by 1141 patients, they found that 68% included an explicit request by the patient to the physician, 85% of which were fulfilled. Denial of several types of requests, including physician referral, pain medication prescription, and laboratory test referral, was associated with lower patient satisfaction rating of the physician. Denial of requests for antibiotic prescription and imaging test referral was not.

     

    patient satisfaction surveys do not correlate with patient care quality – in fact they show the opposite and worse

    these surveys are piss poor statistical measures as they have huge non response biases and are not random while containing response errors

    additionally these surveys place the responsibility primarily on the physician while not splitting out the rest of the care team (RN, MA, front desk) or experience (i.e. parking)

    so my advice: get a higher sample size, increase your response rates, find out what areas of your care team can be improved to reflect better on you, and ask every patient before they leave to give you a 10.  if your scores fail to improve after that then look at yourself

    It’s psychosomatic. You need a lobotomy. I’ll get a saw.

    Avatar bean1970 
    Participant
    Status: Physician
    Posts: 566
    Joined: 07/12/2017

     

    Curious to hear if people are really seeing compensation affected by this

    Click to expand…

    where I work patient satisfaction surveys make up 10% of bonus criteria for physicians. how it is actually applied i do not know.

    #178378 Reply
    Liked by SLC OB
    Avatar Mom2won 
    Participant
    Status: Spouse
    Posts: 2
    Joined: 01/02/2019

    Where husband works, pt sat scores can be up to $30k of his salary. They are measured monthly and can include online portals like vitals, etc. He still refuses most narcotics and all atbs for viral illnesses.

    #178380 Reply
    Liked by SLC OB
    wideopenspaces wideopenspaces 
    Participant
    Status: Physician
    Posts: 1198
    Joined: 01/12/2016

    I get like$900/quarter if I meet a certain threshold on patient satisfaction. So not really much incentive on my end.
    I am not sure if they are helpful for feedback, unless you keep seeing the same complaint repeatedly.
    I tell people no a lot to benzos and stimulants and give my reasoning. If I can tell they are unhappy I offer to have them get a second opinion from a colleague. Not much else I can do but it’s my license on the line, so I do what I think is best to protect it.

    #178381 Reply
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2640
    Joined: 05/07/2017

    it took me ten years to learn to say no, and ten more to learn how to say no well.

    I see a ton of patients.  you learn it’s not really whether you say no, but whether they felt heard and had a chance to respond to your comments.  and if you aren’t doing what they want initially, if you at least schedule some follow up so that they can feel their alternate pathway was still an option.  you get them a second opinion if necessary 🙂

    I have seen people work the system with some shenanigans, but by and large the results correlate with what we know to be the case.  certainly some patients and physicians are not good personality matches and there can be some negative comments resulting, but those are a minority.

    the way to keep patients satisfied is to sell your health.  you start earlier by prepping the charts thoroughly.  this allows you to spend more face to face time with the patient and listen to them (or at least let them feel listened to).  it helps if you are not typing in a note while they are talking to you.   you stay later finishing your notes since they all can read your notes now on the open notes concept.   you try to couch negative comments in a positive light since they are reading your notes.

    you answer their calls personally or failing that at least timely by the nurse.

    the price is whatever bonus the hospital pays you.  in aggregate, my patient satisfaction bonus has been at least 150k, and probably closer to 200k over the years.  I have no idea if it is worth it or not.  when I was younger I did it for no bonus.  then someone started measuring it and handing me bonus.  now I want more bonus because they moved the goalposts with the incorporation of emr and myriad demands of multiple quality agencies.  in a way the bonus doesn’t matter to me, because I take care of the patients the best way i know how anyways.  communication has always been an important part to me, and I think the central issue remains time-note enough is taken/scheduled to establish a rapport that ensures trust, rather than the question asked of how to say no.  however, I’m afraid to calculate the hourly rate of what it takes to maintain a high satisfaction score if the goal is to achieve the score or get paid the bonus.

    ymmv

    🙂

     

     

     

     

    #178393 Reply
    Avatar G 
    Participant
    Status: Physician, Small Business Owner
    Posts: 1872
    Joined: 01/08/2016

    I’ve found that it’s not what you say, but how you say it. My sat scores are almost always 99th percentile, and I guarantee you that I’m not giving antibiotics for uri or narcs for a stubbed toe. It entertains the nurses for sure the stuff that I get away with saying as long as there is a smile on my face!

