Customer Service

[Seaglass]

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Hey anybody. I am putting together a customer service lecture for the residents and I would be especially interested in your approaches to the patient who wants something you really can't deliver (admission for the very well patient, whole body MRI to check for worms, etc.) or for patients who want something that you could do but don't want to (e.g. head CT for recurrent migraine, ultrasound for my recurrent ovarian cyst that had an US in the office the other day). How do you deal with these issues and still have the self esteem to go to work every day without generating a million complaints. Thanks!

 

[TysonCook]

Hey Seaglass...hope everything is well near WF! I've had good luck with saying no, but then explaining WHY its not appropriate, and then giving them access to have that test done (i.e. help schedule outpatient CT/MR for recurrent HA's, check vision, outpatient US etc).

Also, I reassure them that I'll have a copy of the dictation sent to their PCP with my thoughts re: study X that the patient is wanting.

I think that people are frustrated with a lack of access, not just wanting unreasonable tests....that sometimes are very reasonable.

 

[Jeff698]

For the elderly who come in wanting admission (or their kids bringing them in), I tell them upfront that I'm on their side and will cast a wide net to try to find a reason to bring them in but "THEY" have created really strict criteria and that I may not be able to admit them. I also try to let them leave with something, a parting gift if you will. I get them a rapid PCP f/u appt or refer to a specialist if I feel it is appropriate.

I basically try to make it an US vs THEM with me on their side and never quite naming who THEM actually is.

Plus I mention that there are some killer bugs running around the hopsital, including that dreaded H1N1, and they might catch it.

Take care,
Jeff

 

[DrQuinn]

I make copies of every test I did in the ED, and explain each one and give ti to them. You can always tell right when htey roll in what their epxectaions are (although it probably won't come to you until you are out of residency), so you kind of have to read it early and set yourself up for success even before you leave the room during the initial evaluation.

Q

 

[TysonCook]

also, keep them updated either personally or by the nurse. This needs to include their most probable disposition. It really hurts when grandma is ready to go home, and the entire family has left, driven 45min to get home, only to be called back to pick her up...and their response was "we thought she was going to be admitted"....nip it in the bud right up front and continuously during the visit.

 

[docB]

Hey anybody. I am putting together a customer service lecture for the residents and I would be especially interested in your approaches to the patient who wants something you really can't deliver (admission for the very well patient, whole body MRI to check for worms, etc.) or for patients who want something that you could do but don't want to (e.g. head CT for recurrent migraine, ultrasound for my recurrent ovarian cyst that had an US in the office the other day). How do you deal with these issues and still have the self esteem to go to work every day without generating a million complaints. Thanks!

Once you create your lecture can you post it for us? I need to attend.

 

[beanbean]

Great topic for a lecture. It can be very difficult to make a patient and their family happy when them come to us with a specific plan that disagrees with our reality. I agree that most patients are just frustrated and want access. Of course some are completely unreasonable and there is no pleasing them no matter what you do. One thing that really burns me is when another MD dumps a chronic patient to the ED with expectations of seeing a specialist or getting an expensive/complicated test stat. I understand the PCP is frustrated, but try educating the patient rather than sending them off to waste their time and mine. If your patient has had chronic back pain for 3 months do not send them to the ED at 4:30pm on friday to "see a neuologist" and have a stat MRI. In these cases I try to call the PCP back and ask what were they really looking for here. It is interesting that sometimes the PCP has given the patient the appropriate follow ups but the patient had decided to go directly to the ED and tell us "my doctor told me to come here for XYZ"
No easy answers. And yes, please post your presentation here if you don't mind.