Brief patient experiences with lasting impact involving 'physician extenders' (medical assistants, office clerks, technicians, etc.) may occur in or on the way to the doctor's office. These encounters are interpersonal in nature and involve everyone from the receptionist to the doctor. They may actually occur on the telephone, still a primary portal to a visit to the doctor or the media for receiving news from tests. Here are some examples of telephone experiences from patients, both positive and negative.
A patient reports that calling her doctor's office is often an ordeal-she waits for someone to answer, then is quickly put on hold without an inquiry as to why she is calling. She rationalizes that the annoyance is minor and assures that her doctor is popular and good so she “hangs in there”. One day she goes to her scheduled appointment, which happens to be the first of the day. She arrives, reports to the window to sign in and observes front desk staff talking to each other. The phone rings as she stands at the window. The clerk lets it ring, then picks it up and immediately says, “There's a call ahead of you. Please hold.” She puts the caller on hold and returns to her conversation. The patient observing is stuck by the lie and wonders how often she has been treated this way and has been inconvenienced. This is a minor event, but perhaps a brick in building a wall of annoyance and mistrust.
Another patient tells an experience which once again reinforces the importance of the telephone and brief interpersonal encounters there. Late in the afternoon, she is put on hold when she has called needing to talk to the doctor. After a long wait on her land line she decides she will call the office on her cell phone to check on the status of her request. Her call reaches the voice mail and the message that the office is closed. They left her on hold and left for the day! Once again this event may be a minor annoyance, but perhaps, more importantly, a breech in trust which was not forgotten by the patient.
A patient reports her experience where for the longest time when she called the doctor's office to talk to the nurse or doctor it was always a complicated affair to get to the person she needed, often having to wait a long time to reach them or sometimes just to make an appointment. She was about ready to change doctors because of her frustration (even though she very much liked her doctor and felt he was very helpful) when one call replied in reaching a new person where the tone was friendly and competent and the contact she needed was efficiently facilitated. She then and there changed her decision to find a new doctor and happily continued with the one she had and liked.
A physician I spoke to about these reports shared with me that a multi-doctor practice that he had been in was failing because of staff / patients relationship problem. Until personnel and policy changes in “customer service” were made, the practice was not going to thrive. What sees brief, small and incidental when it comes to interpersonal encounters can in fact be more important than we realize and in some cases a deal breaker.
Another patient reported that she spoke directly to her physician about the poor telephone skills with the front desk staff. He told her that he knew about the unprofessional behaviors, and that in the future the patient was to leave a message and the doctor would return the call as soon as possible. The doctor would compensate for staff incompetence by being more aware and available to the patient. His is one way to address the problem, but perhaps not the best.
These examples are just a few of the types of accidents patients remember and are motivated to share. By no means are all the reports negative. Most are remarkably brief, spontaneous, and easily misjudged to be unimportant. Patients tell us that nothing can be further from the truth. And the number of patient contacts with the growing variety of staff (physician extenders of all sorts) is larger than one might expect.