This blog post is a continuation from the email we sent out on 12/23/09. The whole email is here, if you wish to read it ALL over again, feel free to do so. If you want to continue where it left off in the email, scroll to to where it says “************************** START HERE **************************”.

I hope you enjoy it. Please feel free to leave any feedback and comments.

Happy holidays!

From all of us here, we wish you a happy, merry and wonderful holiday season.

We want to thank you for supporting us through the years and giving us a great reason to continue developing new and super cool marketing and patient education materials for the acupuncture profession.

Thank you!

I plan on taking a little time off over the next week or so to relax, play and finish an inspiring book, Point for Profit. I wanted to share with you a blurb from it.

It’s loaded with very practical clinic information.

Every chapter is a goldmine in and of itself!

I really wanted to share some of this with you, so I called Honora Wolfe, one of the authors, to see if she would be willing to let me share a blurb with you folks.

Honora made my day when she said I could use the text from Chapter 11.

Yay!

It’s so dense with information that there is way too much to put in the body of this email, so I linked the rest to our blog.

Enjoy the clinical pearls of chapter 11 that this book has to offer. If you like what you read here, remember, we are having our annual 20% EVERYTHING SALE, so, you can save a pretty penny or two, and certainly glean a few great practice growing nuggets.

Here is the excerpt from her Points for Profit book:

Chapter 11 – Patient Management, or, How Do You Keep Them Coming Back Happy?

Communication and confidence are the most important tools you can have when it comes to patient management, but there is quite a bit more to consider here. This aspect of running your clinic is, possibly, the most important function you undertake, second only to managing your finances. Oftentimes, you will find that getting new patients is easier than maintaining them and keeping them on your active roster for years to come. When you can do this, however, you will also be welcoming their referrals to your clinic on a regular basis. We wish there were magic bullets for this skill. There are not. Like most things in life, it is a group of co-factors that make you successful at managing your patients’ feelings about you and their interactions with your clinic. In Chapter 6, we discussed the importance of the look and feel of your clinic. In addition to these relatively subconscious responses, there are many other aspects of clinic interaction where you may “guide” your patients’ feelings into the most positive zone possible.

Initial responses

Remember that patient management begins before the person walks through your door. It starts with the first phone contact, how prospective patient questions are answered by your front desk staff, what it’s like to find a parking space near your office, even the response to your brochure that they picked up at the health food store. Assuming you have done a good job with all these preliminary pieces, the next part of your work in this area includes the appearance of your clinic and lobby, the professionalism of your front desk staff, and even the quality and appearance of your initial paperwork. These things can have that potential life-long patient thinking either that you are a good addition to their medical toolbox or that you are a quack. Since keeping patients is essential to the survival of your clinic, you need to think about these initial prospective patient interactions that will happen long before they’ve seen the inside of your treatment room or experienced the insertion of a needle.

Close encounters of the telephone kind

Whether referred by a business colleague, a free lecture at the library, or a business card picked up at the climbing gym, most of the time people’s initial contact with your clinic will be on the telephone. Whether you are the one handling phone communications or you have a front desk staff, this contact needs to be scripted, at least to some extent. You can write down several ways that your phone could be answered and allow your front desk person(s) to choose the option they like best. Whatever you have them say, it is most important that:

They (or you) don’t mumble or speak too quickly. This is a very common problem with Asian receptionists speaking in English because Chinese and other Asian languages are spoken at a much faster tempo than English. This can be a difficult issue for Chinese coming to the U.S. to understand and is a common experience with Chinese product suppliers (i.e., you-call-them-but-you-are-not-sure-what-company you- called-because-the-person-answering-the-phone-speaks too- quickly-to-be-understood.)

They sound upbeat and helpful, not bored, preoccupied, or surly.

There is actually someone to answer the phone during normal clinic hours, such as 8-to-4 or 9-to-5. Would you expect any doctor’s office to have only an answering machine with music in the background that says, “I’ll get back in touch with you within one working day”? If we wish to be perceived as professional medical care providers, we have to act, at least in some ways, like other care providers in our culture. That means having normal business phone hours during which people can reach a real person, even if that person is not you.

They have some scripted answers to commonly asked questions so that they sound competent and professional.

They have some idea what to do with people calling about a problem or complaint.

They know approximately how long various procedures require, what initial paperwork needs to be completed and signed, and if there are any other information you need from a new patient prior to their first visit.