    Then again, I’m wealthy and jaded enough that I dont care about survey outcomes, so that also helps.

    #178394 Reply
    Liked by hatton1, Zaphod, Anne
    IntensiveCareBear IntensiveCareBear 
    Spectator
    Status: Physician
    Posts: 243
    Joined: 12/22/2018

    … am not a people pleaser…

    …How do you say no nicely...

    Click to expand…

    This isn’t really a question of medical skills… it is just basic people skills. You could also say it is basic sales skills. I would disagree with whoever said top priority is getting people healthy. Every business sells a product and/or service. What you are doing, plain and simple, is selling a medical service. You are a salesman who aims to provide happiness. Happiness is physical and mental. Many docs can do the work of dx and rx and procedures, but you want to do it in a way that also gives the patients a positive experience they will tell friends and neighbors about. You want them to bring you holiday gifts, advocate for you, and respect your time because they like you.

    Like in any social relationship, you always want to maintain rapport with the patient… you want to be agreeable. Let them dictate the subject matter when possible. Agree and amplify with what they say. Make eye contact.

    Think about people who annoy you or who you don’t like… they probably are disagreeable. Nobody likes someone who constantly disagrees and breaks rapport. That will get you bad surveys every time, lol. That one-sided dry visit interaction is exactly what many docs try to be: talking textbooks that are dull, set in their ways, and not to be questioned. No patient wants that loser who never went to parties since he was in the library non-stop. Some will settle for it, but they still don’t like it. Watch your students and residents and even colleagues; some “get it” when it comes to social and sales skill, and some definitely do not.

    If you have to contradict or criticize what the patient wants or suggests, you can do the compliment sandwich (basic business and sales skill to do minimal damage to rapport). Sure, there are times when you must quickly and blatantly dismiss the patient’s idea and tell them what to do because the matter is so serious, but those are few and far between. As was mentioned, I find it also helps to blame the insurance, the hospital, other patients, etc types of other anonymous third parties when you need to break rapport and stand up to leave, get off the phone, refuse a Rx or other stupid request, etc. They have nobody to be directly upset with in that case… if your skills are good, you appear to be on their team, but mean old entity XYZ is limiting you both 🙂

    Maybe try reading 48 laws of power by Greene, How to win Friends and Influence People, or any number of books on image, impressions, and social skill. Work on your persona and your social skills. You will probably be surprised how fast you can make progress… and how it helps you many more places than just at work. GL

    "Hmm, that sounds risky." - motto of the middle class

    #178395 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1233
    Joined: 11/07/2017

    I agree with q-school that time helps a lot. Time spent listening to the patient goes a long way. Sometimes a request that on first glance is unreasonable turns out to seem much more reasonable given time. A few examples:

    a patient with chronic lumbar radicular pain requesting a note to be excused from jury duty. On first glance, there is no reason he couldn’t do it. On listening to him “I did jury duty in the past with this pain and I didn’t feel like I was paying attention to the case the way I should have, and I don’t want to be in the position of deciding someone’s fate when I’m so focused on wanting to get up and stretch and move around that I just want to finish up as soon as possible”. I could see myself in his shoes and I would feel the same way. I wrote the note.

    a patient with chronic nonspecific knee pain but no functional deficit requesting a work accommodation note. Cue internal eye roll. Then I asked him what he thought it should say. He just wanted it to say he could sit down for a few minutes every 2 hours. He would and could continue to do the same job during an intermittent change of position to sitting but his company policy was to stand all day long in essentially one place except for his lunch break. My knee hurts too when I’m not allowed to change position all day long. I wrote the note.

