Physiatry Practice Management Resources

Every practice has encountered a disgruntled patient. And while it's true that you can't please everybody all the time, physicians can learn to recognize the "symptoms" of patient dissatisfaction and take corrective action before any hard feelings are formed.

The most common causes of dissatisfaction among patients relates to poor service or not getting enough service from a physician and his or her staff, according to Jack Valancy, principal in Jack Valancy Consulting in Cleveland Heights, Ohio.

Under the service umbrella fall a number of practice-patient interactions. The first of these is the telephone call to schedule an appointment. "If a patient calls the doctor's office and gets caught up in an automated voice system and must wait 15 minutes for a live voice, he or she is going to be very frustrated and unhappy," says David J. Wold, a partner in Professional Business Consultants in Oak Brook, Ill.

Speaking of waiting, few things arouse patient dissatisfaction more quickly than a doctor who is off-schedule and running late. "If you refer to your 'reception room' as a 'waiting room,' you probably have a problem," says Mr. Wold.

Creative scheduling can keep a physician on time and patients happy. For example, if a physician is perpetually late for his first patient in the morning, the staff should schedule a new patient first, notes Owen J. Dahl, president of SALCO in New Orleans. "The new patient will need time to fill out forms and won't be as upset if the physician is running late," he adds.

Anticipating no-shows, then getting none, can wreak havoc with a schedule. Rather than overbook, Mr. Dahl suggests that someone in the practice call patients the night before their appointments. "Patients should be informed of the importance of keeping their appointments and coming in on time," he says.

Even with the best schedule management, a physician still may find herself running behind. In these instances, the physician's staff can help diffuse potentially sticky situations with patients.

"If the physician is running behind, this should be communicated to patients when they arrive at the office," says Mr. Wold. "For example, if the physician had an emergency at the hospital, you might tell the patient to come back in an hour or give the option to reschedule."

A 'Moment of Truth'

Each practice interaction with a patient can be viewed as a "moment of truth," points out Mr. Dahl. And only about 15 percent of these occur with the physician. That's why it's important to have a well-trained staff to ensure that the practice passes the test of patient satisfaction.

After the initial telephone call, the second interaction a patient has with the staff is when he or she comes through the door. "The staff should always keep in mind that a patient who arrives at the office is typically not feeling well or is hurt," says Mr. Wold. "The staff must act with compassion toward patients and treat them in the same manner they would wish to be treated."

Patients become quickly dissatisfied if they believe the staff is ignoring them or treating them rudely. Mr. Wold emphasizes that each patient, upon entering the office, should be acknowledged and greeted with a smile.

"Training staff to accomplish specific objectives while the patient is in the office can avoid down-the-road problems," says Mr. Dahl. These problems are commonly seen in the area of collections. Therefore, the staff should be trained on how to collect payment from patients and deal with insurance issues. Miscommunication between a practice and patients with regard to payment can easily set the stage for dissatisfaction.

"Not understanding coverage or co-pays in managed-care situations is a frequent source of patient dissatisfaction," says Mr. Wold. "Frequently, patients will blame the physician. In these situations I usually advise physicians to urge their patients to go back to their employers and register complaints about managed-care plans' coverage and restrictions."

In the best of all worlds, a physician's staff deals with dissatisfied patients and diffuses problems before the patient sees the physician. But good staffs don't just materialize out of thin air. Mr. Wold urges physicians to provide their staffs with the necessary training in patient service and communication. "The training can include bringing experts into the practice or sending the staff to off-site seminars," he says.

Despite the best efforts of a practice's staff, there will be occasions when a dissatisfied patient enters the exam room. "In these situations, it's crucial that the physician recognize that he or she is dealing with a dissatisfied patient," says Mr. Wold.

"The physician should listen, nod his or her head and not take complaints personally. It's a mistake for the physician to confront the patient and get defensive," he says. "Rather, the physician should communicate to the patient that he or she is listening. This will help to calm down the patient."

Mr. Valancy recommends that physicians strive to manage patients' expectations. This includes the patient's expectation that he or she will have time to explain the reason for the visit. "The physician who interrupts the patient every 10 seconds is going to leave that patient angry or confused," he says.

Angry patients pose a particular risk to physicians, Mr. Dahl notes Failure to effectively communicate -- listening and talking -- with patients is the single largest source of medical malpractice suits, he says.