The Doctor’s Guide to Creating A “Patient Gratitude System”
By Michael Tetreault, Editor-in-Chief
I’m a Patient. So, I know what it’s like to sit on the other side of you.
I’m imperfect. Sometimes I ask too many questions. I worry about things I probably shouldn’t and on occasion I’m sure I want a level of timeliness and communication that bends in the right direction of getting the answers I need to make more informed decisions vs. the ‘radio silence’ or ‘you’ll have to schedule an appointment …’ we’ve all come to expect from primary care these days.
Physician’s have an impossible job. Particularly as we all learn to operate and communicate in the midst of a Pandemic.
Patients know how it feels to be passed off to an NP or PA in the practice. They know what it feels like as a parent to have their child sit with a Doctor while in your in the room *concerned,* and for less than five minutes you drop word bombs and leave without any further explanation to give attention to the next chart and patient waiting in the exam room next door.
Patients know compassion when they see it and we sense caring when we feel it.
You’re known for something in your practice and among your Patients. Often when we speak with Physicians, knowing what that ‘something’ is is hard to discern or describe. You just can’t quite put your finger on it.
Yelp! reviews and Google Reviews might tell you exactly “What you are known for …”
As your practice grows older you’ll notice *themes* in these reviews. Some positive, some constructive and some plain rude.
What you’re looking for is a *theme* or a pattern in these comments that you can change.
In our culture and most likely in every community around our country, Patients don’t feel they have an advocate on their side that will sit down and answer their questions.
The pandemic has widened this gap and shown all of us how important and non-existent a deep, caring Patient-Physician relationship is in our lives.
Days full of missed opportunities to connect with Patients abound. Hours upon hours of opportunities have been missed due to busy schedules which could have built more trust between the Patient and Physician eroded by time.
But ergo, there is hope to restore this balance on the scale.
It starts with identifying small moments and missed daily or hourly opportunities.
We know that cultivating a relationship with a Patient and/or a family can have lasting impact. When you win the heart of your Patients, that’s priceless to Physicians.
That’s the sweet spot in your practice.
You can’t quite put your finger on what it is, how you did it … you just know “it” when you have secured “it” with a Patient.
“It” could be a number of things.
Which is what today’s article is about. We have identified seven “it” action items that might help you and your staff create those lasting impressions.
For starters, maybe it’s a smile when you walk in the exam room.
Or, perhaps asking about a mother how school is going this year (or not, given the Pandemic).
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There are a lot of missed opportunities that Doctors can find each day that can help “It” become tangible and real for your practice.
Identifying these “It” moments lead to growth.
Growth is the bi-product of doing these things consistently.
The purpose of today’s “Letter from the Editor” is simply to help you [eg. Doctors] identify a few missed opportunities. We want to help you find these Unexpected Expressions of Gratitude which you can deliver FOR FREE to your Patients and among your Patients who are Parents.
This is an unusual season for all of us. But unusual times provide unusual opportunities. Doctor’s are front and center in our lives right now. This month, we want you to look for an opportunity to leverage your influence as a Physician-Leader. Why? Because we believe there’s someone who could benefit from your influence and your leadership in their life, today.
Here are 7 missed opportunities Doctors can identify today which will make a dramatic impact on the rhythm of your day.
1. Be Aware of Your Climate When Walking In The Exam Room, Greeting Staff In the Morning or Leaving Your Family to Go To Work. A Meaningful Morning Greeting Matters.
We can all get stuck in our routines.
Author and Speaker, Jeff Henderson says “Every relationship has a climate—sunny, stormy, or even icy. And the current climate dictates the forecast. The problem is that many of us are unaware of the emotional climates we carry around with us. We affect the emotional climate [of the room] when we arrive home or step into a meeting at work. The truth for all of us is that at least one of our relationships could use a climate change. And until the climate changes, the forecast will remain the same.”
Let’s apply this to your medical practice.
