Kortney has been a clinical physician assistant for 13 yrs. When not being a PA, Kortney’s hobbies include writing, research, and investing.
The "18 Second" Rule
Although many patients have come to rely on their doctor/provider to lead the conversation at an office visit, this may not be the best approach. Becoming an informed and prepared patient can do a lot, not only for your health, but also for the doctors/providers that you see. Most providers welcome the opportunity to attend an office visit with a new patient who is well prepared, decisive, and direct about their expected outcomes from the visit or treatment.
In a book entitled How Doctors Think, Dr. Jerome Groopman, MD states that patients only have 18 seconds to relay their medical problems and concerns to their doctor before being interrupted or ignored. Doctors have been doubling the number of patients that they see in more recent years due to shrinking reimbursement rates from insurance companies. Although most providers really do want to help their patients and provide attentive and quality medical care all the time, they are being pressured by insurance companies to see more patients in order to maintain the same earnings from previous years.
Some providers have become more and more hopeless about the future of medicine because of the clear imbalance of power with the insurance companies making staggering profits and placing more and more restrictions on doctors' ability to make the medical decisions. So, don't assume that it is the doctor's fault that they are only able to spend a few minutes with you during your visit. Instead, when you see your doctor, use teamwork to ensure that the control is put back into the hands of your doctor and yourself. Collaborate on what your expectations are and discuss how to get insurance to take a back seat.
The following six hacks will show you how to interact with the office staff, how to be prepared for the visit, and how to empower your provider to address your medical concerns most effectively. If we can stretch those 18 seconds even just a little, the benefits are enormous for your health and for the doctor's piece of mind.
Hack #1: Follow Good Patient Etiquette
When you go to the office for a doctor's appointment, it is very important that you present yourself appropriately. Although discrimination and biases are not ideal, most people tend to make sub-conscious opinions about you in the first 30 seconds that they meet you. Keeping in mind our goal to stretch those 18 seconds with the doctor as far as we can, this starts with pleasing the front office staff. If you are rude, smelly, dirty, or late to the appointment, you are already cutting down your time with the doctor.
Being on time cannot be more important. The doctor/provider and the office staff count on you to be on time so that the rest of the appointments that are scheduled are not thrown off. Believe me, there is nothing more frustrating than seeing patients straight through your lunch time because someone didn't show up on time. Before the doctor even comes in to see you, they will know that you were late, and dependent upon how busy their day is, that may be enough to make them sub-consciously shut down.
The only way to be efficient is to be early to your appointment. Show up 10 minutes before your appointment in case there is last minute paperwork to tackle or just allow yourself that 10 minutes to wait and decompress any stresses so that you have a clear mind when it's game time with your doc.
Another thing that is just as important as being on time is being clean. Take a shower right before your appointment or, if that's not possible, at least make sure that you take one the morning on the day that you have your visit. Doctors and other office staff will eventually have to examine you, take your vitals, and sit in a small room with you. If you are not clean and clean shaved, this can become uncomfortable for yourself and the doctor or staff person you are with.
Wear comfortable, appropriate, and respectful clothes. The clothes that you wear say a lot about you. If you show up in raggedy old clothes with wrinkles, that is off-putting to others. Also, if your skirt is too short or top is too revealing, this can be just as off-putting.
It's also important to think about how the doctor will examine you. If you have an injury to your knee, wear shorts or loose-fitting pants that can be rolled up to allow direct examination of your knee. If you are expecting to have to change into a robe, make sure to have clean underwear (and bra if that applies) that covers enough of your un-mentionables to prevent anyone from feeling uncomfortable.
Hack #2: Show Up With the Right Company
In order to ensure that you are able to have a successful interaction with your doctor, it is necessary to consider whether someone should come to the appointment with you or not.
In almost all cases, bringing your young children with you to your adult doctor visit is unnecessary and extremely distracting for all parties involved. While I do love kids, having them present while I'm trying to discuss a medical problem with a patient is difficult. Sometimes there are topics that are inappropriate to be discussed in front of children. Other times, the kids prevent the doctor from locking into a good conversation about the medical problem.
There is also the possibility that children will disrupt other office staff members and this should always be avoided. In an effort to assist the doctor in providing the best care possible to you, leave your kids with a sitter or make the appointment while they are in school.
Alternatively, there are some patients who need someone to accompany them to the visit to act as their advocate. Elderly patients may have a difficult time speaking quickly and precisely enough to be efficient in the short amount of time allotted for visits. If there are memory issues, it's almost necessary to have someone there; both to remember what was said during the visit and also so that they can share their experiences about how the patient's memory has been.
Patients with physical disabilities, such as those in a wheelchair, or those with hearing aids should also consider bringing someone along to advocate for them. Although office staff will help patients with disabilities, this may decrease the amount of important discussion time with the doctor.
When deciding whether or not to bring someone to the visit, ask yourself if that person will enrich the conversation with the doctor or possibly hinder it in any way. If there is any chance for a hinderance, it is highly recommended that you opt to leave them home.
Hack #3: Win Over the Office Staff
You really should think of the office staff as the heartbeat of the practice. They are the ones that make the office work. While your doctor may have the authority to make treatment decisions for patients, those treatments are facilitated by the staff in the office. If a patient needs an MRI or a referral for therapy, that is done by the office staff in most cases.
