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The doctor who wouldn't listen: how to exceed low expectations
A couple of years ago I had a quick question for my primary care physician. So when I made a flu shot appointment over the phone with his receptionist, I mentioned my question. She hesitated, as though this was a large and unusual request - pass a question along to the doctor? - and asked that I just bring it up in person during the appointment.
When I arrived for the appointment, I was unable to get the question to my doctor. (My flu shot was administered by someone I'd never seen before - I assume she was a doctor, as she never introduced herself.) I asked her - and then another doctor - if they could pass it along, or hand him a note, anything - no. Everyone involved was polite, but it was clear that this was an annoyance: a patient with a special request.
Here's the ironic part. As I explained to each person along the way, I was trying to invite my doctor to attend, as my guest, an event a few blocks away from his office. It was my Gel Health conference - all about creating good patient experiences.
A few weeks later, I recounted my experience on-stage at Gel Health. (Jump ahead to 3:05, where the story starts.)
The topic of patient experience was picked up by last week's New York Times article Concierge Medical Care With a Smaller Price Tag, which describes the work of One Medical Group, a network of primary-care offices that actually provide a good patient experience. I'm quoted in the article as a patient of One Medical - having joined, in fact, after my bad experience with the previous doctor. (The founder of One Medical, Dr. Tom Lee, is speaking at my upcoming Gel 2011 conference.)
I left the old doctor because he wouldn't listen to me - literally. I joined One Medical because they'll take my call, they'll answer my email, and they'll start the appointment on time. There are other benefits, too, but my point is that sometimes customers' expectations are so low that just delivering the basics can create an extraordinary experience. Banks, airlines, credit card companies, insurance companies, and many, many others - take note.
Companies often spew about "customer relationship management" or "disruptive customer-led innovation" or any number of other impressive-sounding processes. But as often as not, what the customer wants is as simple as sitting down and listening for a minute.
They may just invite you to do something great.
Got to love the irony in what happened. Good story, Mark, as usual.
While I wish my patient experience with the medical community was better (along the lines you cited), at the end of the day I'd rather have the best doctor looking after me than the most courteous one. Unfortunately those are rarely the same person.
My physician uses email - no problem to exchagne information.
@JMontaigne - I'd agree with that... to be clear, I didn't choose my new doctor based on courtesy - I chose primarily due to the willingness to communicate, listen, make appointments and show up promptly (as well as other experiential benefits of the practice). *And* they're courteous, too :)
A big amen to this subject.
Is there such a group available in the Boston, MA area?
I have to share a FABULOUS user experience I had with Jet Blue as a counterpoint to your bad experience example. This airline "Gets It!"... truly!
My daughter has been flying back and forth between her college city and our home. When I found a great airfare for her first trip home, I signed her up for the True Blue program. Since then, she has flown Jet Blue 5 times round-trip. One of those times she was in a seat next to a Very Large person who had to put up the armrest between their seats to fit into the seating area and was very much into my daughter's personal space. My daughter never complained to anyone (she figured "it's only a little over an hour, I'll live"). A few weeks later, in her True Blue account, a $50 credit appeared with the explanation "Bill of Rights"... apparently, Jet Blue has a passenger Bill of Rights which gets to the heart of good user experience. One of the flight attendants must have observed that my daughter's experience (despite her lack of complaint) was less than promised and recorded that fact. The next trip home my daughter's plane was having technical difficulties with the in-flight entertainment. Because the TVs were not working, Jet Blue automatically credited $15 to her True Blue account. I (the purchaser of these tickets) was unaware of my daughter's experiences and she too was not aware that these credits had happened until I went to buy her next ticket. Jet Blue asked on the payment information page if I would like to apply the $65 credit she had on her account! How incredibly cool is that!? I asked my daughter why she had a credit, she looked into her account history and found those credits with explanations, remembered the flghts that caused the credits and in the end, both she and I nearly fell over with the pleasure of the user experience.
Excellent talk, Mark – it was good to see you in video form.
I don't know how carefully rehearsed it was, but you certainly give the impression of being an excellent story-teller.
One Medical is great. I signed up my daughter after hearing about One Medical at Gel 2010. It is an amazing service and anyone living in NYC should definitely switch to them.
I've been able to email my doctor for several years - Group Health Cooperative, Seattle.
Medical practitioners not introducing themselves before performing a procedure is really inexcusable, I feel.
When did it happen that doctors didn't recognize that HOW they treat their patients and LISTENING is part of their job.
Well said.
The patient experience is a wonderful topic to discuss. A part of the patient experience that is sometimes overlooked is the experience that a patient has at 10pm or 3am.
