Ornery Patients? No Wonder!

I have been working with physicians for over 20 years and know firsthand how devoted they are to their patients. But when I recently became a patient myself, I saw that there are many ways that patients are inconvenienced and treated thoughtlessly in their physician's office.

If your patient seems difficult or surly (we all know the type), it might just be because they have been treated badly by your staff. Based on my own experience, here are the top four "patient insults" I suggest you look for -- and work to eliminate -- 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 for controlling accounts receivable (A/R). But having the patient fill out forms doesn't necessarily guarantee complete and accurate information. Here are several scenarios that actually happen in physician offices:

Stand up, sit down -- 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 acknowledges the patient.

As soon as the patient is seated, someone slides open the glass and calls the patient back to the desk. A clipboard 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 18 years. The completed form from last year's visit is on the clipboard and the 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 returns to her seat to complete the forms. She then 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.

Digging too deep -- The physician's registration 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. But she is informed that this is required information, even though the young lady at the desk is not sure why and goes to ask someone else, while the patient stands at the window.

She is finally told that her driver's license number is collected in case a check bounces, and her 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. 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 so that they 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 and replaced with a paper gown, and then they will wait some more. But is this the way it has to be? Here are some more situations you may recognize:

When more is less -- The mother arrives at the office at exactly the time of her daughter's appointment. Experience from the past three visits has shown that the wait time is at least one hour. She supposes the wait is worth it because she knows that once her daughter is in the room with the physician, she will receive undivided attention, careful evaluation, and complete instructions.

Unfortunately, the office manager hasn't noticed that even though appointments are booked every 15 minutes, the doctor typically spends 25 to 30 minutes with each patient.

Whose time is it, anyway? -- The patient arrives at 8:15 a.m. for her 8:30 appointment. She waited two 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 -- he's always running late. But since she's first on his schedule, she's sure to be seen on time, right? She mentions to the nurse that this is the best time for an appointment and the nurse says, "It sure is because the doctor 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 a half-hour behind. The patient sits in the exam room in a paper gown and 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 physicians. The patient's time is just as valuable to them as the physician's time is to him.

First impressions last

It takes a special person to work in a physician's office -- someone who is considerate, compassionate, and infinitely patient. 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. Make it a point to share these examples with your staff; they may just see themselves.

Don't make it personal -- Receptionist 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 general direction. The patient signs in and awaits further instruction, no longer wearing a smile.

This takes the cake --  The patient spent the night in the emergency room, and has sat in her doctor's waiting room for 30 minutes this morning with pain and nausea. She is waiting at scheduler Irma's desk while her surgery is being arranged. Meanwhile, Irma 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 her nausea and wonders if it would be possible for Irma 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.

Location, location, location

Patients choose providers using many criteria, and proximity to their home is high on the list. They 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. For example:

For physicians only? -- A 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. 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 more than half of them are empty. Not wanting to have her car towed away, she parks in the hospital's satellite lot and makes the long walk back to the doctor's office. By the time she gets there, she is wet and cold and her pain and frustration have increased significantly. 

While physicians are certainly entitled to perks, these shouldn't adversely affect patients' convenience. Take a look at your own parking lot -- and look for other opportunities to make access and comfort for your patients a priority.

Be a patient for a day -- Take a day to 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 examining processes and identifying 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, and you may be surprised at what you discover.

Judy Williams is manager of consulting services for Beacon Partners, a healthcare management consulting firm. Her areas of expertise include streamlining business processes to maximize revenue opportunities, design and implementation of business models, benchmarking, and implementation of HIPAA regulations. For the past two years, she has served as a judge in Physicians Practice's Practice of the Year competition. She can be reached at Judy.Williams@beaconpartners.com or via editor@physicianspractice.com.

This  article originally appeared in the February 2004 issue of Physicians Pracctice.