Paper Robes and Other Patient Insults
By Judy Fargnoli
Director, Corporate Projects
Beacon Partners, Inc.

I have been working with physicians for over 20 years and know first hand how devoted they are to their patients. Nonetheless, when I recently became a patient myself, I saw the many ways that patients are inconvenienced and treated thoughtlessly. It happens in the waiting room or on the telephone and most physicians are not even aware it is happening. If your patient seems difficult or surly, it might be because they have been treated badly by your staff. Based on my own experience, following are the four “patient insults” I suggest you look for in your practice.

The Paper Chase
No one would argue that complete and accurate registration information is critical to maintaining effective collection from third parties and controlling A/R. But having the patient fill out forms doesn’t necessarily guarantee complete and accurate information. Let’s look at several scenarios that actually happen everyday, the names have been changed to protect the innocent.

Dr. Killatree – The patient is greeted by a note on the wall instructing them to sign in. None of the staff members standing around in the glass enclosed desk area even acknowledges the patient. As soon as the patient is seated, someone slides open the glass and calls the patient back to the desk. A clip board and three forms are thrust through the window, and the patient is instructed to complete the forms even though she has been a patient at this practice for eighteen years. The completed form from last year is on the clipboard and the naïve patient asks why she can’t just review the old form and confirm there are no changes. This, she is told, is not “the way we do it here”. She hands over her insurance card to be copied and gloomily returns to her seat to complete the forms. She walks back to the window, hands in the clipboard and returns to her seat. Immediately the glass opens and she is called back to the window to retrieve her insurance card and make her co-payment. Traveling back and forth to the desk is only annoying for this patient who is there for an annual exam, but for elderly or very ill patients this encounter could be daunting.

Dr. Nosy –Someone, somewhere decided that having lots of information from patients will improve the ability to collect debts. Dr. Nosy’s form asks for the patient’s driver’s license number and mother’s maiden name. The patient does not want to provide this information because it seems unnecessary and an invasion of privacy. Unfortunately, she is informed that this is required information although the young lady at the desk is not sure why and goes to ask someone else, while the patient stands at the window marveling at this encounter. She is finally told, driver’s license is used in case a check bounces and mother’s maiden name is used to verify the identity of the patient over the phone. The patient feeling ill and cranky respectfully declines to provide this information since her co-pay is in cash and her mother’s maiden name is used by financial institutions for identification.

Practice managers, consultants and anyone else establishing registration policies and procedures need to think about not only the outcome they are trying to achieve for the office but how the process impacts patients. Of course you must have solid registration data, but it is not necessary for patients to look like “jack in the box” running back and forth to the window, filling out reams of paper with the same information and being treated as if their inconvenience is inconsequential compared with the practices need to reduce bad debt. If 20% (or less) of patients don’t pay or write bad checks, does the other 80% have to be penalized. Establish procedures that accomplish what the practice needs to maintain effective A/R management but allows the majority of patients to be treated with respect.

The Waiting Room Game
How many time studies does it take to realize that doctors rarely follow the structured schedule that has been designed? Most patients are conditioned to expect to sit in the waiting room. They understand that they will be herded to the back where some or all of their clothes will be taken away in lieu of a paper gown, and then they will wait some more.

Dr. Attention- The mother arrives at the office at exactly the time of her daughter’s appointment. Experience from the past 3 visits has shown that the wait time is at least one hour. The mother knows that once her daughter is in the room with the physician she will receive undivided attention, careful evaluation and complete instructions. Apparently the office manager hasn’t noticed that Dr. Attention likes to spend more time with her patients because appointments are booked every 15 minutes even though Dr. Attention spends 25 – 30 minutes with each patient.

Dr. Pool - The patient arrives at 8:15am for her 8:30 appointment. She waited 2 months to get this coveted slot because it is the first appointment of the day. She has been seeing this gynecologist for 20 years and has figured out his pattern. She mentions to the nurse that this is the best time for an appointment and the nurse says it sure is because Dr. Pool likes to take his time in the morning so he can drink his coffee, read his paper and take a swim in his backyard pool. Unfortunately, this means that by the time he gets to the office he is already ½ hour behind. The patient sits in the exam room in a paper gown and wonders why she has tolerated this behavior for so many years and decides it is time to find a new doctor.

Whether appointments are scheduled in a book or in an automated system, time frames must be realistic based on the patterns of the provider. The patient’s time is just as valuable to them as the physician’s time. Demonstrate your commitment to your patients by scheduling appointments to minimize their wait time.

First Impressions are Lasting
It takes a special person to work in a physician’s office, someone who is considerate, compassionate and infinitely patient. These are the people who interact with patients from the moment they walk in the door until the time they walk out. It doesn’t matter how kind or intelligent the doctor is, if the patient is treated badly by the staff they won’t come back. Sometimes it is the little things that practice managers may not even notice that will turn a patient away.

Mary Contrary – Mary has a fight with her boyfriend and arrives at work angry at the world. The patient walks up to the front desk with a smile on her face but finds that Mary doesn’t return her happy greeting. In fact, Mary doesn’t even look up to acknowledge the patient, she just shoves the sign- in sheet in her direction. The patient signs in and awaits further instruction, no longer wearing the smile.

Ima Hungry –The patient spends the night in the emergency room, sits in the doctor’s waiting room for 30 minutes and is experiencing pain compounded by nausea. She is waiting at Ima’s desk while her surgery is being scheduled. Ima is enjoying a huge piece of birthday cake; she eats while talking to the OR, while she is on hold and while she talks to the patient about pre-op instructions. The patient struggles to control the nausea and wonders if it would be possible for Ima to put the cake away until she has completed this particular piece of business. The patient decides that this unprofessional behavior and the doctor’s tolerance of it is unacceptable and decides to seek treatment elsewhere.

Sally Sharesalot – The patient is waiting at the front desk to get a question answered. Sally the receptionist is sharing with Suzy the biller the graphic details of the date she had with Mark. Sally believes that Mark is just not the man for her and Suzy agrees that no one should have to tolerate what Sally has been through and so and so on. The patient wants to interject that she is not interested in their personal life and perhaps they should save this conversation until they are alone. The patient feels that she is so inconsequential that the staff members have totally dismissed her presence.

Location, Location, Location
Patients choose providers using many criteria and proximity to their home is high on the list. Patients don’t typically decide which doctor to see based on parking facilities but many will decide not to go back to a physician if parking or access to the building is very inconvenient, expensive or difficult to locate.

Physicians Only – The patient who is in considerable pain arrives at the specialist’s office after spending the night in the emergency room. The office is in a medical building adjacent to a hospital and as the patient drives around in the rain hoping a parking space will open up she notices two rows of empty spaces near the side of the building. She discovers that these spaces are reserved for physicians and over half of them are empty. Not wanting to have her car towed away she parks in the satellite lot for the hospital and makes the long walk back to the office. By the time she arrives at the office she is wet and cold and her pain and frustration have increased significantly.

While physicians are certainly entitled to perks, they shouldn’t overtly impact patients. Look at your parking lot and building access for opportunities to show patients how important they are to your practice.

Patient for a Day
Unfortunately, we will probably all be a patient someday. Take a day and view your office from a patient’s perspective. Be the person on the other side of the glass, the person in the backless paper gown, and ask yourself how you can improve the patient’s experience. It doesn’t mean redesigning the entire office, just examine processes and identify how to meet your objectives while still showing respect for your patients. This small effort will result in increased patient satisfaction, more return appointments and positive “word of mouth” referrals. Don’t assume that your practice is operating at maximum potential. Be a patient for a day, you may be surprised at what you discover.

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