Author: Beth Workman, O.D

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COMMUNICATION LESSON FROM AN UNLIKELY SOURCE

Reading time: 3:52

I called a plumber to repair a dripping faucet in my bathroom.  He was prompt, efficient and competent.  I asked him about other work I might need done in the future.  I just wanted an estimate of the approximate cost.  Instead, what followed was a detailed discussion about all the possibilities; shut off valves, taking faucets apart, non-freeze faucets, thickness of walls and on and on.

My eyes started to glaze over after a few minutes. He was knowledgeable as he attempted to explain everything to me and to answer all my questions. I tried so hard to hang in there and make the appropriate responses. Despite my efforts, it was a losing battle.  Midway through his long explanation, a horrible thought came to me- Is this the way I sound to my patients?

I’ve always prided myself on educating my patients, but now I was doubting myself.  Do I use terms and concepts they don’t understand?  Do I go into too much depth, or too little?  Am I paying attention to their responses or am I tuning them out?  Do I continue on with what I think they should know no matter what?  I can get quite passionate about what I say and do.  I love to educate a patient who wants to learn. But now I had to ask myself some tough questions.  Am I responsive to their needs? Am I making an effort to answer their questions in a way that is meaningful and useful to them?

Tailoring my response to the individual patient has always been a goal of mine.  Watching a patient’s facial expressions and body language is an important clue if I’m hitting the mark or talking over their head. For some patients, I go into great depth because their follow up questions and responses show they want to know more.  For others, who just want a simple answer, I try and provide that as well.

My experience with the plumber was a great reminder to always stay tuned in to my patients.  My answers can establish a valuable connection with my patients.  We are all facing increased pressures to see more patients daily and that means less time to make a valuable connection.  It becomes more important than ever to maximize that time and make a good impression.

I feel there are some basic rules to enhancing communication.  Most apply to any type of conversation, but especially when dealing with technical concepts.

  • Don’t use technical jargon.  It doesn’t impress patients or make them understand any better.  It sounds condescending and makes you sound like a medical snob.  Find a way to make it understandable without talking down to patients.  Making the effort to be sure they understand shows you respect them. It also conveys the message that they need to take part in their own health care.
  •  Make eye contact.   Whether you’re answering their questions, discussing the results of the exam or telling them the recommended treatment, be certain to look at your patient.  Resist the temptation to be entering data on the computer while you’re talking to them.  I know this can’t avoided through much of the exam.   Today’s electronic records necessitate that we record results as we go through our exam.  But be aware, when you are facing the computer, patients can’t read your expressions.  For that matter, they can’t hear you as well either.  Your head is often turned away and faced downward.  Your voice is absorbed and muffled by the surfaces in front of you. This is especially important to remember with elderly patients who often have problems hearing.
  • Body language can also speak volumes.  Face your patient whenever possible.  Make sure you’re open to them. Arms crossed on your chest is a closed off signal.  Standing, walking away or placing your hand on the door suggest you are already moving on to the next item on your schedule.  All of these give an unconscious message that you are no longer engaged with the patient.
  • Explain with simple examples or imagery.  Learn to use common sense examples or create visual images that’ll be difficult to forget. Both of these go a long way in creating a powerful memory for the patient.  If a patient is well informed and educated, they are more compliant. The time spent explaining also makes a valuable connection between you and your patient.  Never waste that opportunity. You may never get another chance if they don’t return to your office.

These suggestions aren’t profound.  Nor are they difficult.  I suggest listening to yourself explaining some common information.  Record yourself if you need to, or have someone else listen and give you a critique.  Try and improve your explanation by avoiding all the technical jargon that slips in when we are unaware.   Sometimes it’s necessary to use technical terms, but if that’s the case, then define them first.

Listen to your staff too.  Everyone in our offices is accustomed to using a shorthand of abbreviations and medical terms when we talk to each other.  It’s so easy to slip and use these terms when we speak to our patients.  Some patients will ask what you mean. But, many patients will not because they don’t want to look stupid.  Make your staff aware of good communication skills. Discuss it at staff meetings or perhaps role play. Have a staff member explain a problem, treatment or a sales presentation to another staff member.  Have other staff members make suggestions on how it could be improved.  It can be a valuable learning experience for everyone.

No patient should leave without understanding their diagnosis and treatment options.  Your patients will notice the time you spent making sure they understood.

