WRITTEN COMMUNICATIONS – THE HANDOUTS

Written handouts are a simple way to communicate more effectively with your patients, and they require no personality or social skills on your part, as do oral communications.

Besides enhancing your bedside manner by utilizing good communication skills, written handouts, diagrams used in explaining procedures, and signed consent forms will help keep you out of the courtroom. Most plaintiffs’ attorneys won’t take a case when they see great documentation and the damages are not significant. Even if you end up in court, it is very difficult for the plaintiff to convince a jury of laymen that you didn’t explain anything when it’s all there in black and white.

At minimum, every practitioner should have a written informed consent carefully constructed with the advice of your professional organization or an attorney versed in such needs, a pamphlet describing what you do in lay terms and what to expect from treatment, and a post treatment instruction sheet that includes what to expect and how to handle after hours emergencies.

The post treatment instructions are especially important. Rather than calling you in the middle of the night, your patients can read the directions if they experience complications after they leave your office.

If your procedures require multiple visits, make sure you give the patient the post treatment instruction sheet after each visit. While you may think they save your instruction sheet in a scrapbook of important documents, they usually throw them away. By handing them a sheet of instructions after each visit, they will have help when they need it.

People generally remember first and last impressions. To become the great doctor everyone wants to see, always leave your patients on a positive note. When you dismiss your patients, always give them reassurance: “If there’s anything you don’t understand or need help with later, don’t hesitate to give us a call.” This reassurance is the ultimate form of communication in that it tells your patients they can get answers to anything they didn’t understand. Knowing you are there for them goes a long way toward having a meaningful doctor-patient relationship.

Patients getting a second opinion will almost always choose the doctor who explains things better. If you’re the first opinion and have great communication skills, most patients won’t even consider getting a second opinion.

COMMUNICATING FINANCIAL ISSUES

 Financial considerations are one of the biggest reasons patients get upset with their doctors. If you want a distinguished reputation, besides being compassionate in handling fiscal matters as described in the chapter on compassion, you must communicate fees and expectations for payment.

Most patients expect insurance companies to pay for services and when unexpected co-payments arise they often get upset. Just because your forms state that patients are responsible for any unpaid fees, patients may claim they didn’t see, read, or understand the notice.

A well-trained front desk is the key to avoid misunderstandings. They should present financial expectations at the initial call after setting up the appointment. Your staff should have the means to check insurance coverage by phone or Internet connection. They should emphasize that any co-payment they quote is only an estimate based on the “information you provided.”

Many patients believe doctors are wealthy and cannot understand how healing arts professionals could possibly ask them to pay the meager ten-dollar co-payment. They usually have little understanding of reimbursement schedules requiring doctors to treat patients for minimal fees that at times don’t pay for overhead costs. Well-scripted employees can respond to the cynical patient commenting on why the doctor “really needs my ten dollars.”

“Mr. Jones, in order to participate with your insurance company and provide you and your family with the best of care, Dr. Smith accepts greatly reduced fees. Your insurance company determines the co-payment, not the doctor, and that helps to supplement the reduced fees. Between insurance company payments and your co-payment, it doesn’t leave much profit for many of the procedures Dr. Smith performs. I do hope you can understand we are trying to keep payment by the patient as low as possible by participating with these insurance plans. That’s why we have to collect these modest co-payments.”

No matter how wonderful your bedside manner, if the patient can’t afford the bill, thinks they were charged more than they were told upon initial contact, or feels their financial responsibility wasn’t explained appropriately, they will not come back to see you. Quite often, they will badmouth you to validate their perception of injustice.

If your practice deals with emergency care, you may not have the luxury of obtaining preauthorization, in which case you may want to estimate patient financial responsibility and have the patient sign a statement indicating that until the insurance coverage can be verified, they will be responsible for any unpaid charges.

If you withhold care for financial reasons, make sure you offer a less expensive alternative. Patients will not perceive you as compassionate (or worthy of being called a doctor), if money is your only consideration for providing service.