    I also have patients whose further explanations do not change my mind. “Why do you feel you need a handicap placard?” “I don’t want to walk that far” “But walking will help your endurance and conditioning and in your condition I would actually recommend walking intermittently throughout the day” “but all the good spots are taken when I show up to work” “I’m sorry, but I really can’t sign for a handicap placard for your condition.”

    For narcotics, I never blame someone else. When I don’t think they are indicated, I explain why and give alternatives.  I let them know that I believe they have significant pain, why I don’t think using narcotics for their condition is in their best interest, and other things we can try and let them help decide which path they would like to take with the options.

    The patients that are going to complain and write nasty reviews are probably going to do that regardless. Don’t let them frustrate you to the point that you write off the patients that are really seeking your advice.

    And personally, I completely want the “loser that never went to parties and was in the library non-stop”, i.e. I value conscientiousness and knowledge above shmoozy salesperson people skills and compliment aka crap sandwiches. I can smell that stuff a mile away and personally would run if I ever felt it coming from a doctor. I want a doctor who listens to me but is also frank and honest with me and tells me what they really think is best rather than what they think I want to hear. I think if you are straightforward and honest, you will over time attract the patients who value that in a doctor, and if you are schmoozy and tell patients what they want to hear, over time you will attract patients that value that. Either way your patient satisfaction will go up.

    You may have to ask the patients that seem happiest with your style to fill out their surveys. As with many things, people who have something to complain about tend to be more vocal than those who are content.

    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 3033
    Joined: 01/03/2017

    I’ll certainly do my best to educate the patient. Many are receptive and can understand the reasoning behind the decisions. With that said, there’s some patients that you know you aren’t going to please. The key is not to spend much time with those patients arguing or trying to convince them that you’re only trying to practice good medicine. Tell them your decision and discharge them. Once a patient is upset that you aren’t going to give them antibiotics, narcs, whatever, you’re not going to improve that interaction. Hopefully, your compensation isn’t tied to patient satisfaction scores as there is no correlation between a well satisfied patient and the practice of good medicine. The goal is not to be an outlier. Besides, I checked my Press Ganeys for last quarter and about 5% of the patients that I saw returned the survey. Not what I would call statistically significant.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #178428 Reply
    portlandia portlandia 
    Participant
    Status: Physician
    Posts: 414
    Joined: 07/07/2017
    And personally, I completely want the “loser that never went to parties and was in the library non-stop”, i.e. I value conscientiousness and knowledge above shmoozy salesperson people skills and compliment aka crap sandwiches. I can smell that stuff a mile away and personally would run if I ever felt it coming from a doctor. I want a doctor who listens to me but is also frank and honest with me and tells me what they really think is best rather than what they think I want to hear. I think if you are straightforward and honest, you will over time attract the patients who value that in a doctor, and if you are schmoozy and tell patients what they want to hear, over time you will attract patients that value that.

    Click to expand…

    +1000.

    Years ago, as part of new hire orientation, I attended a class on improving Press Ganey scores. Some of the language suggested was too used car salesman for my liking. It felt shmarmy, insincere and manipulative, so I abandoned it.

    #178436 Reply
    Liked by Hank, hatton1, Mom2won
    Avatar LizOB 
    Participant
    Status: Physician
    Posts: 322
    Joined: 06/05/2017

    I’m ob/gyn so don’t really deal with coughs and colds, but I occasionally see patients with chronic or complex pain/bleeding/discharge/etc who seem a little on edge and maybe not totally on board with my recommendations. I usually conclude those visits by saying something like “I certainly hope this helps you and I think there’s a good chance it will, but I would also like you to schedule a follow-up with me on your way out today so we can touch base in a few weeks and make adjustments if we need to”. As much as I internally cringe at the thought of seeing some of them back, I do notice some relief/gratitude when they realize I’m not just trying to rush them out the door and am willing to keep working with them. This also ends up saving some hassle for both me and my staff because there tend to be a lot fewer triage calls from that type of patient when she already has a follow-up scheduled.

