Modifying Patient Behavior Patterns

July 22, 2011
J. Scott Litton, Jr, MD

There are specific patient behaviors that can disrupt the harmonic workflow pattern in our practice - late arrivals, no shows, calling for medication refills to avoid a copayment, etc. I could go on and on. About a year ago, I posted practice guidelines regarding patient expectations.

How many times have we seen the following example in our own practice? Just as you are about to enter the next exam room, your staffer alerts you that Ms. Jones has arrived 35 minutes late for her appointment. You look at your schedule and see that you are already 15 minutes behind due to an already busy schedule. In the early years of my practice, I would ask them to wait and I will work them in. My policy has changed and we have managed to motivate our patients to be more compliant with their behaviors.

There are specific patient behaviors that can disrupt the harmonic workflow pattern in our practice - late arrivals, no shows, calling for medication refills to avoid a copayment, etc. I could go on and on. About a year ago, I posted practice guidelines regarding patient expectations. Believe it or not, it has been very well received and I have received a minimal amount of criticism. The repeat offenders typically remove themselves from my practice. They are either frustrated with not being able to receive new medications via phone requests (antibiotics and pain meds, just to name the top two examples) or they are discharged after repeated no-shows.

The rule of thumb is that five percent of your patients can represent 95 percent of your headaches. For the patients that are repetitive in their work flow disruptions, I initially politely mention to them at their next office visit: "...Hey Mr. Jones, I see that you have missed three of your last four appointments."

For the majority of patients who were habitual no-shows, this polite comment usually helps them to be more aware of their behaviors. I simply explain to them that not only has their missed appointment prevented me from taking care of them, it has also prevented me from taking care of another patient that I could have placed in their appointment slot. I am also quick to remind them that they might be that patient we are trying to fit in some day and we very much appreciate their courtesy to let us know if they are unable to come and we can reschedule. There will be patients that are repeated no-shows and it only takes a couple of dismissals from the practice for the word to spread regarding missed appointments.

Some patients will press you to do things that are just not appropriate. I tell my patients that I do for them what they need and this is vastly different from doing what they want. When patients call the office and ask for an antibiotic, they are reminded by my nurse that any request for treatment requires a history and physical examination that can only be performed in the office setting. Once the examination has been completed, my nurse informs the patient that they will be given the treatment that is appropriate for their condition.

The current high unemployment rate coupled with the increase in consumer goods over the past year has produced a behavior from patients to call the office for refills of their medications. Without being nosy or making the patient feel embarrassed about such a request, my policy is to give the patient a month's supply of their medications when an appointment change is requested and ask them to please schedule a follow up within the next 30 days. For the very small minority of patients that repeatedly call and ask for refills, my nurse forwards their names to me and I call them personally and explain to them why a follow up is necessary. Most patients understand, and again the word spreads quickly in our small town that repeated calls for refills just will not work.

Most patients view pharmaceutical reps as being intrusive and monopolizing the physician's time. Our policy for drug reps is posted and is able to be viewed by the patients. All drug reps are free to drop off samples and I will sign during designated times in the late morning and late afternoon, however face-to-face meetings with the physician only occur during lunch time. You can't imagine the positive response from the patients that we receive. Very often my patients are reminded that their time is just as valuable as mine. This has also produced a very high patient satisfaction rating.

One of my attendings in residency could not have been more brilliant when he said, "....your patients are like your children. Proper and consistent parenting (a.k.a. practice guidelines) will produce wonderful behaviors from day one."

This cannot be stressed enough, as my initial lax policies produced deviant behaviors that took years to correct. Now that I am following the advice that I was given years ago, my practice workflow runs smoothly and the no-show percentage is extremely low. There are several methods that you can utilize to coax your patients to walk the line, and putting these policies into practice can be difficult initially for patients that are not accustomed to them. The end result from your efforts will be nothing less than practice utopia.

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