Some patients perceive any discussion of money as unprofessional. Try to avoid placing undue emphasis on financial matters. On initial contact by phone, bring up fees and financial arrangements after attending to all of the patient’s questions concerning treatment and making an appointment. Fees should always be discussed but not at the first moment of contact.

COMMUNICATING WITH YOUR STAFF

Communicating with your staff is just as important as communicating with your patients. And how your staff communicates with the patients is equally important. Besides assuring that they assist you in the appropriate manner while performing technical procedures, they can help explain routine things and answer common questions with your prepared, fully scripted responses.

Make sure your staff understands every procedure you perform, but don’t let them explain or respond to complex or controversial questions. The last thing you need is a patient making claims that your nurse told them something for which you could be liable.

Your staff should never give medical advice. This happens in most offices in spite of the potential risks. Every time a staff member tells a patient what to do regarding postoperative care, it could be perceived of as medical advice. That is why it is important that you clearly instruct your staff with appropriate scripting anytime you have them give patient instructions.

Your staff should not be instructing patients on issues like dosage of medication unless you have a standing protocol that doesn’t necessitate that they ask you in each case. For example, if patients call with continued swelling that may require doubling the dosage of an antibiotic or anti-inflammatory agent, and you routinely make that recommendation, you may allow your staff to make that recommendation without asking you. Of course you must be able to justify the recommendation when a savvy personal injury attorney tells a jury that you should have read the chart and never let your staff make the recommendation.

There are so many instances where we let staff communicate instructions to the patient that we take for granted. Having a secretary tell the patient to use hot compresses or ice or any other recommendation must be grounded in sound practice. This requires more instruction than allowing staff to make the recommendation they heard you make a hundred times unless that recommendation is the only appropriate option.

You don’t want to have to defend yourself in a case where your secretary told a patient to place a hot compress on an abdominal pain that turns into a burst appendix, just because they heard you make that recommendation for some other ailment.

Every area of practice has certain routine recommendations that are offered to the patient on the phone every day. While it is best for you to make all the decisions, practically speaking, you do have to delegate certain duties. Make sure you have documented that you trained each staff member regarding any recommendations you have them make. This is best written into a staff manual.

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An Endodontist Says:

When patients call with postoperative pain, I have my secretary ask a few key questions:

“Is there any swelling? Do you feel feverish? Does it hurt to close your teeth together without any food in your mouth?”

 As long as they respond “no” to those questions, I have my secretary use the following script:

“I want you to rinse your mouth with hot saltwater for five minutes each hour. You can take the pain medicine prescribed if the Advil or Tylenol doesn’t help.  If there is no change in twenty-four hours I’d like you to call back and let me know.”

 This way, I know there is consistency in communicating the appropriate instructions to the patient. If they are swelling or have any fever or if they can’t bite down, I want them to come in to see me.

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Each realm of treatment requires that you prepare scripts like described above and make sure anything that can be confusing is not left for the front desk to handle. You don’t want to have a problem as noted below.

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I told you to prick his boil, not boil his…

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If the patient insists on speaking with the doctor, your policy should provide for them to speak with the doctor. While you can't be expected to stop everything to speak with patients when it is not practical, you should set up a system that encourages the patient to work out their problem with the front desk. Perhaps a policy like this may help:

Dr. Jones is with patients and can't come to the phone this moment. If you would like to tell me your problem, I may be able to help you, or relay the message to Dr. Jones."

If the patient is insistent, proceed:

"I'll be happy to have Dr. Jones call you back when he is finished with patients or if he gets a break. That usually is at the end of his appointment hours, so if I can help you regarding any emergency concerns it would be best to tell me now so that we can get you back in if necessary, but otherwise I will have him call you as soon as possible."

This script offers the patient two chances to work with the front desk staff, it let's them know you won't necessarily be calling them back until after hours, it tells them that emergency questions should be mentioned at that moment, and it is not refusing their request to speak with the doctor.