    I sometimes get requests for work notes from my pregnant patients who have no contraindication to working (although I will ask what they need, I am happy to write notes for more frequent bathroom breaks or to keep a bottle of water at their work station for instance) but for the ridiculous ones I am currently at the point in my own pregnancy where I can say “well I’m more pregnant than you and here I am- there’s no medical reason you can’t keep working too”. It’s fun watching them realize they got the wrong doctor for that request

    #178479 Reply
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6327
    Joined: 01/12/2016
    And personally, I completely want the “loser that never went to parties and was in the library non-stop”, i.e. I value conscientiousness and knowledge above shmoozy salesperson people skills and compliment aka crap sandwiches. I can smell that stuff a mile away and personally would run if I ever felt it coming from a doctor. I want a doctor who listens to me but is also frank and honest with me and tells me what they really think is best rather than what they think I want to hear. I think if you are straightforward and honest, you will over time attract the patients who value that in a doctor, and if you are schmoozy and tell patients what they want to hear, over time you will attract patients that value that. 

    Click to expand…

    +1000.

    Years ago, as part of new hire orientation, I attended a class on improving Press Ganey scores. Some of the language suggested was too used car salesman for my liking. It felt shmarmy, insincere and manipulative, so I abandoned it.

    Click to expand…

    Yes and no. It may seem a little bit that way and often when just translated to medicine without any effort it really is. However there is a lot there that you can learn in just how to talk to people. No offense, but so many doctors are terrible at talking to pts like theyre people. Minor improvements and simply thinking about the why of how those things work and apply them to your personality and practice.

    The exact language rarely matters, much more about delivery, tone and your face, but unfortunately at times it can be true that certain phrasings work. I have long refused to say many of the words and phrases that are supposed to be golden, but you’d be shocked at when it slips out how powerful it is to some pts. Now I dont care about ratings, dont have press gainey stuff, though have hundreds of reviews online at various sites but it definitely matters how you handle yourself. If you’ve never seen yourself during a consult/follow up etc…I guarantee you will be mortified and find things you do not like and do want to change.

    I agree with Anne you should run from the obviously schmoozy, these guys are usually frauds and only will hurt you/pts, and you . You should also be surgical about who you give surveys to, its a game, learn to play it. You should be able to improve your interactions while still being true to good care, etc…I usually explain my reasoning to pts, seems to work well, and it always includes what will happen next if my current assumptions turn out to be wrong. This helps to alleviate the anxiety they may have, they know you’re willing to change your mind.

    I dont give people anything stronger than 5 days of tramadol and dont do refills for surgery. Most of the time, they never even ask, when they do I dont have any issues with people complaining they need it. Theyre pretty much told up front how things will go and so know whats happening anyways. As someone else mentioned if someone has an issue and is afraid theyre not getting the full court press, the easy thing is to simply monitor them closer and make them feel watched/safe until it gets proven in your favor. You cant blow people off and leave them afraid, which is the underlying drive for why theyre annoying you.

    Seriously if anyone wants to hate themselves, just get a secret shopper video of yourself interacting with various types of pts, it will be painful.

    #178503 Reply
    IntensiveCareBear IntensiveCareBear 
    Spectator
    Status: Physician
    Posts: 243
    Joined: 12/22/2018

    …” “I’m sorry, but I really can’t sign for a handicap placard for your condition.”…

    …For narcotics, I never blame someone else. When I don’t think they are indicated, I explain why and give alternatives.  I let them know that I believe they have significant pain, why I don’t think using narcotics for their condition is in their best interest, and other things we can try and let them help decide which path they would like to take with the options.

