3 lessons from the trenches

Having worked 40 years as a doctor, I'm asked what lessons I learned from my practice that I might offer to younger physicians. I want to share three suggestions with Physician Practice readers. Upon graduation from medical school, every new doctor takes the Hippocratic Oath, which says, "I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing." Every doctor has it ingrained in their DNA to help the patient, first and foremost, not harm them. Yet, there are other examples that every doctor entering the field should know, which will serve them well for an entire career in medicine.

Lesson #1: Exceed patient expectations

First, exceed patients' expectations. Customers form perceptions about what they are going to experience from the airline industry, as well as from an accountant, a dentist, and a stockbroker. What are the expectations that our patients are seeking?

It is also a given that the doctor will make a diagnosis and offer a treatment for the problem presented by the patient. But that is only the minimum every doctor who has graduated from medical school must provide. I never say that the medications that I prescribe are better than those of other physicians in my community, or that my surgical instruments are sharper and smaller, and cause less discomfort than those of others. However, the care you receive in my practice will exceed your expectations.

I have surveyed my patients, and I know that they expect to be seen within a few minutes of their appointment time. They expect all their phone calls to be returned by me or someone on my staff in a timely manner. They expect me to answer all questions about their medical condition in each doctor-patient encounter. They expect me to have the latest technology, both in the clinical aspect and the business component of my practice.

Lesson #2: Beyond the Hippocratic Oath

Second, I wish my medical school had taught me the importance of ensuring every patient has a positive experience before, during, and after visiting my clinic. I refer to these as magical moments of truth.

For example, the first interaction with the patient is often the telephone. You can manage that moment of truth by ensuring that the phone is answered by the third ring. The receptionist should answer with a smile that can be heard on the other end of the line. A receptionist can easily accomplish this by placing a mirror in front of the telephone for visual feedback. (See photograph at the end of the article. Please notice that the receive contains a reminder for all members of the staff that “The Telephone Equals an Opportunity”, i.e., an opportunity to create a positive first impression on the telephone for everyone who calls the office.)

Also, the receptionist should state their name and then make sure to use the caller's name at least twice during the phone conversation, such as, "Mrs. Smith, it is nice to speak with you, and we look forward to your first visit to our office. If you have any questions, Mrs. Smith, let us hear from you."

The best patient experience continues after the patient makes a follow-up appointment and leaves the office. A good example is the practice of sending patients a regular newsletter, informing patients about what is happening in the practice and provides guidance on how to lead a healthy lifestyle.

I am reminded of a hand surgeon who sends out a monthly newsletter. In addition to discussing common hand conditions, hand surgeon offers advice on managing insomnia, which is unrelated to his specialty. However, the doctor is trying to convey to the patient that there is concern for the whole patient or is focused on caring for the patient distal to the eight carpal bones at the end of their upper extremities.

Lesson #3: Answer all questions

Another good example is calling special patients at home to check on their condition or answer any questions they may have. Examples of these special patients include those who have been recently discharged from the hospital, patients undergoing one-day procedures under anesthesia or sedation, patients with complications or side effects, and patients with lingering questions about their treatment or condition.

While the busy doctor's schedule may not allow such calls to all special patients on any given day, someone in the office, such as a medical assistant, can call patients late in the day to make sure they are clear about how to take their medications, how to manage their wounds and dressings, and when to make the next appointment. This covers most questions patients will have, and a call from the office is very reassuring. Additionally, there are two benefits: first, these calls discourage many patients from calling doctors or their offices at night or on weekends. Second, patients are greatly comforted in knowing that the doctor and the practice genuinely care about their situation. It is a demonstration of empathy and compassion, which are often missing from medicine today due to the need to see more patients and perform more procedures, thereby reducing engagement between doctors and patients.

Bottom line: Although these three suggestions are not part of any standard medical curriculum, they have served me very well for many decades. They are inexpensive and easily implemented by the doctor and staff, and they generate exceptionally positive word-of-mouth that alleviates pain points, reduces the risk of burnout, and enhances the overall pleasure of practice.

If you have any lessons from your medical career that you would like to share with our colleagues, let me hear from you: doctorwhiz@gmail.com

Neil Baum, M.D., is a physician in New Orleans and the author of Business Basics for Creating and Managing a Healthcare Practice (Springer 2022)