Insights from the Outside: The Clinical Care Examination

Insights from the Outside s a group of practicing clinician-owners. They are a diverse group from many medical specialties, including dentistry, veterinary medicine, cosmetic surgery, ophthalmology, audiology and optometry. Uniquely created by CareCredit, the groups’ purpose is to capture and share “best practices” to some of the common challenges all healthcare business owners face, such as attracting new patients, patient barriers to care, care acceptance, patient retention, social media, team training and empowerment and much more.

This article features ophthalmologist Dr. Ethan Sadri, owner of Atlantis Eyecare, dentist Dr. Howard Ong, owner of Seal Beach Dentistry, and Nola Aronson M.A., CCC-A, owner of Advanced Audiology.

As a healthcare provider, your focus is on identifying health issues and providing solutions. One of the most important stops along the patient journey is the clinical care examination. How do you make this part of the patient journey a positive experience for patients—especially those who may be nervous or skeptical about the need for care?

Dr. Sadri : I think the most important thing is to make the appointment and overall experience relaxed, positive and educational. Most of the patients I see are afraid of losing their eyesight so you can imagine the level of anxiety is extremely high. To address this we really focus on bedside manner and the patient’s mental status. Are they scared? What is their body language saying? After assessing this I’m able to place the patient into one of two buckets—either they’re ready to move forward with care or they’re not.

Ms. Aronson: I agree it’s very important to help the patient feel relaxed. One of the first things I do with patients is just sit and talk and give them an opportunity to tell me in their own words why they came to see us. I tell them a little about myself and then we review what they told the front office on the phone and let them add any additional information that might be helpful. Then I share what we’re going to be covering during the exam.

Dr. Ong: To create a positive patient experience in our practice we focus on training based on our practice care philosophy. So that the message the patient receives is the same. Without our systems and protocols, the journey and the patient experience may be vague and that’s when patient doubts come into play and trust kind of crumbles a bit.

Is there anything you do with the physical environment to help create a positive experience?

Ms. Aronson: I think the biggest way we use the physical environment to help create a positive experience for patients is in our waiting room. It feels like your walking into a comfortable living room. There is coffee, tea, water and snacks of all kinds to help patients relax before their exam.

Dr. Ong: That’s great. We also do what we can to create a comfortable, non-threatening physical environment. But I think what creates a positive experience, ultimately, is how the doctor interacts with the team, and how the team interacts with each other. Patients are always watching us. So a well-orchestrated team will help create a positive experience and instill confidence.

Dr. Sadri : Our physical environment reflects our desire to make the experience relaxed and informative so we have educational videos playing. Once the patient is in the exam room we try not to keep them waiting too long.

Do you have a system or process when it comes to the clinical examination?

Dr. Ong: Absolutely. One process we actually nickname “the handoff” and it’s where we purposefully position the patient between the doctor and the assistant, whether it’s a front office admin person or a chair-side assistant. The goal is to make them feel they’re the center of attention. They can look at either one of us as equals in agreement of care. Once we have acceptance, then the front office or admin walks them through the care in sequence.

Dr. Sadri : We view our system or process in a similar way, in fact we see it as sort of a “well-oiled machine” of technicians and myself.

Ms. Aronson: Well, I’ve been doing this for so long I don’t think I have an exact process — but again I start by educating the patient before testing them. I ask questions and we talk about what they will experience. During the test I talk to the patient over a microphone so that they know I’m there and I’m listening to them. Once testing is complete, I go over the results with the patient and get their feedback.

During the clinical examination do you share information and findings with the patient and if so how do you do it?

Dr. Sadri : In our situation patients often have multiple diagnoses so it’s important to slow down and go one by one. Usually I’ll have an anatomy chart or video and I’ll point to different parts of the eye and explain to them the different disease phase they’re being affected by and why it matters.

Dr. Ong: I agree, We also leverage technology. With our intra-oral cameras and digital X-ray systems the patient can see what we see—so we co-diagnose with them. It’s the classic statement “a picture is worth a thousand words.” When we can show patients what’s normal and what’s not normal the need for care becomes obvious.

Ms. Aronson: During the clinical examination I have a graph and pictures of the sounds the patient can’t hear and I go over the sounds with them and explain how it relates to their life. For example, testing may reveal that patients have what is called a high frequency hearing loss, which doesn’t allow you to hear certain sounds in the English language like unvoiced consonants. Because these sounds are in around 80% of our language — when I show them the graph that has all of the sounds on it they can actually see for themselves which sounds they’re missing.

Are there situations when the patient is resistant to your clinical findings or recommendations?

Ms. Aronson: Of course you have people who don’t want to wear hearing devices. They think that the hearing devices make them old. Luckily in today’s world we have hearing devices that are Bluetooth. And Bluetooth is very accepted, especially among the Baby Boomer generation, which is the generation we’re working with right now. They get really excited when I tell them about all the features and then I put it in their ear and then they can see how small it is and how it doesn’t show and it’s not this big thing that makes them look old—or means they’re getting old.