    The patients that are going to complain and write nasty reviews are probably going to do that regardless. Don’t let them frustrate you to the point that you write off the patients that are really seeking your advice.

    And personally, I completely want the “loser that never went to parties and was in the library non-stop”, i.e. I value conscientiousness and knowledge above shmoozy salesperson people skills and compliment aka crap sandwiches. I can smell that stuff a mile away and personally would run if I ever felt it coming from a doctor. I want a doctor who listens to me but is also frank and honest with me and tells me what they really think is best rather than what they think I want to hear. I think if you are straightforward and honest, you will over time attract the patients who value that in a doctor, and if you are schmoozy and tell patients what they want to hear, over time you will attract patients that value that. Either way your patient satisfaction will go up.

    You may have to ask the patients that seem happiest with your style to fill out their surveys. As with many things, people who have something to complain about tend to be more vocal than those who are content.

    Click to expand…

    I am guessing you are very young?

    …We are not talking about what you might want in a doc, we are talking about the median patient… the vast majority of patients. The people at the grocery store or on the bus or watching Masked Singer right now.

    We docs are obviously all people who were in libraries for significant time. We all passed steps. We all have diplomas on the wall. We all have hospital badges for major hospitals. We all have white coats. The patients know we are generally pretty smart and competent. What I was trying to illustrate is that there is an art to being in rapport with the patient (and staff, etc). Two doc visits can both give the same patient the same Rx and a brief recommendations… yet one doc is viewed as dry and boring where the other would be a fun neighbor or buddy. It is definitely not a foregone conclusion that “nasty reviews are probably going to do that regardless.” It has been proven that people are unlikely to sue, or jury to convict, a doc they find likable as opposed to neutral or unlikable. Which do you want to be???

    If patients want to “be educated,” they will ask. If there is the occasional time for seriousness, you will sense that. The rest of the time, staying in good rapport, knowing good sales skill, using positive conversation and body language, and a handful of lighthearted anecdotes about their kids, hobbies, pop culture, holidays, etc is generally what they tend to appreciate and what they’d want from anyone in their life, including a doc. Think of other docs and who you’d want to have a beer with versus who you can barely force small talk with for a few minutes in the elevator. Again, the patients just generally want a good experience with good results… they know you’re smart, ok? They want smart with positive and kind interaction. They want you to be at ease so that they can too.

    It is called “acting the part” or having “character” for good reason. It is your work persona, and you generally want it to put patients at ease and amuse them a bit also. If you want to be a know-it-all or a No-Fun-Nancy, that is fine. That is the persona you choose. Those are consistently rated low by patients, even if objective results or test scores are nearly flawless. Nobody likes an overly serious and rigid person… and definitely not one who is aloof or domineering or viewed as DISAGREEABLE (again, biggest personality sin of all). Staff also “yes sir” those docs while they then whisper and laugh when Dr. Hardass has the occasional slip-up. Again, everyone picks their own persona. Just be aware that, unless you are humbly aware you are a regular human just like your patients and your $10 per hour employees, your persona’s high horse may occasionally hit its head on doorways. 🙂

    …as an option (I would say tip, but your head may explode), for the frivolous narcs or handicap stuff, you can say “ahh, I’m sure it hurts, but the state is really cracking down on that stuff, let’s try X” or “well, that is a fine idea, but you might need to see a pain/disability doc for that. I want you to get the best full evaluation” (they will seldom follow up on that). None of those are lies, and none of those blamed anyone else. “The state” or “your insurance” or “going to do rounds on a couple of my surgery patients” aren’t someone… they are anonymous things the patient can’t really be upset with. The team of you + patient stays intact, as does your rapport. Again, do that… or don’t. It is your persona. When in doubt, just remember what actors or people around you are generally likable. I would love to spend a fun weekend with friendly Drew Barrymore but not abrasive Kourtney Kardashian. You probably feel the same way about goofy Bradley Cooper versus snide Jack Nicholson. Now pretend they’re doctors.. who gets good reviews and who has their patients searching for a new doc? Cheers

