The current rage of practice management and marketing is the “meet and greet.” You cannot attend a seminar or read an article in one of the many podiatry magazines without suggestions such as: 1) have the doctors do a meet and greet at the local hospital, or 2) have your staff set one up with a primary care physician practice. Employing the services of a marketing person is useful to promote and educate others about your practice to local businesses and other related health care providers such as physical therapy centers, other specialists, and pharmacies. The other trend in vogue right now, which is very similar in nature, is the term “lunch and learn.” These are all excellent ideas and should definitely be implemented if you haven’t already done so, but an aspect that often needs constant reinforcement is the relationship between doctor and patient. This should be your first marketing implementation, and I would like to give some helpful reminders to what I‘ll title the “10 steps to the doctor-patient meet and greet.”
- Be friendly- Whether you like to greet patients with a big smile or addressing them with a more serious tone to keep a professional distance, it is very important to act in a warm manner. You must instantly put the patient at ease and the best way to do this is with a caring, sincere, initial greeting.
- Open with something general- Initiate the conversation by introducing yourself and either stating something general or asking how they are doing. You can talk about the weather, traffic, or a benign current event topic (no religion or politics). This will often enable the patient to open up and be more informative when you delve into the chief complaint. If you are seeing an established patient, the initial conversation at this encounter can be more personal such as: how is Mom enjoying Florida, etc. Beginning with a conversation involving the chief complaint immediately after entering the treatment room can create the perception of a “rushed” office encounter, no matter how true or false that actually is.
- Sit eye level- When you sit (or stand) above the patient, you are giving the appearance of superiority and this may lead to patient intimidation. They may not be as forthright in their presenting to you the process that led them to seek podiatric treatment. Conversely, if you sit too far below the patient, you will lose the patient’s confidence in you. They will perceive you as undecided and unsure of your abilities; again, whether true or not.
- Make eye contact- When you are engrossed in this initial conversation, it is important to look at the patient. Nothing gives the perception of indifference by the physician more than looking at your chart or computer screen while having this conversation. This creates the perception that you only care about their problem, and not about them. Eye contact also enables you to give a nod or smile when they are responding to your interaction, showing empathy and compassion.
- Be a good listener- This goes hand-in-hand with number four. You must acknowledge what the person is saying, whether it is of a personal nature or pertaining to their visit. We are all very busy and not without the many office and personal distractions that clouds our day, but concentrate on listening to them. It is very easy to mentally drift off topic and lose the focus of the encounter. Bring yourself back into the conversation by truly listening to what they have to say.
- Show a human side- We are always trying to dispel the deity perception that many have of physicians. How often do you overhear someone say “oh, they think they’re God.” After being in practice for 26 years, I have noticed a tremendous changeover towards a more compassionate, caring doctor. We have toned down the double and over booking. We spend much more time going over an informed consent form, and returning phone calls regarding test results. I think that as we have had a turnover in the physician pool, this new stream of caregivers becomes just that, a caregiver. Let patients know a little about you, what your hobbies or interests are. The car pool problems you experience or the perils of Uggs on your daughters feet are the same things they are willing to share, and will create a bond that will bring you to the top of their list when referring a friend or relative to a podiatrist.
- Be a good historian- Now that we have gotten through the initial phase of the visit, it is time to show them what you got. Ask the right questions to achieve a good differential diagnosis. If you have an assistant or intake person do this prior to your encounter with the patient, set up your own protocol to delve a little deeper before you enter into the physical examination stage. Even though you may already attained a lot of this information from patient or staff intake, take a few minutes and take charge of the encounter. This really does not have to take a lot of time, but will put you in control of the visit. For example, they state in the history that they run 2 miles, 4 times a week. Very briefly you can ask, what kind of running shoes they wear, how often do they replace them, what type of surface they run on, do they use the incline on the treadmill, do they stretch before and cool down after they run, and do they have an alternative workout program for the days they do not run. You could have this done for you already, but if you do it personally, you have taken one important aspect of that history and wowed them with your knowledge of the subject matter, in addition to showing a genuine concern for their visit.
- Talk in two languages- You have taken the history, performed the physical, and now with your diagnosis in hand or a good differential worked up, you must explain it to the patient. The more skilled you are in taking a medical condition and explaining it in terms that are easy to understand yet not condescending, the better your outcomes will be. Patient compliance increases dramatically with a complete understanding of their condition and how their treatment protocol is to be followed. Explain why their foot or arch rolling in causes their toes to become contacted or their bunions to worsen. Go over the anatomy of the shoe in the hope that the next pair that they purchase will have foot comfort as a priority. Spend some time going over the pros and cons of oral vs. topical anti-fungal agents. As you embark on this discussion in easy-to-understand, yet professional terms, you will have the trust and confidence from the patient towards you. Now this conversation differs from the discussion you have about the patient with their primary care physician. This ability to deliver a professional, succinct update on a patient’s condition to another physician is drilled into us as early our 3rd and 4th year as podiatric students presenting cases to our clinicians and going right through our residency training. We already have mastered the professional-professional conversation, now we can always improve the podiatrist-patient one.
- Ask what else- I cannot take credit for this one as this has been ingrained into me by Dr. Jeff Frederick, President of the American Academy of Podiatric Practice Management. I have been a member of this vital podiatric organization for many years and I have learned and implemented many a “pearl.” I first heard him lecture on this point four or five years ago and have made it an integral part of my examination protocol. There is absolutely nothing more frustrating than having done a thorough workup for a particular chief complaint, explained everything, begun a treatment plan, and as you are about to embark onto the next treatment room the patient then asks you about something that hurts on their other foot. Mentally, you are already out the door. Frustration, unless you are a great poker player, will show all over your face. Now you have to gather your composure and either politely explain to the patient that this will have to be addressed at their next visit or go through the same time consuming workup on chief complaint number two. Either way, you lose. You have either created a frosty relationship with the patient from your perceived sudden premature exit or are in danger of falling hopelessly behind in your schedule due to your extended time with this patient. This practice management faux pas could have been easily averted by simply asking at the time of the history taking part of the examination, “is there any other foot issue that I can help you with today?” You can number and prioritize them, as this type of patient that will omit certain things initially will also have a multitude of issues. This will allow you to multitask through the physical examination, explaining each concern at least briefly. There is nothing wrong with putting off some non-urgent issues to the next visit and at least they were initially given your attention. You have now saved considerable time and kept the doctor-patient encounter preserved without negative emotions involved. I will tell you that from my experiences that this works! I cannot count how many times that I have avoided a frustrating encounter by asking what else early in the exam.
- Make them feel important- It is vital to implement many or all of these ideas into a doctor-patient encounter. We have this tremendous challenge currently in medicine to make an office visit as productive as possible in as short a period of time to achieve a satisfied result. If you can make a patient’s visit feel like they are the only patient you are seeing that day, you will have gained their confidence and trust which will lead to a compliant, satisfied patient. By starting the visit socially, performing a thorough exam, using your expertise in the explanation of their diagnosis, and proper execution of the treatment protocol, this visit will appear to be much longer than it actually was.
In conclusion, I will tell you that as I was formulating ideas for this article and jotting them down, I found myself reminded that I didn’t always practice what I preach. Recently though, I have been extremely conscious of making each and every meet-and-greet a special one and becoming a better caregiver as a result.
Dr. Jacobs practices in West Chester, PA and Newtown Square, PA as part of a four-doctor group, Podiatry Care Specialists, P.C. He is board certified in foot surgery with the American Board of Podiatric Surgery and is an active member of the American Academy of Podiatric Practice Management.
By Bradford J. Jacobs, DPM