When writing these short scripts to answer these and other questions, remember that you want each answer given by your front desk person speaking to a prospective patient to lead to: “We could see you at 2 PM on Friday or at 10 AM on Monday. Would either of those work for you?”

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Forms and paperwork

Your new patient has just arrived, grabs a clipboard stuffed with paper and sits in your comfortable lobby to read, check, circle, and sign. Everyone in this country who has ever seen a medical practitioner in their life is used to going through this process. Don’t apologize for it and don’t cheapen it with homemade-looking forms that leave large gaps in a necessary medical history. As well as gathering information from your patient, this process is designed to tell your patient how you do business, how their account with you is to be handled, what your rates are, and any other information that you wish to give them. An informed patient is a keeper. Remember that people don’t like to feel confused.

Forms you need for an initial exam and visit:

• Patient information – Name, address, phone number, email, emergency contact, etc. How do you get in touch with this patient? What do they prefer to be called? Who referred them?
• Health history – Chief complaint, secondary and other more minor complaints, medical history, prescription drug and supplement use, last medical exam and reason, recent surgeries. This form is designed to flesh out why the person is there, what they have done about it in the past, gives you a social and family history, and points to any communicable or life-threatening disease or disorder they may suffer concomitantly.
• Financial policies – What you offer, how much it costs, and accepted forms of payment. If you have a sliding scale, describe the process here and how they must prove hardship if requesting lower fees. If you bill insurance yet want patients to know they are responsible for any unpaid balance, tell them here. If you offer a payment at time of services discount, describe it in detail here. It is very important that you have people sign this page signifying they understand your policies. Some clinics take an imprint of a credit card in the case of non-payment; if this is your policy, describe it here. The more you tell people on this form, the less difficulty you will have in getting paid later.
• Office policies – Do you have observers or interns from the local acupuncture college? Do you have a required cancellation window of 24 hours, or 12? How should changes in appointments be handled and with what notice?
• Privacy policy – If you are abiding by HIPAA rules, you are required to tell patients how you will protect and use their Personal Health Information. Please see Section 2, Chapter 9 for more details on this.
• Insurance form – If the patient presents you with an insurance card, make a copy of it and then present them with a form designed to gather all of the necessary information for you to bill said insurance company. Make sure to include information such as the insured’s name, date of birth, address, and Social Security number. Do you accept assignment of benefits? Even if you are compliant with HIPAA, add a release of information block so that there is no misunderstanding that you will share information with the insurance company.
• Consent to treatment – If you do not have malpractice insurance that requires the use of a certain form, make one up. Consent to Treatment form is designed to tell people what the risks associated with your services are: acupuncture, herbs, tuina, cupping, gua sha, moxibustion, and the like. This is not to try and scare people. However, if you list that a possible side-effect of acupuncture is bruising, and they read and signed the form telling them this, then they will be less likely to be upset about getting a bruise.
• Arbitration agreement – Although a touchy subject, some malpractice companies will cut you a break on pricing if you have patients sign an arbitration agreement. This form waives the patient’s right to a jury trial, saying that they can sue you if they want, but they will arbitrate instead of going to trial. More and more professionals are using this type of form, including medical practitioners and even real estate brokers. The more information you give to your patient, the less reason they have to claim ignorance or, worse, to be ignorant. Tell your patients up front everything about how you expect the exchange of your services for their green qi is to take place. Tell them their information with you is safe. Tell them, without saying it, that you are a well-trained medical professional.

Intakes that WOW

Your initial intake is like a first date. This is where you can possibly make up for the cramped lobby and poor lighting conditions in the bathroom. You have a chance here to really impress this person who has possibly never had an acupuncture experience. Dimes to dollars, however, they have seen a doctor at some point in their life. It is for this reason that doing an intake that WOW’s , something that really knocks their socks off, is crucial. Being that we are performing a medical service, we all know that asking all about the chief complaint is one of the first steps in this process. Next, the nature of our medicine stipulates that some of the questions we ask are those that no person has ever had asked of them before, unless they are suffering from some sort of bowel or sexual disorder. Just by this alone, we are already spending more time face-to-face with our patients than most physicians spend in a day with all of their patients combined – a definite plus.

Take their blood pressure. Obviously, in some cases, this is called for (such as headaches and dizziness). But take it on the first visit no matter what. (In some states this is a requirement before every treatment.) This is also a great tie-in to what patients are used to from their previous life in the Western medical system. Does the blood pressure fit into your Chinese medical diagnosis? Probably not. Does it convey a sense of professionalism and show that your medical techniques have some feeling of being grounded in a reality they are comfortable with? Definitely. A thorough exam on a patient’s first visit to your office will go a long way into wowing them back again. You may also consider weighing them and doing a simple urinalysis to check for sugar content if you feel comfort a b l e with that.

