Let’s face it—by the time patients visit a neurologist, their lives have been disrupted in some way. The daily routines they have come to depend on have been replaced by pain and other symptoms, medication schedules, doctor visits and questions about the future. There is no doubt that coping with neurological illness can cause a patient to lose his bearings.
But your office can create a refuge from the chaos. If a patient knows exactly what to expect at each visit, they can relax and be a better participant in their own care. Each interaction during every step of the appointment is an opportunity to put the patient at ease with the process.
Make each step of the arrival process uniform. This might even include scripting for a time until all of the staff is comfortable with the routine. Make sure each staff member introduces themselves at every visit. They have the benefit of having the patient’s chart in front of them, but it can be awkward for a patient who feels she should remember a name but doesn’t.
Explain what is happening during each part of the visit. The front desk staff should explain that they are updating information to be sure insurance is billed properly and on time. They should also give the patient an idea of the expected wait time before the nurse calls them back. If there is a delay, let the patient know.
The nurse, in turn, should explain what information she is gathering and why. She should point out the location of the restroom and give an estimate of time until the doctor is able to come in. Again, if there is a delay, let the patient know.
History and Examination
For many doctors the office visit is a single fluid event mastered over years of practice. But for patients it can be confusing. Explaining your routine to the patient can relieve a lot of anxiety about what comes next. In fact, it can help put both the patient and the doctor at ease if you set the agenda at the outset of the visit.
Allowing the patient to remain clothed and seated in a normal chair is a signal that it is time for discussion, not examination. It can help the patient relax and think about her responses to your questions while you set the agenda and take the history.
The move from chair to exam table will signal to the patient that the history is complete and now it is time for the physical exam.
Likewise, moving back to a comfortable chair, is a signal that the exam is complete.
Treatment and Education
There are things you can add to your routine to make the final part of the office visit more successful. Explain that you are ready to discuss a plan going forward and offer the patient a moment to get a pen and pad or recorder so they don’t miss any important instructions. This small addition to your routine can signal to the patient that they need to tune in because you are giving important information now.
This is no small factor. A review of the literature on physician-patient communication showed that “the quality of communication both in the history-taking segment of the visit and during discussion of the management plan was found to influence patient health outcomes.” So there is real value in setting up this portion of the appointment for success.
Be specific about what the patient should do when they leave. Do they need to stop to make an appointment or payment at the desk? Or can they go ahead and leave?
Many of these aspects of your office routine are obvious to you and your staff, but might not be to your patients. Making the process clear from start to finish puts your patient at ease and helps relieve any anxiety he might have about the appointment. In the end these small steps can save you time that might be lost because of confusion or misunderstanding on the part of the patient.
Most importantly, they help engage patients in their appointments and put them in the best position to understand and implement your advice moving forward.