by Terri Schmitt, Editorial Board

Dear Health Care Provider,

Recently, I have had more interactions with the healthcare system in which you work, specifically with you as my provider and I as the patient or family. The past few months have served as an important reminder that the majority of the time I do not enjoy interacting with the healthcare system and neither do my patients. This role reversal has served as a good time to reflect on my own practice.  After a recent visit I jotted down the following list of advice, from the patient perspective:

1.)    Hire at least one good registered nurse (RN), who has acute care experience and then train them in primary care.  Registered nurses have more extensive training than medical assistants and in the long run they will save you time, money, lawsuits, personal time answering patient questions, identify issues with patients, and generally make your practice more safe.  Some programs require a nurse to manage them like the Vaccines for Children program. Most importantly, this will leave you with happier patients. Let’s be honest, in the ever-changing climate of U.S. healthcare, one element that keeps patients returning is quality.  Just get one.  O.K.?

2.)    Perform good phone triage.  This means actually answering the phone first, then having a system for pharmacy refills, questions about home care, etc.  This leads back to advice in #1. It’s worth repeating that when RNs do your phone triage you can keep your patients better educated, connected, and your practice running more smoothly. Not only is this good customer service, its safe practice.  Do you wait several days to be called back by your own healthcare provider?

3.)    Good customer service begins at the front desk.  Patients first encounter the front desk staff.  This area should be relatively pleasant, quiet, understanding, and not a place where co-pays, addresses, and phone numbers are shouted out for the rest of the waiting room to hear. Their job is difficult no doubt; balancing numerous activities, but treating patients kindly and with respect should begin in the reception area.  Providers, part of this leans back into the culture you set up in your office. How you pay/incentivize staff and how you respond to them making errors, or doing something right, all sets the stage for how they will respond in their job.  Love your staff and they will probably love you, your patients and make everyone a bit happier.

4.)    Remember you are there to serve, not the other way around. Being able to see patients, hear their most intimate physical, emotional, psychological, and spiritual needs is a great responsibility.  Every aspect of being a healthcare provider means service.  This does not mean you should not be compensated or treated with respect.  Your patients should get both as well, respect and your time/knowledge.

5.)    Remember that being a healthcare provider is a privilege, if you do not want to do the job, then maybe it’s time to rethink what you do.  Your patients know when you are grouchy.  Everyone is entitled to a bad day, but we can hear you question your staff in the hallway. We can sense when you don’t want to show up for work.  If you work too many days in a row when you don’t want to be there… then take an extended leave to regroup or find something else that excites you.  Everyday should be an adventure.  Do you live the adventure?

6.)    Put your hands on the patient and examine them. Use your senses and your brain, not the results of tests.  Here is where it get’s personal for me.  I actually have an issue that has been quite obvious to me for some time. In fact, I have been easily able to palpate this ‘obvious’ for 18 months.  I have seen 4 different providers now and not one, no not one, has palpated my ‘obvious’ chief complaint.  They have imaged, tested, screened, and are planning for even bigger and fancier tests, but not one single provider has actually palpated ‘obvious’.  In my last two visits to my former primary care physician, one of which included a well woman exam. No one even put a stethoscope on my chest and listened, no one did a bi-manual exam, etc.  Of course I am switching primary care providers. I am going to find myself a good family practice NP.

7.)    Listen to the patient.  Ask them not only if they have questions, but also if they have fears or doubts about the information you are providing them.  I appreciate that you are on a schedule, so was I while I waited 45 minutes in your waiting room and listened to your receptionist give the woman who came in after me a hard time about being 15 minutes late.  I am here to see you because I think I have a problem.  I know you have a solution, but I want to know more than just the medical ‘risks’ that you blurted through like a big pharma TV commercial.  I swear it will only take 5 minutes.  You can even set a timer if you want to.

8.)    Smile a little. Laugh or crack a joke.  It really will make your day better.  Of course, use discretion, but a good laugh at something, or at yourself, balances the power in the room and diffuses tension.

9.)    Allow patients to call you by your first name.  I know we like formality and being called by our ‘title’.  I like to throw mine around when I can, but if you get to call me ‘Terri’, then I should get to call you ‘Bob’.  Fair and again, makes the ‘team work’ aspect of healthcare so much more real.

10.) Hire an advanced practice nurse, one with credentials and experience suited to your patient population. Please, please, pretty-please with sugar on top.  I personally prefer to see one and then if the problem gets too difficult or they need advice they will come seek you out.  Plus the NP will generate revenue for you by increasing your capacity for seeing patients.

11.) Make your own return phone calls to patients regarding medications or lab work.  You can bill for this.  Trust me, I know it takes time and sometimes the patients get tangential, but its worth it.  Talk to them.  Let them know you give a crap about how they are doing.  Clear out time in your schedule to do this.  Or, refer to #1 and #10.  Registered nurses, should you hire them, are qualified as well.

12.) Don’t run two offices with one health care provider. This is a common practice in South Florida, which spreads the provider too thin, is financially straining, and creates the potential for an atmosphere of rushing the patient through to see more patients. Get a partner.  It ensures that someone is always available in the office.

13.) Remember that you do not know everything and sometimes you may have to say that up front.  It’s o.k. to do this… really… it lets me know you are as human as I am and creates more respect.

14.) Train other medical students, nurse practitioner students, and PA students… regularly.  Always have one in the office. Seriously. I’m not kidding.  This speaks volumes about your character and your devotion to healthcare quality.

15.) Wash your hands, frequently.  PLEASE! I want to see you do this.  I guess if you do not touch me though, then you believe there is no need to wash up.  You are wrong.

Finally, thank you for choosing to be a healthcare provider.  I am personally thankful for your passion, skills, knowledge, and work ethic. I hope you find this advice useful.  I know I am going to put more of it into practice myself.

Sincerely,

Your Patient (who happens to also be a health care provider)

P.S. A final note to my NP friends who work in physician offices… If you work in a restrictive practice where you must ask for permission to do anything, like taking on a student, having your own business cards, or even making copies… get out now.  Start your own practice.  Do what you want to do. Do not be held captive by fear, convenience, or your mortgage payment.