Let the patient talk, but control the flow of the conversation. When you begin your intake, you may start with some open ended questions that allow you to get some general information, some of which the patient does not even know they are giving (such as general energy level, tone and strength of voice, and body language). Then, as you whittle your choices of pattern discrimination down, ask more “yes/no” questions that leave little room for explanation but give you the specifics you need (“Is the nasal mucus clear and thin or yellow and thick?”). If and when the patient veers off course into some story about their brother George who choked on a hamburger at the family reunion last summer, pull them back gently to the process at hand. Remind them again of the question you require an answer for and give them another chance.

Be an active listener. Don’t just stare at your chart and make notes as they talk. Make eye contact and look as though you are listening as well as actually hearing them. Repeat their statements to them when you are looking for confirmation. Patients really appreciate knowing that you have heard them. “So, Mr. Johnson, you’re complaining of left lower quadrant abdominal pain that eases once you have a bowel movement. Is that correct?” Once the intake is over, you have another chance to really shine.

Explain your actions. That’s something that you rarely get in a doctor’s office. What are you doing and why? Why do you need to touch me there? My pain is over here. Why are you looking at my tongue? What do you feel when you take my pulse? By telling your patient what you are looking for during a physical exam or what you are trying to accomplish with your treatment, you give them more power over their own body. Remember, we like smart patients, and most patients like to feel that they are participants, not passive receivers of care. The more you tell them, the more educated about their own body and health they become only make your job easier.

Allow the patient to ask questions. While you may want to control the flow of the intake, allow your patients the opportunity to fulfill their need to acquire information about what it is you think is going on, what you think you can do about it, and how many needles you are going to stick into them. Again, knowledge is power. Answer whatever questions you feel comfortable with, especially about the needles. It seems everyone has a question about those. Keep your metaphors as simple and straightforward as possible. It is easy for people to understand analogies from the natural world, but Chinese or quasi-spiritual jargon may turn them off or scare them away. Finally, be sure to explain to your patient what side effects they can expect after the treatment and then give them some treatment options from which to choose. Some practitioners prefer to simply tell people to come back X number of times in the next X number of weeks, but it can work better to give the patient the option to choose from a couple of treatment plans. Another form you may want to use is a written assessment of the patient’s condition and how you think you can help. List a few treatment options such as “band-aid,” “good,” and “best.” Who in their right mind doesn’t go for the best treatment plan when it comes to their health?

Communication

Most of the section above has a common thread— communication. Talk to you patients about everything you are doing. Let them know where you think you can make a difference and even let them know when you’ve made a mistake. If you really botch something up, take care of the problem and see it through to satisfactory resolution. Don’t let someone walk out your door angry, upset, or frustrated. It may come back to haunt you in court.

I [ES] have a perfect example of this. I know an acupuncturist (who shall remain unnamed) who was doing some cupping on a brand-spanking new patient. The patient had read his forms and disclaimers and signed all of his paperwork, but what happened was not covered on that form. He lit the patient’s inordinate amount of back hair (slathered in Tiger Balm) on fire. Not just a little singe of hair – three foot flames licking him in the face. The practitioner and the student observer from the acupuncture school quickly extinguished the flames. The patient was not harmed, but it was more excitement than any practitioner really wants! After the treatment was over, the practitioner explained what went wrong but did not apologize. The patient rescheduled for the next week. He was fine and his back pain was much better even if his back hair is a little less thick.

This situation could have been a nightmare. In fact, when I first heard of the encounter, I got out my Rolodex of attorneys to give him a referral. However, after speaking with the practitioner and getting a good feel for how the situation was dealt with, I felt relieved. It also helped the next week when our hapless practitioner put a fire extinguisher in the treatment room just as that patient was arriving. Laughter is the best medicine, you know!