These experiences will most likely involve the patient speaking with a representative at an answering service.
An excellent answering service, as with any other vendor that has contact with the patient can enhance the patient experience at this critical time, by doing the very obvious tasks of:
Answering the call in a timely fashion
Providing a caring voice as they collect pertinent information the doctor or nurse practitioner will need to begin assessing the situation
Relaying that information in a timely fashion to whoever is on call.
A glitch in any 1 or all of those "simple" tasks and as unpleasant an experience that required placing a call to the doctor after hours is can become disastrous from an "experience" perspective as well as escalate the emergency into a visit to the emergency room that may not have been required.
Has this topic come up for discussion in previous Gel conferences?
I would be very interested in the responses.
All the best.
Sometimes you may have to be a little, well, not so polite. I'd start with "which part of get it to him don't you understand?" and work it through, maybe using the "5-why" approach. You can report an MD to the Board: you have rights as a passenger, but also as a patient. MDs tend to think they're somehow above the rest of us.
Great stories. I too switched doctors after being treated like a stranger each time I had an appt. Now my doctor thru St Vincent phy Indianapolis sits down and has a conversation just like a friend would
For the past 12 yrs my company has mystery shopped healthcare systems and communication is always in the top 3
important factors for patient retention.
Brooke
perception strategies, inc
Good for you! I found a new Dr about a year ago (due to the same frustrations as yours). He's great, but I'm almost afraid to tell others. If he gets too many patients, he may become less customer-oriented. Now, can you recommend a good bank, please?! I bank with Chase, and they just don't get 'customer experience'. The only reason I stay with them is because they're open on Sat - more convenient hours to get below average customer experience.
It's all about economics. Concierge doctors get subscription fees, which when pooled among all members, let doctors significantly reduce the number of patients they see per day while keeping or increasing their take-home pay. Non-concierge doctors overbook appointments -- which result in long wait times -- as a mechanism to have high patient-visit loads, which let's them keep or increase their take-home pay.
My doctor is excellent HOWEVER the process of booking an appointment is perhaps up there in my top 10 worst customer service experiences. I asked the receptionist if she could email the travel health questionnaire template as collecting in person was impossible given my working hours. She said "If everyone emailed everything we would be INUNDATED" I remarked that it was 2011 and that was the point - plus it might be more efficient and a better service.... No I had to come in in person. :(
This is exactly why my husband and I changed doctors. Now both of our doctors have email and either he or his nurse will respond. It's so much more convient and comforting.
This is close to medical. My wife has pretty bad eye sight. So she went to a boutiuqe with supposedly high end lenses, and stylish frames-L A Eyeworks. She loves their frames and got some frames and lenses for $930.(Not our usual budget for this) Now our expectation was that these were really high quality and would work really well. Wrong. She could only see out of the reading part and nothing else. They said it was her fault and she didn't know how to use them. (She has been wearing this type of lense for 25 years) Then they refused to look at anohther manufacturer or listen to her eye doctor who volunteered some hint on what kind of lenses to spec. Then said they would not give our money back. So we settled for a second pair of frames and a store credit-which is worthless. The rich and famouse shop there but they must not care to see. The underlying premise was to buy glasses and be able to see.!
Very bad experience.
My HMO, Kaiser Permanente (SoCal) has had online access for patients for several years now (I think they're fairly trendsetting in this area), including the ability to email my physician(s) (including my kids' pediatrician). The doctors have been uniformly excellent about responding to emails promptly.
On several occasions over the last couple of years, especially when I see doctors other than my primaries, I've conducted informal and unscientific surveys about their views on the electronic medical record system they are forced to use now. The responses are not glowing, by any means, but they don't pine for the "old days" either (admittedly, at least partly because they know there's no going back).
And Mark, that was a terrific presentation. You're absolutely channeling Woody Allen there, and I say that as a compliment of the highest order.
Mark, great story but unfortunately all too common. I have found so many examples of patients who love their doctors and are very loyal to them, but will leave because of the office staff. These frustrating encounters start on the phone. It takes just a few seconds for a caller to decide if they are being heard and respected. In your case, you are a loyal fan of the physician. Imagine how quickly a practice loses potential business when first-time callers get a run around or are rudely interrupted. Thanks for sharing your story and for the work you do on improving the patient experience. You are a champion.
I think I got a mailing from One Medical. It's sitting on my desk at work.
In my experience issues I have had arose from administrative thoughtlessness, indifference or incompetence, rather than anything the doctor did or didn't do.
