first contact


Q10.08.13 first contact

A cautionary tale for those of you in the business of providing patient care.

I work from a home office. (Others in my house refer to my home office as “the kitchen.”) It’s in close proximity to the den, which is where Cara sat yesterday trying to schedule an appointment with a dermatologist. This is what I heard:

Cara: Hi, my name’s Cara McGill. I’m a new patient who was referred by [a friend]. I’d like to schedule an appointment for a baseline screening.

. . . 

Cara: Doctor [name].

. . . [5 minutes of silence]

Cara: Is this for October or November?

. . .

Cara: Ok, how long does a full body scan appointment take?

. . .

Cara: Wait, 15 minutes isn’t enough for a body scan.

. . . 

Cara: So what is this 15 minutes for?

. . .

Cara: Ok. How long will I be there? Because I have to pick up my kids from school.

. . .

Cara: So I’ll be seen at 1:15?

. . . [5 minutes of silence]

At this point, Cara walked into the kitchen, her face a combination of dismay and incredulity. She replayed the conversation described above, filling in the blanks (all while still on hold):

Physician’s Staff #1: Hello, Dr. [name] office, please hold. [4 minutes of silence]

Physician’s Staff #1: Hello?

Cara: Hi, my name’s Cara McGill. I’m a new patient who was referred by [a friend]. I’d like to schedule an appointment for a baseline screening.

Physician’s Staff #1: Which doctor?

Cara: Doctor [name].

Physician’s Staff #1: Hold on. [Followed by 5 minutes of silence.] The 15th at 1:15.

Cara: Is this for October or November?

Physician’s Staff #1: 15th of October. It’s a new patient appointment

Cara: Ok, how long does a full body scan appointment take?

Physician’s Staff #1:  Oh, no, you have to come in early and fill out all the paperwork. It’s a 15 minute slot, but plan on being here for a while.

Cara: Wait, 15 minutes isn’t enough for a body scan.

Physician’s Staff #1: Hold on. [muffled discussion in the background between Staff #1 and Staff #2 about Cara]

Physician’s Staff #2: This isn’t a full body scan appointment. This is only a new patient appointment. We’re booking in January for full body scans.

Cara: So what is this 15 minutes for?

Physician’s Staff #2: Well, we slot 15 minutes for new patients or people who have something wrong with them.

Cara: Ok. How long will I be there? Because I have to pick up my kids from school.

Physician’s Staff #2: You’ll be here awhile. You have to fill out paperwork. But it’s not a full body scan. The lady was mistaken. You have to come out early to fill out the paperwork.

Cara: So I’ll be seen at 1:15?

Physician’s Staff #2: [Sighs, exasperated.] Just wait one second. [5 minutes of silence]

After reciting this full history – still on hold, mind you – Cara made several cogent observations to me: (1) if she sat on hold for 5 minutes immediately after identifying herself as a potential new patient – also known as “new business/revenue” for the physician – how likely was it that she’d be treated like a human being upon arriving there in person? (2) after putting someone on hold for 5 minutes, is jumping back on the line with “The 15th at 1:15” the best way to communicate? And should you sigh in exasperation when the prospective revenue stream asks for clarification about which month those words apply to? And (3) “Why am I waiting on hold for these people? On principle I should just hang up!”

A look of epiphany suddenly spread across my wife’s face. She triumphantly pulled the phone away from her ear, held it at arm’s length from her body, staring at it with a combined look of menace and glee, and clicked the “Off” button.

Unfortunately, different variations of this conversation repeated itself as Cara called other doctor’s offices through the afternoon. When she finally did schedule her appointment, the staff advised her to be prepared to wait for a good hour after the scheduled appointment time before seeing the doctor. When she asked if would then make more sense to simply come in an hour later, she was told, “No. You have to be here on time.” I commented that this reminded me of the Seinfeld episode where Jerry attempts to pick up the rental car he reserved. (“See, you know how to take the reservation. You just don’t know how to hold the reservation.”)

Dermatologist #1 may be the most talented and nicest dermatologist in the United States – indeed, she came highly recommended to Cara through multiple referrals – but her staff cost her a patient. The people who speak with patients are an extension of the medical professional. They represent that person. Presumably a doctor or prosthetist wouldn’t let an incompetent doofus present the findings of her clinical research at a medical conference because it would reflect badly on her. But yet, every day, multiple times an hour, health care professionals let incompetent doofuses represent them in dealings with the lifeblood of their business – the patient.

Everyone’s busy. Everyone’s overwhelmed. Everyone’s under pressure. As patients, we get that. We’ll even cut your staff a break, often more than once. But how hard would it have been for the conversation with Cara and the doctor’s office to have gone this way?

Cara: Hi, my name’s Cara McGill. I’m a new patient who was referred by [a friend]. I’d like to schedule an appointment for a baseline screening.

Physician’s Staff #1: Thanks so much for calling! It means a lot to us when we get referrals from our own patients. Which doctor did [name] refer you to?

Cara: Doctor [name].

Physician’s Staff #1: Great. Now, let me explain that our appointments for baseline screenings are lengthy, and as a result, we don’t have many openings for them in the immediate future. However, I can slide you in more quickly to address any specific areas you’re worried about. While that won’t be a full scan, we can address your most serious concerns right now and then schedule a more complete full body scan after that. Would the 15th of October work for you?

Cara: Well, how long does a full body scan appointment take?

Physician’s Staff:  A full body scan appointment usually lasts for more than an hour if we’re going to be complete. For the proposed appointment, however, it would be much quicker. Oh, and that reminds me, we’ll need you to fill out the necessary paperwork before you’re seen. If you’d like I can email you our intake form and you can bring it here with you to the appointment.

Cara: Ok. How long will I be there? Because I have to pick up my kids from school.

Physician’s Staff #2: We try to stick as close as we can to the schedule, but sometimes we do run late. Depending on what time your kids need to get picked up, we might be better off looking for another slot earlier in the day to make sure you don’t get caught in a time crunch.

If you’re a really slow reader, this version of the conversation probably still took you less than a minute. If you were on the phone actually having the discussion, it would only take half that long.

In contrast, Cara sat on hold for 4 minutes before even getting the chance to introduce herself, sat on hold for another 5 minutes while the staff person attempted to find an open appointment slot, and then got placed on hold a third time for another 5-7 minutes when she asked the challenging question, “Will I be seen at the scheduled appointment time?” Thirty seconds versus (conservatively) 17 minutes?

There’s a lot about health care that’s broken that we can’t easily fix. But we can fix this.

Doctors, physical therapists, prosthetists – your patients are your customers. Treat them like customers. Train your staff. I promise, nothing bad will happen.

One thought on “first contact

  1. Funny Dave, I wrote about something similar last week. The inability to cultivate the customer relationship seems to be epidemic.

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