What is your interaction like with your husband or wife in the morning? Does a disagreement with your spouse in the morning dictate your climate and how you greet the first patient of the day?
How we begin and end our days creates rhythms in our life.
The goal isn’t perfection, it’s progress.
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How we choose to begin our interactions with people [eg your Patients] can impact your mood, your day and the words you say to your Patients and staff.
Start with a positive verbal or non-verbal connection with your staff and Patients as soon as you walk in the door or greet them.
Greeting them by their first name, preferably.
Why is the “first name” important you ask?
Well, research proves this out …
Northwestern University found Doctors do not address patients by name in half of first-time visits, even though nearly all patients want this personal greeting, according to new research from Northwestern University’s Feinberg School of Medicine.
“Greetings may seem a rather mundane part of physician-patient communication, but they create a first impression that can affect the chance of developing a therapeutic relationship,” said Gregory Makoul, lead investigator of the study, professor of medicine, and director of the Center for Communication and Medicine at the Feinberg School.
There has been little evidence to guide doctors about how they should greet patients or what patients actually expect. Makoul’s study focused on finding out what patients think is an appropriate greeting. He also analyzed a sample of interactions between doctors and patients during first-time visits.
Makoul and his colleagues collected information from 415 phone surveys in which people were asked how they expect to be greeted by a doctor. Researchers also viewed and analyzed more than 120 videos of primary care visits in which the doctor and patient met for the first time.
The study, published June 11 in the Archives of Internal Medicine, reported that 78 percent of survey respondents wanted the physician to shake their hands. Nearly all patients wanted to be greeted by name, including 50 percent by their first name, 17 percent by their last name and 24 percent by both their first and last name. Most patients, about 56 percent, wanted physicians to introduce themselves using first and last names, while 33 percent expected last name and 7 percent expected first name.
Makoul’s research team found a striking difference between expectations voiced in the phone surveys and the actual interaction between doctors and patients in the videos. While 83 percent of doctors shook hands in the videos, only half addressed the patient by name.
Source: Many Doctors Don’t Use Patients’ Names on First Visit; June 26, 2007 | by Marla Paul
To apply further concrete application to support our point about the importance of Doctors greeting Patients, an interview with Ritz-Carlton’s former CEO, Horst Schulze in Chief Executive said “We taught our employees no matter what you do, when a guest comes within 10 feet, you look up and greet that guest. If the guest needs help, no matter what you’re doing you help. That’s a culture of ours. That’s what we do. That works in every country. If a guest asks for directions, don’t point. Take them there. That was appreciated …”
Ricco de Blank, CEO of Sun Hung Kai [Hotel] Properties, which owns Hong Kong’s Four Seasons, Ritz-Carlton and W hotels, said the following when it comes to customer greetings, first time interactions and first name service.
At Ritz-Carlton, every employee from vice presidents to busboys carried a small folded paper brochure call the “Credo,” a Schulze version of the Ten Commandments, dealing with everything from how to give guests directions to the elevator to treating fellow employees. From the Capella Canon, Number 8 on the expanded 24-point list reads, “Always recognize guests. Interrupt whatever activity you are doing when a guest is within 3 meters (12 feet), greet them with a smile and offer of assistance.”
When was the last time we’ve seen that happen inside the four walls of a Doctor’s office?
What can you do, today?
Start by smiling and greeting the Patient (or their child in the room) by their first name.
It’s as simple as that. Try it. See what happens.
And, here’s another free tip. Don’t be looking at the chart when you enter the exam room … it looks like you can’t remember their name.
Even though that might not be what you’re actually looking at, that’s what we think.
Remember, I know what it’s like to sit on the other side of you.
2. Stay On Time, Within 5-Minutes and Apologize If You’re Late.
The two dreaded words of each Physician’s day.
You never quite know when it’s going to start but you dread the moment each day that the pattern starts.