Getting the second appointment

It is important to remember that most patients need several appointments to get well. When you read Chinese journal articles, you virtually never see a protocol that was successfully completed in only one treatment. Most of us will, rightly, suggest a plan involving 4–8 treatments for an initial course of treatment. It is up to you to help your patient follow through with this plan. Advise the patient that you really believe you can help them (unless you don’t believe you can) but that, to restore the dynamic balance in their body, they will require a course of therapy that is sensible and manageable. Make them aware that they can get appointment times more suitable to their schedule if they make them in advance. Some practitioners sell an appointment “package” at slightly reduced pricing. While it is technically illegal to do this in some states, it works well to motivate patients to come in for a series of treatments. Check with a lawyer or your state board about this type of practice before you leap into territory that may be illegal. Secondly, you should simply assume that patients will be coming in for a series of appointments because that is what they need to get well. Explain to each patient that this is how acupuncture works and that they can expect improvement in their problem only with several treatments. Otherwise, you are probably short-changing yourself and your medicine and not meeting your patients’ needs either. If you have internal questions about whether a patient will ever come back to see you again, your patients will subconsciously pick up on this lack of confidence and you probably won’t see them again. Don’t even go there in your mind. Either take courses to improve your Oriental medical skills (and thereby your confidence in yourself ) or find a mantra or affirmation to help yourself get past this imaginary monster in the closet.

As a course of treatment is coming to an end, you should have a short consultation, either on the phone or, better, in person, to decide whether treatment is completed or, if not, how much and in what way it will continue. While it is important not to string people along unnecessarily, it does not serve a patient to give them fewer treatments than they need. If you have done 10 or more acupuncture treatments, it may be useful to let the patient rest for 2–3 weeks before continuing therapy.

If you are largely an herbal practitioner, you should explain initially to your patient that you are giving them a one week supply of medicine after which time they will need to come in for a short appointment for you to take their pulse, ask a few questions, and adjust their formula. After that, they can call in to have their formula refilled for up to one month without a revisit, unless there is some problem or change in their situation that arises. You may have to change these parameters depending upon what type of patient you are treating or the nature of their problem (for example, infertility patients may need a different formula each of the four weeks of the menstrual cycle). If you are doing largely herbal medicine, it is assumed that you are managing many patients and that a goodly portion of your income is coming from filling your patients’ prescriptions. Another pointer for the largely herbal practitioner is the issue of dosage. Just as acupuncture usually requires adequate numbers of treatments closely enough spaced to have the needed effect, herbal medicine requires adequate doses to do what it is meant to do. I [HW] can’t tell you how often I have seen patients who were properly diagnosed and the proper medicine prescribed but treated with such low doses that they came to believe that, “Chinese herbs don’t work.” This is useless for the patient and even worse for our profession as a whole. Think carefully about how much medicine a patient would be getting with a standard decocted formula in China. If you are not doing bulk herb decoctions, take a look at the type of medicine you are giving the patient (whether pills, powders, tinctures) and the concentration ratio of that medicine. If you don’t know the concentration ratios from the bottle, call your supplier and find out. While powders or pills may be easier for your patients, you need to make sure you are getting something close to a daily dose that would match the standards of care in China down your patient’s throat. Otherwise they may be wasting their money and not getting better. This will do nothing for your reputation or the reputation of our medicine. This is especially t rue in the case of acute or serious disorders. So re m e m b e r, good patient management with Chinese herbs means giving the right dose.

What to do about the disappearing patient

If a patient comes in once or twice and then never makes another appointment or does not show up for one that is already scheduled, it may be that you “cured” them in one or two sessions, but it is more likely that something in your newpatient procedure needs improvement. You must try to reach that patient and learn from them what you could be doing better. This may be difficult in that they may be embarrassed to tell you what was wrong with their experience or they may not really be able to articulate it. They may not return your messages or, if they do, you may not get honest answers to your questions. However, if you can get them on the phone, we suggest the following approach that may disarm them enough to actually try and tell you about their experience of your clinic and your care. Hopefully, you already did a standard bonding call with the patient. So you know how they seem to have responded to the first visit to your office. If not, this may be the first thing you need to add to your procedures.

In any case, first ask them how they are doing. Ask them if they would like to reschedule or if they have any questions about your exam or treatment. Tell them you are sorry if their experience was not everything they expected it to be and that you’d be happy to assist them in finding another practitioner or another type of service to solve their health problem. That should disarm any “armor” to some extent. Explain to them that, as a health care practitioner, it is your responsibility to close their file with some “release from care” and you need to know that they are better or have determined another way to manage their problem. Depending upon how they respond to this, ask them if they have any advice about what you or your clinic staff could have done better or differently that would have allowed them to make the decision to return for further treatment. Thank them for trying Oriental medical or acupuncture.

This entry was posted on Wednesday, December 23rd, 2009 at 10:52 am and is filed under News. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.