Giving Your Patient a Pound of Gold in a One-ounce Bag

The perception of time spent with your patient is related to your energy directed toward them.  Their psychological and medical needs can be fulfilled in a short time with simple techniques.  This starts with their perception and expectations.  Their expectations can be exceeded by making their perceptions reality.  Much of this information shows common courtesies our parents taught us as children, which are frequently lost in adulthood.  

The first impression you create with your energy is the most vital to establishing this perception of time for your patients.  According to many studies, we all determine whether we like or have confidence in someone within seconds of the first meeting. Your patient’s level of acceptance is often set with signals you send immediately upon entering the treatment or consultation room. This first sixty seconds with a new patient is your opportunity to lay the foundation for your successful relationship during the entire course of treatment. 

Most patients, due to their previous experiences and prejudices, come to our offices with a preconceived notion that the doctor may lack a degree of personal skills. This first sixty seconds is your golden opportunity to break through this barrier and gain this patient’s trust by showing them that you are a caring human first and then a doctor!

To begin establishing a positive perception during your patient visits, your introduction to each and every patient encounter should begin with eye contact and a friendly smile as you cross the doorway into the room.  Follow this with a handshake even if you’ve seen the patient a hundred times This delivers a clear message of warmth and caring that helps to reduce the fear factor patients often experience.  This opens their minds and ears to what you then tell them about their conditions.  These simple skills say to the patient that you are friendly and relate to them at the same level, not from the ivory tower where many physicians seat themselves.

 The importance of eye contact cannot be stressed enough—it is the most fundamental skill taught but often not put into practice.. That instant patient-doctor connection can be made with eye contact even before single word escapes your mouth, and can hold or break that connection throughout the visit.  If you have a hard time doing this, practice for a week, noticing the eye color of everyone you come in contact with. Eye contact is important throughout the entire patient visit, especially when you are presenting your treatment plan. Focus on controlling distractions that can cause your eyes to sway or head to turn, losing important eye contact 

Another means of establishing the patient-doctor connection is by human touch.  As you begin to speak with them, place both hands on their feet.  Studies have consistently proven that human touch portrays compassion.  

A patient’s perception during a visit is also influenced by how a doctor demonstrates acknowledgement, appreciation, and value for a patient.  A basic human need in any circumstance is to feel valued.  Mary Kay Ask, famous for creating a cosmetic empire, told her sales team to make believe every person you are speaking with has a sign around their neck that says, “Make me feel important!”  Research has shown that what people really want is to be acknowledged, appreciated, and valued.  How do you do this while in contact with your patients?  To get high grades for this, one needs to make a conscious effort focusing on the patients’ needs beyond their podiatric condition. Something as simple as asking about their families can do this or mentioning how pretty the pin is that they are wearing.  Your exercise is to take a piece of paper and make a list of how you can make a patient feel important.  This would also make an interesting drill for one of your office meetings. 

For instance, open your conversation with a question relating to their overall well-being such as “How have you been?”  This may lead to an extended conversation, so be sure to control the conversation by switching to how their podiatric problem is doing, i.e. “So how’s the heel feeling?”  At this point LET THEM SPEAK and get it all out.  The typical patient will do this fairly quickly.  However, if you interrupt them early in the encounter to move the visit along, they will feel as though you are rushing through the visit.  If they speak their piece, the rest is yours to control.

Time spent with the patient will be reduced if you take control of the visit.  This sounds obvious, but too often the patient leads the visit.  Remember that the patient is in the office because you are the expert.  You can begin to establish control by outlining to your patient the goals of the visit after establishing that personal bond with your patient.  For example, begin your presentation to patients with this type of statement to ensure that they feel comprehensive care will be provided:  “At today’s visit, I want to be sure you know what you have, why you have it, and what the options are for treatment, as well as understanding your decided treatment plan.  And please feel free to ask me any questions you have.”  The ability to tactfully take control of a patient visit also attributes to a communication of confidence to patients as well.     

Confidence is another important aspect of a patient’s perception of a positive visit with the doctor, which also translates into patient compliance and treatment outcomes.  Deliver your treatment plan with confidence, and the patient will be more likely to accept quicker and with less apprehension.  Stay away from statements such as “you may benefit from.…” and “I think this may work….”.  Emphasize the importance of the treatment by using phrases like “this is critical for you to have relief.” “This will make a significant difference is how you’re feeling” and “our goal is to get you better as quickly as possible so you can return to your normal activities and reduce the chance of surgery.”

Physicians often have a disconnect in understanding how the patient perceives our message and evaluate each and every word we say.  With this in mind, it is critical to develop presentation skills with “strategic words” that drives our point home in the patient’s eyes and leads them down the road we wish.  The practitioner needs to have clarity in relating the beneficial nature of a particular treatment to their patient.  For example, if a patient asks if a nail avulsion is necessary, the practitioner’s response should make the patient understand that the treatment will help resolve the infection, reduce pain, and decrease the chance of complications.  Using concepts to which the patient can relate to increases their acceptance of proposed treatments and strategies.  

Bottom line: by using certain words, we can direct the patient’s thinking down the road of the treatment plan we advise.  The impact of these single words is powerful and paints a clear picture in the patient's mind of what is most important in achieving their goal of relief.  Again, use of these words portrays confidence, which puts the patient at ease and gives hope of resolution of their chief complaint.  For example use words of conviction such as “important, critical, or vital” and stay away from saying “possibly, maybe, and probably.” 

Finally, there should be something said regarding how to maintain that positive patient perceptionduring the remainder of your patient visit beyond the important first impression. Listening is one of the most important skills that will result in winning your patients’ trust and earning you high marks. Listen to others and they will listen to you; you will get to know more with improved accuracy and you will gain their confidence. Letting others finish before you begin to speak delivers the message that you are sincerely listening.  Acknowledge that you are actively listening with a small nod of your head, an occasional “yes” or “uh-um,” and occasionally repeating back what your patient just told you in short form. A saying that sums up the importance of active listening so well is: “God gave us two ears and one mouth for us to listen more than we speak.” Also be sure listen with your eyes by focusing on that all-so-important eye contact.

When at the end of your patient visit, it is important to summarize and reinforce what the “most important” or “vital” parts of the treatment the patient will need to have done at the next visit to obtain the most effective long term outcome.  They need to understand that without this recommended “next treatment,” the end result can be significantly less than hoped for.  This ability to give a clear “take home” message again speaks to a doctor’s ability to deliver the comprehensive podiatric care, to depict confidence and conviction for a patient’s plan of care, and to define for the patient expectations of treatment based on adherence and compliance for the plan set forth. 

Equally as important during the closing of a patient visit, and throughout the patient visit, is always allowing sufficient time for answering questions and critical exchange between the patient and the doctor.  Again the ability to demonstrate listening to your patients willhelp solidify and  increase patient satisfaction and trust with focused time spent during an office visit. 

Spend the next month focusing on quality of time spent with patients with keen awareness of eye contact, smiling, body language, and your listening skills.  Take a critical look at what you say or do the first sixty seconds you are with a new patient. Too often we have our eyes looking into the patient chart as we quickly get into questions about the chief complaints without forming that all-so-important “personal bond.” Although you are providing medical services, your comments, body language, and demeanor during those first sixty seconds set a generic stage common to all delivering a service to customers.  Ask one of your office TEAM members to give you a report card for one patient per hour and rate you on a scale from one to ten on the five key factors above.

 And remember: a patient’s perception of time is an amazing thing!   Attention to common courtesy throughout a patient’s visit, especially during the first moments, can result in better compliance and more patient referrals.

Hal Ornstein, DPM and Neil Baum, MD