It’s a complex race to the finish. It’s stressful on you, your staff and creates unnecessary tension and friction between you and the Patient.
Unknowingly, it creates a gap between you and the Patient even though you’re doing your best.
Number 18 on the Capella Canon we mentioned above is, “The suggested hours of operation are guidelines, not limitations for satisfying individual guest desires and preference.”
In other words, if you walk into the exam room 45 minutes after you were supposed to, there’s not a lot of grace. But, there’s no reason not to address the elephant in the room [eg. you’re late] and not apologize for being late. Welcome the Patient by their first name vs. just plowing through the awkward lateness and don’t seem like you’re in a hurry to get to the point.
No one likes that.
So how late or how behind is too late?
A study done at San Francisco State University found that about 20% of the U.S. population is chronically late–but it’s not because they don’t value others’ time. [But] It’s more complicated than that, says lead researcher Diana DeLonzor.
“Repetitive lateness is more often related to personality characteristics such as anxiety or a penchant for thrill-seeking,” she says. “Some people are drawn to the adrenaline rush of that last-minute sprint to the finish line, while others receive an ego boost from over-scheduling and filling each moment with activity.”
Let’s circle back to practical application in your medical practice, shall we?
Beloved author Charles Dickens once said, “I never could have done what I have done without the habits of punctuality, order, and diligence, without the determination to concentrate myself on one subject at a time.”
DeLonzor says that 45% of everything we do on a daily basis is automatic: “Our lives are filled with habits–from the way you brush teeth to how you get dressed and leave for work,” she says, adding that they’re necessary. “If we didn’t do things automatically, it would take us forever to get through our day.”
The habits of people who are always on time are highly structured. They analyze their daily activities, set routines, and stick to them on regular basis. Chronically late people, however, don’t have structure and often fall on the attention deficit disorder spectrum, says DeLonzor.
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“Instead of thinking about why their routines don’t work and trying something different next time, chronically late people simply hope that tomorrow will be better,” she says.
To become punctual, DeLonzor suggests putting more routines and structure into your life. For example, do everything you can to prepare for the morning the night before.
FOR PATIENTS, according to Esquire Magazine,
You are always encouraged to show up fifteen minutes before your appointment time, so that you can take that filthy clipboard with the Lyrica-logo pen attached and fill out a million forms. But, especially while you’re young and your medical issues are relatively few, it turns out you can do that pretty quickly. Then you’re stuck on a leather couch watching House Hunters International until fifteen minutes after your appointment time. Nuts to that. You can push it a little bit here. Time spent in a doctor’s office is time spent contemplating your mortality, and it behooves you to minimize it.
THE RIGHT TIME IS FIVE MINUTES BEFORE THE SCHEDULED TIME, JUST IN CASE THERE’S SOME WEIRD ISSUE WITH YOUR INSURANCE.
“We must not be distracted from the four supreme objectives of any organization that wants to succeed: 1. Keep the customer. 2. Get new customers. 3. Encourage the customers to spend as much as possible!—but without sabotaging Objective Number One. 4. In all of the above, keep working toward more and more efficiency.”― Horst Schulze, Excellence Wins: A No-Nonsense Guide to Becoming the Best in a World of Compromise
I love that quote from Horst Schulze because it’s circular.
We’ll conclude with this final thought from a Physician on this topic where she says “Years ago I once had a patient send me a bill for her time as I was running 90-minutes late. That’s the day I thought long and hard about my schedule and made some leadership-changes and shifts in my practice and told myself, ‘Never again.’ Honestly, I was more ashamed than angry. She was right. I had disrespected her time. I valued my time as more important than hers and it was a chronic condition. As I said earlier, I’m occasionally late when I walk into the exam room. Sometimes a true emergency happens, or an outlier event transpires. When it does happens, I try to give a very detailed account of why I was late to every Patient for the rest of the day, apologize profusely, asking forgiveness … which by the way, not many Doctors do and that’s the key ingredient to the process. Without it, you just piss people off. I then make sure the other person knows I’m sorry and that I take their time very seriously, and assure them it won’t happen again.”