What do you do in your office to improve communication? What tools do you use to help patients better understand their conditions? Join the discussion. Write your comments below. Visit our website and social media for other suggestions and free resources to enhance communication skills.

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ACTIONS SPEAK LOUDER- SHOW GRATITUDE

Reading time:  3:49

We've all been in other doctors’ offices either as a patient or visitor. Keeping our eyes open and observing can give us some valuable lessons.  There's always something to we can learn- sometimes positive and sometimes negative.  I accompanied my mother to her oral surgeon’s appointment.  What I saw was all positive.  It was a caring environment for patients and staff.

But, they did one thing that blew me away.  It could have been a great marketing tool, but was even more meaningful because they didn’t use it as one.  It was an honest and thoughtful gesture.  It was not a calculated move, nor offered with expectations of returns.  All which made it even more valuable.  It was unique, generous and offered with an authentic desire to just be kind.

It occurred in our last few moments in their office.  We were ready to leave and were taken to their financial office to pay for the services we received.   When I made the appointment, the staff said that fees were due at the time of the service.  With our checkbooks out and ready to go, a staff member told us that we owed them nothing.  You heard it right- my mother’s fees were totally waived!  It so happens that this oral surgeon does not believe in charging people who are over the age of 90.  I mean, I've heard of senior citizen discounts, but I've never heard of anything like this!

What a decent, caring and generous gift.  A gesture like this is so important when you think about the lives of the people who receive it.  They were born before the Great Depression and have lived a long life.  They're living on fixed incomes.  Yet, they have many health issues that whittle away at what little income they do have.  You couldn't pick a group who'd be more appreciative.

The cynics among us will say that it doesn’t cost the practice that much. How many of their patients would it involve?  After all, how many 90+ patients are going to need oral surgery?  Cynics could say that the positive word of mouth advertisement would be well worth waiving the fees.  I am proof of that point.  I have recommended this practice to anyone who needs oral surgery.  But, if you look at it for the possible benefits to you and your practice then you are entirely missing the point.

It's not about the cost to the practice or the possible benefits at all.  It's about what it says about the heart and mission of this practice.  It's what it says about the doctor. It's about the way they offered this gift.  They don't advertise this benefit, nor do they use it in any of their marketing attempts.  They don't need to.  This is a large practice with a great reputation and their schedules are full for all their doctors.  Instead, they offered it in private.  They offered the waiver to help a patient who has lived a long full life.  They offered it without conditions or expectations of reward.  All which makes it so much more valuable.

I'm not suggesting that this is something you should incorporate in your practice.  Most practices could not afford such a gesture.  It wouldn't be practical to do this in an optometric practice.  But, it does make me think about what we can do to show our patients that we care about appreciate them.  The point is that it doesn’t have to be a dramatic act.  It can be a small act of kindness and caring.

There many ideas of how to bring that personal touch to our practices. Creating an atmosphere that is positive and welcoming can be both healing and encouraging. Thanking patients and acknowledging referrals is a good practice.  Writing a personal note to send to a patient on a special occasion can be meaningful.  Many offices do automated birthday greetings and that's nice.  But why not send a personal note, if the patient mentions some other occasion when they're in your office?  If they mentioned it, then it's an important event for them.  Celebrating anniversaries, graduations, the birth/adoption of a child, a job promotion, or welcoming a new patient to your office are just a few events worthy of noting.  Sending a note shows you heard them and that you cared.

If you like the idea of writing a personal note, but struggle with what to say, go to our website.  Look under Free Resources for a document called "Greetings and Salutations".  Download it and use it as a reference for your office to help you get started.

It can also be fun to honor groups of patients on special days like Mother’s Day, Father’s Day, Grandparent’s Days, or Valentine's Day.  Single out specific groups (senior citizens, military, police and fire departments, first responders, teachers, etc) for special treatment certain times of years. If you chose to feature a specific group, it doesn't have to be expensive or elaborate.  A simple sign acknowledging that group and thanking them for their work is a place to start.

The point is- be creative!  There's no limit to what you can do.  But do it for the right reason.  If you're doing it to just gain points and make yourself look good, patients will see right through you.  Your efforts at gratitude should be consistent with the culture of your office.  Do it with an open and generous heart.

Our patients already know we care for them, but how do you show them you also care about them? Waiving fees is an extreme example, but what has worked in your office?  How do you thank patients for selecting your practice and trusting you with their health care?   How have you let them know that they matter to you?  What have you done that your patients have enjoyed and appreciated?    Write down your ideas and share what works in your office in the comments below.