    "Hmm, that sounds risky." - motto of the middle class

    #178509 Reply
    IntensiveCareBear IntensiveCareBear 
    Spectator
    Status: Physician
    Posts: 243
    Joined: 12/22/2018
    Click to expand…

    Yes and no. It may seem a little bit that way and often when just translated to medicine without any effort it really is. However there is a lot there that you can learn in just how to talk to people. No offense, but so many doctors are terrible at talking to pts like theyre people. Minor improvements and simply thinking about the why of how those things work and apply them to your personality and practice…

    Click to expand…

    Amen.^^^

    I hate to say it, but most docs are just the type who must be right all the time and love to debate. They must win (look at this forum often!). Sure, we all did graded tests and debate EBM all the time for a decade or more, and acting type A and competitive was great back then. But now, you have to let it goooo. I swear, I hardly even like going out with groups of docs for dinners and at conferences and such since so many are dull or know-it-all… sad but true.

    We are all smart. The letters after our names say that lout and clear. Patients are not inferior minds who are in need of a schooling, though. Sooo many docs have that mentality, but it is not a one way street. You can be likable as well as informational. It is a show for them; you are a seller of a service. Make it a show they want to see again! A clinic or OR where staff and patients are happy and at ease can make your day much easier and more enjoyable… in addition to good reviews and referrals.

    The good thing is, improving your personality and social (sales) skill set is just not too hard. There are many good books, many good people to model. You can find a good middle ground between the talking textbook and the shiny salesman. I know I’m always trying to improve every day…

    “Working on yourself like clay should be one of your greatest and most pleasurable life tasks. It makes you in essence an artist an artist creating yourself.”

    "Hmm, that sounds risky." - motto of the middle class

    #178513 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1233
    Joined: 11/07/2017

    …” “I’m sorry, but I really can’t sign for a handicap placard for your condition.”…

    …For narcotics, I never blame someone else. When I don’t think they are indicated, I explain why and give alternatives.  I let them know that I believe they have significant pain, why I don’t think using narcotics for their condition is in their best interest, and other things we can try and let them help decide which path they would like to take with the options.

    The patients that are going to complain and write nasty reviews are probably going to do that regardless. Don’t let them frustrate you to the point that you write off the patients that are really seeking your advice.

    And personally, I completely want the “loser that never went to parties and was in the library non-stop”, i.e. I value conscientiousness and knowledge above shmoozy salesperson people skills and compliment aka crap sandwiches. I can smell that stuff a mile away and personally would run if I ever felt it coming from a doctor. I want a doctor who listens to me but is also frank and honest with me and tells me what they really think is best rather than what they think I want to hear. I think if you are straightforward and honest, you will over time attract the patients who value that in a doctor, and if you are schmoozy and tell patients what they want to hear, over time you will attract patients that value that. Either way your patient satisfaction will go up.

    You may have to ask the patients that seem happiest with your style to fill out their surveys. As with many things, people who have something to complain about tend to be more vocal than those who are content.

    Click to expand…

    I am guessing you are very young?

    …We are not talking about what you might want in a doc, we are talking about the median patient… the vast majority of patients. The people at the grocery store or on the bus or watching Masked Singer right now.

    We docs are obviously all people who were in libraries for significant time. We all passed steps. We all have diplomas on the wall. We all have hospital badges for major hospitals. We all have white coats. The patients know we are generally pretty smart and competent. What I was trying to illustrate is that there is an art to being in rapport with the patient (and staff, etc). Two doc visits can both give the same patient the same Rx and a brief recommendations… yet one doc is viewed as dry and boring where the other would be a fun neighbor or buddy. It is definitely not a foregone conclusion that “nasty reviews are probably going to do that regardless.” It has been proven that people are unlikely to sue, or jury to convict, a doc they find likable as opposed to neutral or unlikable. Which do you want to be???