As unfair as it may be, I've seen circumstances where disruptive or rude patients get pushed to the end of the pile. We are all humans and have emotions. When someone is rude to you or is cold and demeaning towards you, that affects you. It's hard to want to turn around and do something for a person that has disrespected you.
The same is true in medical offices. If you are rude or disrespectful to the nurse during your visit, they may have a hard time advocating on your behalf. Nurses are in charge of calling patients back who have medical concerns and also in some cases, scheduling therapy visits, and ordering diagnostic tests. A nurse who was wronged by a patient can delay all of these things to a certain degree. Instead of getting started on your treatment right away, the nurse may choose to shove you to the bottom of their pile and get to you in 2 to 3 days. This obviously is less than ideal.
In the same way, the receptionist and those that work at the front desk scheduling appointments and collecting money for co-payments and co-insurance can be affected by disrespectful behavior. In my opinion, the receptionist is your gateway to the entire office. They "unofficially" have the power to squeeze you in for a visit when there is already another patient scheduled in that slot. They answer your phone call and decide whether or not to allow you to speak with the doctor directly when you have a medical concern. Additionally, those last minute cancellations can be forgiven by an office staff member who doesn't charge you the standard cancellation fee.
As you can see, there are multiple things that you need to rely on the office staff for. Treat them with respect from the moment you walk through the door. Greet them by name, shake their hand, and bring small tokens of gratitude like a flower you picked from your garden.
Hack #4: Greet the Doctor
I always find it to be so respectful when I enter a patient's room and they stand to greet me. Even patients in robes have stood up, bare butt and all, just to shake my hand when I entered the room. The first impression that you make on the doctor is important. Don't wait for them to set the tone for the visit. This is your opportunity to start the visit the way you want it to start. Instead of watching the doctor walk in and plant themselves into a chair, stand up and meet them halfway to show them that you are prepared to be as professional as possible.
The most important part of this is to stand up so that you are on the same level as the doctor and make eye contact while you shake their hand. There is something about a doctor coming into a room and hovering over a seated patient that immediately sets a tone of inferiority. Your goal in these first few seconds is to show the doctor that you don't intend to take a back seat.
If you also start the conversation by asking the doctor about how their day has been, you are immediately taking a stance as the dominant person in the conversation. If you were referred by a friend or family member, tell the doctor that and tell them that you've heard good things. This immediately brings the intensity of the initial encounter down to a more comfortable level. The doctor doesn't need to worry about proving themselves and you also motivate them to do a good job with your care so they can uphold their good reputation.
I also strongly believe that patients should find an opportunity to thank the doctor for seeing them and for listening to their medical concerns. However, this is most effective when it is done before any medical issues are discussed. By thanking the doctor ahead of time, you invite them to earn that gratitude and create a sense that they owe you at least that.
Hack #5: Addressing Your Medical Concerns
Before your visit, sit down and write down a short, concise description of your problem, including how long it has been since it started, what treatments have been tried, what makes the problem better, what makes the problem worse, and how the problem impacts your daily functioning.
These five things are all part of the standard history that doctors obtain when seeing a patient for a problem:
- Aggravating Factors
- Alleviating Factors
- Impact on Daily Function.
If you can get this desciption down to no more than a few sentences, you should be good. Once you have a written description about your problem, then jot down your expected goals for the office visit as well as your long term goals for 6-12 months down the road.
Bring the written description and goals with you to quickly reference when you first start talking with the doctor. It is very important to try to get through the description and your goals without pausing, as this invites the doctor to reply or ask further questions. Once you have stated your description and goals, the doctor is likely to ask further questions. You should answer as honestly and concisely as possible.
Hack #6: Be a Consumer
Sometimes, doctors forget to provide a complete service to their patients. In other businesses, consumers expect to be provided with high quality service for their money. In fact, if a consumer isn't satisfied with the service in other businesses, they don't pay for it. In healthcare, this is more complicated. Although you can refuse to return to a doctor who provided incomplete service, you can't opt to not pay them for the initial service, even it was lacking in completeness.
For that reason, you should expect that you will receive a complete service for your time and money. If you feel that the service is incomplete in any way, it's important for that to be expressed before you leave the office. Take a moment after the doctor leaves your room to review your goals and to determine whether the plan going forward is unclear.
If you find that one of your goals have been skipped over, it is very important to voice your concern. However, once the doctor leaves your room, it's not a good idea to run and chase him down or to scream his name down the hall. This will almost always result in the complete opposite response that you deserve.
Instead, go to the receptionist check out area and ask who is the appropriate person to talk to about questions that you have about the visit. A nurse will likely be available to talk to you or the office manager may try to accommodate your request herself. You should start the conversation by saying that you had reviewed your goals with the doctor at the beginning of the visit, but you both had forgotten to get back to the goal or question that remains unanswered.
If you pose it as being entirely the doctor's fault, that may be off-putting to staff trying to help you. Speak about your interaction with the doctor as if it were a business meeting between co-workers. This creates the perception that you both had wanted to address the concerns and goals that you have, but inadvertently forgot to circle back to it at the end of the visit.
Hopefully they will be able to answer your concerns or questions. However, if not, ask them what you should do next. They may be able to come up with a solution for you and, if not, ask to schedule another visit in four weeks to address it.
Finally, ask for a print out of your treatment session. With electronic medical records, there is usually a summary page that can be printed out that provides details about the diagnosis, treatment recommendations, and next follow up visit.
For research purposes: Opinions about healthcare
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2018 Kortney T