The place where I currently go is one of the largest health care providers (as well as employers) in the area where I live. However as far as I can tell their consideration of the patient experience is pretty much non-existent. I've encountered several issues which at best were annoying, but ultimately had varying degrees of impact on my health or well-being. The only thing preventing me from running out of there screaming is that from a consumer perspective, I have no way of being assured that the next place will be any better so I stay where I am, because I simply don't have the time or the energy to kiss a bunch of frogs in order to find the prince, as it were. I feel like I am caught between a rock and a hard place.
Anyway, in the course of resolving my latest bad experience, I learned that the provider network of which my doctor's office is part, had implemented a new electronic medical records system. Purely by chance I was able to connect with an administrator to whom I described the problem I'd had (and one that turned out to be directly related to the new system). She was very open to hearing my feedback and investigating what happened, for which I am very grateful. However, it should also be noted that I would not have been able to identify her as the appropriate person to contact on my own, and she is not physically located at the particular office that I go to, so probably cannot see first hand how the new system is working (or not working) in practice.
Anyway, I learned several things:
* that the system does not really allow for, or encourage human intervention
* that a critical change in how the new system works increases the chances for the problem I experienced, to occur. Now, in addition to approving a transaction, the doctor most also explicitly forward it to the staff or dept to carry out, whereas in the old system, the approval automatically moved the transaction along. You can see how this might be problematic in a medical setting.
* that an ADMINISTRATIVE decision was made **NOT** to notify patients that a new system had been implemented, putting patients at a further disadvantage. For some reason that I find inexplicable, it was felt that such notification would increase anxiety among patents. Well, I can tell you that the delay to in receiving care certainly caused me a great deal of anxiety and a bit of expense.
and that's the very short version.
Great article. A good answering service for a medical office is absolutely necessary for a great patient experience. For current patients, the answering service is an extension of the office and a contact when they need it most. For new customers, the service can portray the professionalism of the office.
I find the doctors themselves to be very open and helpful. It is the receptionist and phone answerers that put up the barrier and do a poor job taking messages.
Just like a retail sales person or a wait person - these positions are critical to the success of a business but no one seems to help them understand that they OWN the customer experience and shouldn't be gate keepers but facilitators. Their energy and enjoyment should come from talking to people and helping them navigate and understand a system.
I had a terrible experience with the office staff for another one of my doctors. I merely wanted to confirm the office's mailing address in order to send a copy of some test results, per the doctor's request.
It took a couple of weeks before I was able to get through. The receptionist kept putting me to the sec'ys VM, which she simply did not respond to. I finally had to literally beg the receptionist to personally flag the woman, which she did.
When the sec'y came to the phone she was belligerent! I asked whom I was speaking to and explained what I needed. Her tone changed immediately. I think she realized that she had gone over the line. She now suggested that I should fax the information to make sure the doctor received it sooner, which I declined to do.
I decided to contact the doctor directly by letter to explain what happened, and to advise that this sort of treatment was simply unacceptable. If this is what I could expect, I would be seeking services elsewhere. Given medical office staff's access to sensitive information, I feared retaliation. I stamped the envelope "For Your Eyes Only" and hoped for the best, praying that the secretary (the source of the problem) would not be the one to open this letter.
Things actually worked out, after a fashion. The office administrator contacted me and thanked me for giving them an opportunity to correct the problem before filing a formal complaint. Apparently the secretary was responsible for supporting 3 doctors, all of whose practices had grown over time. She was simply overworked. They supposedly have since assigned my doctor her own dedicated sec'y.
Let it again be noted that, an administrative decision (i.e. appropriate staffing levels) adversely affected patient experience as well as well-being. Also, I had to go out on a limb and hope my letter reached the appropriate person. The office administrator's contact information was not displayed anywhere in the waiting room.
I still lack confidence in this office and will be seeking a new doctor at some point. The office has far too high a volume of patients for the available staff and physical space. During a subsequent, recent visit, I watched in horror as two nurses ran around like chickens without heads. I was waiting to have my routine vitals taken (weight & BP). One nurse started the process, than got distracted with something else. The second nurse re-started and completed the process without really knowing where the first person left off. While I waited I observed that charts for several patients were open in the work area, making it highly possible that patients' records could be misfiled; the phones were ringing off the hook; and I watched in horror as one nurse mislabeled another patients lab test kit. This in the space of about 15 or 20 minutes. I tremble at the thought of what might happen during an 8 hour work day, 5 days a week.
An excellent post and I'm really enjoying reading all the comments too. Again, Mark, it's as if your finger is on the pulse of some kind of collective subconscious. I've had nothing but bad experiences with all of my doctor's visits it's a bit insane how out-of-touch one industry can be. There's a sense of entitlement and ego behind this way of communication, and it's clearly not an appropriate way to treat customers let alone other human beings. Thanks for posting this.