    If patients want to “be educated,” they will ask. If there is the occasional time for seriousness, you will sense that. The rest of the time, staying in good rapport, knowing good sales skill, using positive conversation and body language, and a handful of lighthearted anecdotes about their kids, hobbies, pop culture, holidays, etc is generally what they tend to appreciate and what they’d want from anyone in their life, including a doc. Think of other docs and who you’d want to have a beer with versus who you can barely force small talk with for a few minutes in the elevator. Again, the patients just generally want a good experience with good results… they know you’re smart, ok? They want smart with positive and kind interaction. They want you to be at ease so that they can too.

    It is called “acting the part” or having “character” for good reason. It is your work persona, and you generally want it to put patients at ease and amuse them a bit also. If you want to be a know-it-all or a No-Fun-Nancy, that is fine. That is the persona you choose. Those are consistently rated low by patients, even if objective results or test scores are nearly flawless. Nobody likes an overly serious and rigid person… and definitely not one who is aloof or domineering or viewed as DISAGREEABLE (again, biggest personality sin of all). Staff also “yes sir” those docs while they then whisper and laugh when Dr. Hardass has the occasional slip-up. Again, everyone picks their own persona. Just be aware that, unless you are humbly aware you are a regular human just like your patients and your $10 per hour employees, your persona’s high horse may occasionally hit its head on doorways.

    …as an option (I would say tip, but your head may explode), for the frivolous narcs or handicap stuff, you can say “ahh, I’m sure it hurts, but the state is really cracking down on that stuff, let’s try X” or “well, that is a fine idea, but you might need to see a pain/disability doc for that. I want you to get the best full evaluation” (they will seldom follow up on that). None of those are lies, and none of those blamed anyone else. “The state” or “your insurance” or “going to do rounds on a couple of my surgery patients” aren’t someone… they are anonymous things the patient can’t really be upset with. The team of you + patient stays intact, as does your rapport. Again, do that… or don’t. It is your persona. When in doubt, just remember what actors or people around you are generally likable. I would love to spend a fun weekend with friendly Drew Barrymore but not abrasive Kourtney Kardashian. You probably feel the same way about goofy Bradley Cooper versus snide Jack Nicholson. Now pretend they’re doctors.. who gets good reviews and who has their patients searching for a new doc? Cheers

    Click to expand…

    My patients also frequently guess that I’m young, based on my appearance. I tell them it’s sunscreen. Plus because I never ever smile I don’t have any wrinkles. If you were born the year I graduated med school you would now be old enough to drive. That may still be very young based on who is doing the judging.

    I don’t disagree that having good interpersonal skills is important. You seem to have a difficult time with a colleague questioning some of your strategies. I do find your style of lecturing to be amusing (because I don’t take it seriously). Personally I think Jack Nicholson would make a great doctor. (“You want the truth? You can’t handle the truth!!!”). I don’t keep up with the Kardashians so that reference is lost on me. And I am a disability doctor, so I guess I could use that line and really confuse people (not sure why you think people won’t follow up on that–people come to me all the time and say “my doc told me I had to come see you to get a handicap placard”). I prefer to be honest with people. The state is not “cracking down” on disability placards, the paperwork leaves the determination more or less to the doctor’s judgment. Same for narcotics–there are monitoring rules that need to be followed, but if I really think they are indicated, I can write for them–I know that decision is up to me, I am not going to lie to the patient and tell them the bogeyman won’t let me do it. I am old and experienced enough to take responsibility for my own decisions, explain the rationale for those decisions to my patients, and maintain rapport while doing so. The patients that appreciate this approach, well, they appreciate it. And the ones that don’t I guess can go hang out with Dr. Barrymore.  Salud!

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