Timeliness is a repetitive rhythm we can all follow and work on day to day.
Remember, the goal isn’t perfection. The goal is progress.
The Etiquette Rules of Being on Time
3. Looking For Everyday Expressions of Gratitude
This concept is less about missed opportunities and more about creating new opportunities you could’ve done/made or inserted into your day but didn’t.
It could be a thoughtful question you asked each Patient that day when they are about to leave. It’s intentional, but not forced.
As you get to know the Patient better, you’ll find it gets easier and easier to do this.
It could also be an opportunity in which you are giving permission to a staff member to ask a personally unique and friendly question to your returning Patients that week.
Or, it could be a note or a card or even a text you “intentionally” send.
Handwritten notes haven’t gone out of style.
Make it personal.
Patient’s want to know you care.
It doesn’t have to be some grand gesture, just something unexpected.
Let’s pause under this gratitude idea for a moment as well and talk about your spouse, a vital component of most Doctor’s offices, career choices and lives.
We’ve heard from many, many Physicians over the years about how and what your spouse has sacrificed to help you become who you are today. Maybe finding that unexpected expression of gratitude needs to be felt back at home?
“Notice what your wife does regularly for you and take a moment say thank you for it,” said one psychologist we spoke to recently about implementing a gratitude system in a medical practice.
“I noticed something the other day. I made dinner (which I probably do about once a week) and when we sat down to eat, my kids said, ‘Thanks, Mom; this was great.’ It made me feel good. But you know what? I make dinner the other six nights a week and no one ever says ‘thank you’ or even acknowledges it.”
Your patients may get the best part of you eight to twelve hours of every day but it’s important to recognize what your spouse does regularly for you and thank them for it.
Just a thought.
4. Facing Conflict When You’d Rather Avoid It
This is a tough one. Disagreements professionally are never fun nor easy.
It might sound counter-intuitive, but a disagreement can create opportunities for connection between the Doctor and Patient. Generally, when we all argue, we’re in defensive mode.
We feel justified about our position.
Maybe it’s about a treatment or prescription they don’t want to take that you feel strongly about.
But what is at stake?
“To be kind is more important than to be right. Many times, what people need is not a brilliant mind that speaks but a special heart that listens.” — F. Scott Fitzgerald
What if the next time you and a Patient or you and a staff member disagree, you decide you valued connecting with them more than being right?
Listening more might be one intentional tool you can communicate that helps diffuse the situation.
We’re not saying you throw in the towel on every decision or disagreement. This article is simply suggesting that perhaps listening, questioning and empathizing what the other person’s point of view is saying is far more about you and is maybe more important than looking for the “weakness” in the argument so you can win the battle.
It’s not that easy, I know. I’ve been married for a long time now and have three kids. It’s never black and white.
But, sometimes victories however small are really missed opportunities.
5. Celebrate Patients by Making More of an Effort Than We Expect
I think this one is easily identified, happily celebrated but rarely remembered or acted upon.
For example, Patient milestones and Patient anniversaries.
A patient milestone might be a weight-loss goal that was achieved or a cancer treatment or marathon that was recently done.
Patient anniversaries are important. One year of membership or 5 years of service … these anniversaries are easily tracked in your medical charts. Through the technology of EMRs and EHRs, all too often these missed opportunities to shorten the confidence gap between Patient and Physician are all too often filed away and completely forgotten.
Henderson says “A customer who feels appreciated will always to more than is expected.”
That’s absolutely true.
Former CEO and Founder of Chick-Fil-A, Truett Cathy once said “The universal sign that a person needs encouragement is … if they are still breathing.”
You know this to be true in your own world with your Patients, your kids or your spouse and friends.
Over the lifespan of a patient in your practice there might be plenty of anniversaries and milestones.
