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MMP Classic: How to Apologize to a Patient

Sincerely Apologizing to Patients

I like to get complaints from patients.

No, I’m not a glutton for punishment. What I like about complaints is that I hear directly from the patient what is bothering them, and I have an opportunity to connect with them personally. The ideal situation is having the opportunity to meet face-to-face with the patient when they are in the office.

Here’s how to apologize to a patient.

Step One: Introduce Yourself

I introduce myself and shake the patient’s hand and the hand of anyone else in the room.

Step Two: Sit Down

I sit down. There are two reasons for that. One is to send the message that they do not need to hurry – this conversation can take as long as they need it to. The second is to place myself physically below the patient. If they are in an exam room sitting on the exam table, I will sit in the chair. If they are sitting in the chair, I will sit on the step to the exam table. The message I am sending is “I do not consider myself to be above you.” It sends a strong message.

Step Three: Let Them Tell Their Story

I say “I understand we have not done a very good job with __________ (returning your calls, giving you an appointment, getting your test results back to you, etc.) Can you tell me about it?” I do not take notes as I want to maintain eye contact and focus on the patient, but I take good mental notes. The patient and/or anyone with them needs to be able to talk as long as they want. They might need to tell their story twice or many times to get to the point where they’ve gotten relief. The patient has to get the problem off their chest before the next part can happen.

Step Four: SINCERELY Apologize

I apologize, saying “I’d like to apologize on behalf of the practice and the staff that this happened. I want you to know this is not the way we intend for _______ to work in the practice.” If anything unusual has been happening, a policy has changed, or new staff have been hired, I let them know by saying “So-and-so has just happened, but that’s not your problem. We know our service has slipped, but we’re hoping we are on the way to getting it fixed.”

Don’t forget that patients can tell if you are not being sincere when you apologize.

Step Five: Answer Questions

Answer any questions the patient has. Why did the policy change? Why can’t I get an appointment when I need one? How will you fix this for me?

Step Six: Close the Meeting

If the patient complaint requires an investigation and resolution, I give the patient a date when I will be back in touch with more information. If the patient complaint does not require any resolution on the patient side, I offer my name again and give them a business card or a way for them to contact me if they have further problems.

Step Seven: Resolve the Situation

I follow-up on the information the patient has given me to find out where the system broke down or where a new system might need to be developed, and if needed, contact the patient with further information and/or resolution.

Although most people prefer not to hear complaints, paying close attention to patient complaints helps a manager to keep a pulse on the practice, know what patients are struggling with, and of course, practice humility. All good stuff.

Photo Credit: CarbonNYC [in SF!] via Compfight cc




There is No Such Thing as a 10-Minute Office Visit

Time is MoneyI will never forget something a patient told me several years ago when I was covering the front desk in a practice I was managing. If you manage a practice and haven’t worked at your check-in and check-out desks recently, I highly recommend it.

An insured patient that I checked out was shocked when I said the charge for her visit was $100. She said, “But he was only in the room for ten minutes!”  I was briefly at a loss for words.  I recovered, we agreed on a payment plan for her co-pay, I made a note on her encounter form for the billing office and she left.

I’ve been thinking about our conversation, and thinking about what that $100 – actually the payer would probably only pay about $35 and with her co-pay, the grand total would be $55 – and what that $55 is supposed to cover…

  1. First, we scheduled the appointment, which was a work-in, so it took several people to take the message, pull the medical record (paper charts), call the patient to assess the problem, determine the need for the appointment and schedule it.
  2. When the patient arrived, we checked to make sure her address and phone were the same, quickly checked her eligibility to make sure the insurance on file was still in force, and asked for a photo ID.  An encounter form was generated at the nurse’s station to notify her of the patient’s arrival.
  3. The nurse called her from the reception area, weighed her, and took her into an exam room to take her vitals, take a brief Chief Complaint and History of Present Illness, review the medications she is taking and check to see if she needed any chronic medication refills while she was there.
  4. The physician came in to see her, asked about any changes since she’d last been seen, reviewed her History of Present Illness and examined her. He talked to her about her illness and described a treatment plan for her upper respiratory infection given her chronic health problems.
  5. He prescribed a medication for her problem, updated her medication list and made a copy for her to take with her.
  6. He marked the encounter form with the level of service and her diagnoses and gave her the form to take to the check-out desk.
  7. He refiled the medication reconciliation in the chart, finished documenting the visit, and placed the chart in the bin to be refiled.  The chart was filed, and the encounter form was sent to the billing office.
  8. At the billing office the charges and any payment was posted and the claim was filed.  If there was no problem with the claim, it electronically passed through two scrubs and a final one at the payer.
  9. If payment was not denied for any of a dozen reasons, the payment would arrive at the billing office and would be posted.
  10. Since the patient did not pay her co-pay at the check-out desk, the patient balance is billed to the patient.  If the patient pays on the very first statement, it has taken the practice from 45 to 60 days to receive the complete payment of $55.

I know that patients often say “But he only spent 10 minutes with me.”  Checking back with the provider, I find it was typically longer.  Patients tend to underestimate the time as it goes very fast.

The total visit encompassed the work of the phone operator, the medical records clerk, the triage nurse, the check-in person, the nurse, the doctor, the check-out person and the biller.  It took 8 people, and at least 45 minutes of work to make that appointment happen.  Plus, that visit had to help pay the expenses for the rent, the utilities, malpractice insurance, medical supplies, computers, phones and janitorial services.

The practice, the patients and the overseers of healthcare want each visit to be non-rationed, safe, high-quality, error-free, holistic, pleasant, clean, accurate, efficient and reimbursable.  It’s what we all want.  And it isn’t cheap.

Even though healthcare and healthcare reimbursement have been sizzling hot topics in the past few years, most patients – already anxious and often sick – do not have a strong grasp of what actually goes into the services they receive. They see very little of the behind-the-scenes efforts. I don’t think the patient visit is necessarily the perfect time to educate patients on what goes into an office visit, but maybe each of us should be prepared to offer a meaningful answer when the patient says “But he only spent 10 minutes with me.”




[Video] – The Manager’s Minute Episode #10 – Identifying Your Patient on the Phone

In Episode #10, Mary Pat discusses the importance of taking a moment and verifying who you are speaking with when you interact with patients on the phone.