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Nine ways to meet and exceed patient expectations

Carlquist, Jennifer PA-C

Journal of the American Academy of PAs: June 2010 - Volume 23 - Issue 6 - p 10
COMMENTARY
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Jennifer Carlquist, PA-C, works full-time in the Emergency Department of Salinas Valley Memorial Hospital and part-time with a solo practitioner in cardiology, both in Salinas, California. She has indicated no relationships to disclose relating to the content of this article.

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As managed care whittles away at the amount of face time we spend with patients, there seem to be more patients to see and fewer health care providers to see them. In our effort to cram a half-hour visit into 15 minutes, we sometimes lose sight of why we are here in the first place—for the patient. I would like to share some tips for being more organized and reducing stress.

Utilize technology E-mail has made being time-efficient easier. Patients can send you their questions, and you can answer them quickly without getting trapped on the phone. Using e-mail also creates a record of the correspondence that would not necessarily exist with a phone call. However, e-mail communications should be restricted to simple follow-up questions.

Empower your patients Most patients have three problems on their mind when they come into the examination room. Completing a previsit questionnaire that lists the three most important topics helps to focus the patient before he or she gets into the room. If all of the patient's concerns and questions are addressed thoroughly during the office visit, redundant future visits and phone calls can be avoided.

Show respect by arriving on time One of the biggest complaints from patients is that they feel their time is not important to the health care provider. Many patients even avoid health maintenance appointments because of the need to set aside 3 or more hours of their time.

Be prepared and expect the same from your patients Read the patient's topics list and review the most current laboratory results before you are sitting in front of the patient. Instruct the patient to bring all medication bottles for review. This helps you detect if there are duplicates. In addition, if the bottles are full when they should be nearly empty, you will have real-time data on how well a patient is adhering to the medication regimen. This is also a good time to talk to your polypharmacy patients about the advantage of using a single pharmacy as a backup screen for potential interactions.

Show interest The patient's perception is what counts here. In a study on time perception, patients always thought the office visit was longer when the clinician sat down compared with when the clinician remained standing, even though the length of time for both visits was exactly the same.1 Make good eye contact and be aware of nonverbal communication. An empathetic facial expression and active listening can go a long way toward making your patient feel heard.

Let them talk A study published in JAMA found that 72% of doctors interrupted the patient's opening statement after an average of 23 seconds. Patients who were allowed to state their concerns without interruption spoke for only an average of 6 more seconds.2 Cutting to the quick may seem like we are saving time. But patients will tell us what is wrong with them. We just have to listen.

Listening to what the patient says is important; however, listening to what the patient is not saying is just as important. Nonverbal cues can provide important clues to what a patient's real issue may be. Is their speech fast and rushed? Are their hands clasped in their lap and relaxed?

Follow through If you order tests or refer to a specialist, make sure those happen. A system of communicating test results to patients is important. No news is not always good news; but if patients do not hear back, the assumption is often that test results were normal. One in three doctors does not always inform patients of abnormal test results, especially if the results are mildly abnormal.3 About half of doctors surveyed thought that informing patients of normal results is important, but only 28% always did so.3 Before the patient leaves, have your staff make sure the patient's contact information is correct and ask for the patient's preference on how he or she would like to receive the test results.

Be nice The old saying goes, “Patients don't sue people they like.” This seems to go without saying, but when we are overworked and pressed to see more and more patients, our kindness can be the first thing to go out the window.

Choose your words and tone of voice carefully. Use simple terminology when explaining diagnosis information. Research has proven that doctors who do not communicate effectively are more likely to end up in court.4

Go above and beyond Give your patients a way to be involved in their health maintenance. Create a Web site for one-stop shopping for health promotion; include patient education pages and answers to frequently asked questions. Have downloadable questionnaires that patients can complete and print before coming to your office to save time.

Through mutual understanding comes trust, and through trust comes patient cooperation. This ultimately fulfills your goals and theirs.

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REFERENCES

1. Toombs SK. The Meaning of Illness: A Phenomenological Account of the Different Perspectives of Physician and Patient. Dordrecht, The Netherlands: Kluwer Academic Publishers; 1992:66.
2. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient's agenda: have we improved? JAMA. 1999;281(3):283-287.
3. Boohaker EA, Ward RE, Uman JE, McCarthy BD. Patient notification and follow-up of abnormal test results. A physician survey. Arch Intern Med. 1996;156(3):327-331.
4. Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med. 1994;154(12):1365-1370.
© 2010 American Academy of Physician Assistants.