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DEALING WITH THE FEARFUL, ANXIOUS PATIENT

Reading time 3:30

My dog is a more cooperative patient than many patients who walk in my office door.  I am blessed with a wonderful Golden Retriever named Champ.  He developed an eye infection. Antibiotics and steroids have not resolved the infection. So I decided to seek out the advice of a veterinarian specializing in ophthalmology.

In their office, a technician reviewed the history.  A Schirmer’s test and tonometry were performed without a topical anesthetic.  Champ didn’t pull away, turn his head, squeeze his lids shut, or make any sounds of whining or growling.  He just let her perform the necessary tests.

The veterinarian did an external evaluation, hand-held slit lamp and binocular indirect ophthalmoscopy.  He instilled fluorescein and retracted the nictitating membrane. In all this time, Champ was the model patient.

Observing Champ’s exam, it occurred to me how nice it would be if all my human patients were like Champ.  Most uncooperative patients don’t set out to be that way. But, it still creates a frustrating and challenging exam for both patient and doctor. Along with the frustration, there’s also the fear of missing something or obtaining inaccurate findings under these less than ideal situations.

There’s not one simple explanation for lack of cooperation nor one universal solution. One frequent cause is fear or anxiety.  If you suspect that is the reason, then try and identify the source.

Is it fear of making the wrong choice and concern this will harm their eyes?  Is it fear that they will lose their vision?  Do they have high levels of anxiety associated with medical exams of any type? Do they have a history of a bad experience?  Do they dislike having their lids touched?  Do they object to the bright lights?

Whatever the reason may be, try and allay their fears. But, a word of caution, don’t lie or minimize possible discomfort associated with a test or procedure.  I may not tell every detail, but I do tell my patients what to expect and I answer their questions honestly. After all, they will soon experience the procedure themselves. If you lie, you will lose the patient’s trust. Once you have lost trust, it may not be possible to regain it.

Whatever the reason for their fear, I find that good communication is key.  Take the time needed to explain and reassure them as you perform the tests. In the long run, it will actually save you time. If you try and rush your patient through the exam, you will escalate their anxiety and further decrease their cooperation.  You will have to repeat tests and still end up with a poor and unreliable result.   Both doctor and patient will feel stressed and depleted by the end of the exam.

Acknowledging and discussing your patient’s fears actually calms the patient down.  Being empathetic and normalizing those fears can have a major impact on the patient.  I stress that it is natural to have concerns about medical tests. In fact, I confess that my own weakness is having a throat culture done. Letting your patient know that you also find some tests difficult, allows the patient to make an important connection with you.  Connection facilitates the exam.  Fears often embarrass patients.  Putting yourself in the patient’s position decreases their embarrassment and increases their cooperation. You haven’t added to their shame, but allowed them some dignity.

It is within your power to help them relax.  Share with your patient ways that they can make it easier on themselves.  Deep breaths are a proven method of relaxing and centering the patient.  For that matter, some just need to keep breathing.  (I’ve observed that many patients hold their breaths when anxious).  Simple advice can work for many patients.

When a patient can’t keep their eyes open for pupil testing or are photophobic, have them look up.  It may not be ideal, but you can still see the pupillary response. The patient is more comfortable and that is preferable to forcing their eyes open and trying to make an evaluation.

Whenever possible, allowing a patient to have some control can also help.  I ask my patient to tell me when they are ready for a test so they can prepare themselves instead of surprising them. They might want to hold their own lids. If so, let them try.  Instruct them on how to hold them without getting their fingers in your way. Show them how to have good control without exerting too much pressure on their eyes.  I am often surprised at how allowing them lid control can work and if it doesn’t work, at least the patient knows you tried it their way. These simple steps can make a difference in the exam and its results.

Fearful and anxious patients are appreciative when you make the effort to treat them with kindness and compassion.  It would be wonderful if all patients could be as cooperative and reliable as Champ, but the fact is many can’t. Remember that your attitude and approach to them can sometimes make a difference.  Why not try to make the exam more pleasant? You have nothing to lose and everything to gain.

What helps you when faced with an anxious or uncooperative patient?  Share your comments below and let’s begin a discussion.

 

 

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THE BIONIC WOMAN AND PHYSICAL DISABILITIES

Photo by rawpixel on Unsplash

Reading time 4:18

I am a bionic woman. After many surgeries, I am now the proud owner of two artificial knees and two artificial hips. Performing daily activities and being independent are wonderful gifts that many of us take for granted.

