“An Unexpected Act Goes a Very Long Way”
I consult with a medical office in New York that has been plagued with a low number of new patients. This doctor is clinically excellent, participates in all the insurance plans, is hospital based and very personable, yet after 10 years of practice, he can’t get his practice off the ground. Over the last month, we have had numerous conversations and I realized that he has very little expendable income to advertise and feels awkward going to the community to introduce himself. He calls it “canvassing the community.” Therefore, we had to conceive a plan of action that would allow him to stay somewhat in his comfort zone to build his practice, without spending money that he didn’t have. For his practice, the solution wasn’t education, because unlike chiropractic, the media already educates the mass population on the why, how often and when to see a medical doctor.
The solution was simple. I put him on the task of calling his patients after their visits, understanding that in primary care patients usually come only once for a malady. There are exceptions, but that is the rule until their next check-up or urgent visits for a systemic disease. This was an uphill battle with the doctor. After all, he is an MD and MD’s don’t usually do those things. What would his colleague’s think if they found out? How would his patients feel if their doctor acted in this manner? He had all of the pompous retorts to my advice. I then spouted “truisms” to him. “The definition of insanity is to do the same thing again and again and expect different result.” This got his attention. I then continued to say that, “Successful people do the things that unsuccessful people don’t like to do…continuously.” I felt I was not quite obnoxious enough, so I then continued and said in simple language, “I agree with you. Doctors don’t do these things and you shouldn’t either. Be like a real doctor and go bankrupt and maybe you can get a job changing bedpans in that fancy hospital of yours for minimum wage.” I finally succeeding at being thoroughly obnoxious and my point hit home.
He finally asked exactly what he should say. The script is as follows: “This is Dr. _____. I wanted to follow up with your visit today, just to make sure you understood everything and to see if you had any additional questions.” He then went on to tell me that he didn’t have the time to call his patients with the exception of abnormal test results. He saw 15 patients per day. I told him 15 patients is a great morning, just prior to breakfast, and if he doesn’t have the time, stop wasting time on issues that are not patient related. I also advised him that if he felt overwhelmed in calling every patient, start with 1 and see how it felt to both him and the patient. Then call 2 and 3 and so on; baby steps.
I curiously awaited his phone call and after a week, he called to tell me that he was “overwhelmingly pleased” by the reaction of the patients. Almost every patient thanked him for calling and he now looks forward to that part of his day to talk to his patients. As a result, his practice has started to grow with increased internal referrals. Patients talk to friends and family. Whether you are good or bad as a doctor, healthcare is predominantly (in non-life-threatening issues) a success through personality business. If they like you, they will refer. I don’t have the final statistics, as we started this about 1 month ago, but this is the same action I took for 25 years in practice. It was a basic standard of practice to call every patient after their first visit and again after 4-5 weeks of care and part of the success system that many other ultra successful doctors and I utilize in our practices. I know when I stopped this action step, my numbers always dropped.
Initially, patients are scared about their condition, sad because they hurt and mad because of the predicament that put them in your office. You cannot overcome all of that in 1 visit or with 1 phone call, but you can change how they feel about you, the vehicle and solution to all of their problems, with a timely act of “unexpected kindness.” The script is no different than that of the MD in the above scenario. At the 4-5 week point of care, I made a subsequent follow-up call to the patient to just say hi and to make sure that I didn’t overlook any of their concerns. This phone call is what I call the “cheerleader phone call.” By this time, the majority of patients are out of pain and they now are entering the rehabilitative portion of their care.
If not educated about their condition and the different phases of care, this is the point where many patients drop out of care and do not continue with the treatment plan. Remember, no matter how often you educate them about not being able to correct their problem, until the pain goes away from the spasms subsiding and the bone being taken off the nerve, they still go home and watch television and read the papers and magazines that reinforces a lifetime of symptom-related beliefs. You need to reinforce with the patient, during the “cheerleader call," as to why they need to continue care even though their symptoms (pain) have abated. This educational step should also continue on each visit. However, a “special” phone call often gets their attention, as it is unexpected and often better received than a conversation during a visit.
The next level of phone call is to call the lawyer after the first visit with their client. We have discussed this before, but it is important enough to repeat. After the first visit with the patient, their lawyer should be called with a preliminary report on their client. You should let them know the complaints of their client and the treatment plan regarding both your care and any referrals you have recommended. The script is as follows: “This is Dr. Studin and I saw your client, Mr. Jones, yesterday. I wanted to give you some preliminary findings, so you know what’s going on with your client. The evaluation revealed neck, shoulder and low back findings, of which x-rays were taken and no fractures were evident. I ordered a course of conservative care for the next 6-8 weeks, as well as an MRI of both the cervical spine and the shoulder. I have also referred him to an orthopedist for the shoulder and pending the results of the MRI, a neurosurgeon will be considered for his spine. In approximately 8 weeks, I will package all of the results and send them to you, including the orthopedist's report and the MRI report. Please send me an authorization to release the records for your client. Do you have any additional questions?”
With this phone call the lawyer will know that you understand both their needs and the needs of the patient. This is the first very big step in gaining their trust for any future referrals. Also note that it is as important for the lawyer to know that there are no problems and they should release their client as it is to know that there are problems. The earlier in the case they have this knowledge, the better it is for their practice. At the 6-8 week period in care, by using the calendar system (as discussed in a prior consultation), send the lawyer all of the information.
The first visit phone call and the 4-5 week phone call to the patient, along with the phone call to the lawyer, should be documented on your chart and part of your business system. You should have your staff create a “tickler file” either on your computer or in a “tickler paper file,” and bring to you during the day the phone calls that need to be accomplished for that day.
You should also check the system regularly, so as to delegate vs. abdicating the responsibility. Abdication of any important task is the shortest way to failure in an office. You need to have a series of checks and balances, no different than government, so that you can ensure that nothing “slips through the cracks.”