I’ve been married now for over 15 years and that’s a lot of birthdays and anniversaries that may seem mundane after a while, so I get it.
You don’t want “celebratory” milestones or anniversaries to feel forced or fake.
But as Cathy said, “The universal sign that a person needs encouragement is … if they are still breathing.”
If I know the heartbeat of so many of our Physician readers, and I think I do … right now, you know exactly who deserves the extra encouragement because of their recent hard work. You can probably see their face right now and know them by name, right?
You know exactly which people out of all the faces of your patients need this “win”. And you know how much a kind word, a card, or a nod in their direction would mean from you.
When we, your patients feel appreciated, we will always do more than is expected … because if we think you’ll notice us and care enough to mention it … we’ll work hard.
So consider bringing a cup cake from the local bakery or maybe even a cake or a simple “celebratory card” to mark a special occasion in the life of your Patient.
These little moments matter.
They don’t even cost a lot of money. If anything, they create a lasting memory in the minds and hearts of your patients that create a Patient-Physician relationship so remarkable … that they begin to “remark” about it to others.
That’s how you win the battleground which you fight for each day and win the heart of your patients and create patient referrals.
That’s true patient appreciation. That’s the golden ticket every Physician strives for which can bring you the positive word of mouth advertising that you’ve long fought for and work so hard to find.
No matter how OKAY both you and your staff might be passing up or not celebrating milestones in your Patient/customers’ lives, it’s bad for business.
Every year, every month a person works toward a goal you’ve set together … is worth making a big deal about it because being together is worth celebrating.
Don’t pass it up. You don’t need to drop lots of money, but you always should do something.
6. An Evening Routine With Family
So many of our Physician-readers and friends have family.
They depend on you. You depend on them.
Nothing is more important.
What is the last thing you do every night?
We talked about being intentional earlier in this article by starting and leaving the house by having a warm greeting or goodbye with your family before you start the day and leave for the practice.
It can create a happy rhythm for the rest of the day.
It puts you on the right path.
Whether you’re home or working late at the hospital, you should connect in some way with your spouse and kids throughout the day as well.
It helps keep us grounded and knowing that however terrible or crazy today gets, they are your “constant”. They are you’re reset at the end of the day which you come home to for peace and refuge.
Remember what Henderson said (above) … “Every relationship has a climate—sunny, stormy, or even icy. And the current climate dictates the forecast. The problem is that many of us are unaware of the emotional climates we carry around with us. We affect the emotional climate [of the room] when we arrive home or step into a meeting at work. The truth for all of us is that at least one of our relationships could use a climate change. And until the climate changes, the forecast will remain the same.”
So, if you’re home and having dinner … a few times each week together around the table is an important rhythm and pattern to keep and show up for.
If you’re away quite often or coming home after everyone has gone to bed, take a moment in the day to do a video chat or a quick phone call.
Just as beginning the day with connection is key, so is ending.
7. “Great Toys Should Come From Doctors” My Interview with a 4 year old and Her Advice For Doctors.
Every parent loves it when a visit to the doctors office does not end in a car ride of tears. That’s not fun. I know from personal experience what I’m talking about here. Oddly enough, as I write this today, my wife called and said “That doctor’s office had GREEEAAAAAAAAT!!!! prizes!” And that is exactly how you want visits to the doctor’s office to end. With smiling, happy faces on the kids and the parents. It doesn’t have to cost a lot but it will take an intentional and thoughtful trip to the Five Below store.
Look for pre-packaged items that are one-person grabs from a basked. For example, individually wrapped and packaged LEGO packs, Beanie Boo’s, Hot Wheels toys. Kids and parents are resilient but they can often have very long-term memories of how awful the last visit to the doctor’s office was or short term memories about how great the last visit was. Which one are you going to be?
So now it’s your turn to sound off: What other missed opportunities exist for you to connect with your family, staff and Patients? Email us at email@example.com