I learned valuable lessons while my joints were failing, and as I recovered from my surgeries.  What I learned from my experiences can be applied to the patients in all our offices. There are many people who are considerate when faced with someone who needs help.  Yet, I am still amazed at how many people seem oblivious to the challenges other people face. I am always stunned when this neglect occurs in a health care setting.

When using a walker, crutch or cane, entering a medical office is the first of many challenges. Look at the door to access your practice. How does it open?  Does it require a pull or a push?  Both can be tricky. If a patient is not alone, no problem.  But if they are alone, the struggle begins.

Let’s talk first about the doors that pull open.   A patient must step back to open the door. Then they must try and thrust themselves into the doorway to prevent the door from closing.  Not exactly a safe maneuver.  And if the door opens in, the patient has a new set of challenges. Both hands are on the walker or crutches. So the patient must use their head, shoulder or walker to push the door open.  Not exactly a graceful entrance and it can throw a person off balance. And if there is a vestibule with two doors and a small space between them, life gets even more interesting.

Understand that if a person is using a walker or crutches, they are using them for support and strength.  Removing a hand from the walker or crutch can affect a patient’s stability.   I am amazed when office staff and patients in the reception area can watch someone struggle without offering help.  We can’t control how other people respond. But, we can make certain our staff is aware of the importance of helping when a patient is struggling to navigate our offices.  Think about the positive impact of offering a helping hand without waiting to be asked.

Furniture selection for the reception area is important. Chairs with straight backs are good for patients using a walker or cane.  Sitting on furniture that is too low or too soft is disastrous for someone with physical disabilities or the elderly.  Also be certain you have several chairs with arms in your office.  People with disabilities learn that it is never safe to use their walker for support as they stand. Walkers can tip forward and cause a person to lose their balance or fall. Patients learn to use the arms on a chair to push up to a standing position and then safely transfer to the walker.

Many times I heard my name called at a doctor’s office to go back to the exam room.  The technician or nurse was halfway down the hall while I was still trying to get out of my chair.  I was already self-conscious about how slow I was moving, but the tech rushing away only made me feel worse.  My response is to hurry to try to keep up, but this is not actually safe. When someone is in pain or recovering from some injury or surgery, I can assure you that they are not moving slowly to aggravate you.  They are moving at the speed that allows them to feel safe and stable while minimizing their discomfort or pain. Slow down!  The exam can’t start until the patient arrives in the room. So show them respect and compassion.  Reassure the patient that you want them to take the time that they need.

Changing positions from seated to standing can take some time as well. It is vital that the patient feels secure before moving. Many people will stand still for a moment to get their weight redistributed and muscles engaged.  Then, when comfortable, will begin to move forward. Generally, allow your patients to get up on their own.  When a person has to use a walker or crutches, most will learn what works best for them.  You can politely ask if they need or want your help, but don’t force it on them.  If they do want help, ask them what they want you to do, rather than presuming you know.

Your staff can assist your patients in many different ways.  Just being aware of physical limitations is a start.   If the footplate on the examination chair is in a raised position, it allows a patient to walk up to the chair, turn and sit.  When they feel the chair behind their legs, they can then lower themselves onto the chair using the armrests for support.  Staff can then move the walker, cane or crutches out of the way for the examination. Never ask a patient who is disabled, either temporarily or permanently, to step up on the footplate and then try and turn around to sit in the chair. Once they sit, ask if they want the footplate put back down.  Most people will want this unless they have long legs.  Another source of discomfort is letting legs just hang with no support under them. It can be very painful, especially on a post-surgical patient since gravity will pull the leg down.  If their feet don’t reach the footplate, place a large book or platform on the footplate to support their feet and relieve the pull on their legs.  This also applies to people who are short.  Try and make your patients comfortable if at all possible.

If the patient had surgery recently, staying in one position without being able to move can make the patient uncomfortable.  When they are uncomfortable, they can’t concentrate and respond well.  Be aware of this.  If a patient is moving and repositioning themselves a lot, ask them if they need to stand or move.  Just changing position or moving a little can relieve this discomfort. Sometimes offering a small footstool and allowing them to elevate their leg will also help.

These are all simple and inexpensive things to do that can have a big impact. Being aware of your patient’s needs and limitations and responding appropriately will mean a lot to your patients.  They will remember your kindness and consideration.

What ideas do you have to make your patients more comfortable?  Share them below in the comments section.