Dr. Ong: Oftentimes those that resist our recommendations do so because initially they feel nothing hurts. But many times in healthcare not much hurts until it’s too late or the issue is far along. So we try to encourage patients to move forward by drawing on different experiences they may have already experienced with the dental care they have now and how it got there or other scenarios we can show them.

Dr. Sadri : In our specialty resistance to clinical recommendations and findings happen a lot. Patients are afraid. They’re afraid of cost. They’re afraid of getting care. They’re in denial. And you have to recognize that and give them time.

Are there any other reasons patients might be resistant?

Ms. Aronson: Well, usually if you fit the patient with hearing aids and you give them an in-home trial where they don’t feel obligated to have to pay upfront and they have a chance to see how the hearing devices can change their lives they often become less resistant. But price can be a big thing for patients. So we have devices in all price ranges and we offer payment options including the CareCredit credit card and that’s something that’s a very big thing for patients.

How do you create a culture of trust?

Dr. Sadri : I think you have to treat everybody like you would want to be treated yourself. Again the goal is to educate and let the patient know we’re here to help. If they’re not ready, that’s okay. They’ll eventually come back. What we’ve found is when you do it that way, you have a constant flow of patients that trust you and really appreciate the way they’ve been treated.

Dr. Ong: Our philosophy is a culture of relationship building and that only happens if we’re all engaged with each other and also engaged with our patients. So we take time to just want and visit with the patient. It’s important to understand each other’s interests and experiences—before we talk about the clinical diagnosis. I think once you’ve established that engagement, the trust flows naturally. They become a neighbor or a friend and it just rolls from there.

Ms. Aronson: I’m very honest and upfront with patients and I don’t push anything on them. I always say, “Look, I’m here to help you. I’m not here to sell you anything. I’m here to give you a solution to make your life better. That’s all I want from this appointment and that’s what you came to me for and that’s what I need to provide for you.” A lot of times when you give patients an in-home trial they appreciate the fact that I’m loaning them something expensive and I’m not asking them for the money right away. I think they trust more that way, because then they don’t feel so tied in.

When the clinical findings are significant, how do you communicate them to the patient and communicate the urgency of care?

Dr. Ong: Once we communicate what we feel a patient needs, the next step is to kind of bring them along our path or journey to the healthcare choices they require. We call that leading them—leading them to a solution so that they don’t have to experience the issues they’re experiencing now. So it’s important that they understand that we’re offering a solution to end their negative clinical findings or bad experiences.

Ms. Aronson: When the findings are significant I remind the patient of why they sought out help in the first. If they reported having trouble hearing in meetings at work I’ll say, “You told me at the beginning of the exam that you’re having trouble hearing in meetings at work. I can help you with that.” I also talk about the brain and how it’s affected when we are missing sounds and that all of the studies have shown in the last couple of years that you’re more prone to get Alzheimer’s and dementia when you don’t stimulate your brain. So if a patient is missing all of these sounds it could lead to other problems over time.

Dr. Sadri : We also try and explain significant findings in ways that relate to the patients everyday life. For example, if they have bad vision, and it impairs their ability to drive it can create any number of issues. So we talk about how it could impact the safety of themselves, their loved ones and others.

What can derail a clinical examination and discussion?

Dr. Sadri : If the physician is hurried, if the patient is hurried. I find in today’s modern age, everyone is distracted. Emergencies happen. If we’re late, patients can be derailed. Not being able to get in on time derails an exam. Not being able to communicate – sometimes language barriers can be a problem. Thanks to the advent of things like Google Translate and other apps it’s getting better. In fact, recently I scheduled a patient who doesn’t speak English. He’s from Korea. And we went ahead and booked the appointment and we used an application. So there are barriers but you have to overcome them.

Dr. Ong: I think patients want to be recognized and they want to be heard. So being flippant about care or being dismissive can derail things pretty quickly. This goes back to one of the main tenets of our practice — they’re buying us. They’re not buying a crown, they’re not buying a dental implant — they’re buying us. So making them feel unique and seen and heard by me and my team is ultimately going stop any sort of derailment.

Ms. Aronson: I agree, when you’re not actively listening to what the patient is saying and you’re just talking all the time. If you start getting nervous about whether or not you’re going to make the sale. You have to sit back and you have to be willing to be quiet and not talk for a while and let the patient think about what you just said and come back with a response. If they present objections, you need to know how to handle those objections so that the patient is satisfied with the response. If you don’t handle their objections properly, then you’re not going to get the sale.

What is the next step you take when the patient doesn’t own their healthcare need and leaves the practice without scheduling care?

Ms. Aronson: Well, the next step is to call them within 48 hours and try to see if there are any questions you missed or concerns they may have that you can address. Simply asking “Is there something I didn’t answer for you? Is there something that you disagreed with? Can open up a dialogue and uncover concerns that weren’t shared during the exam. So I think the patient follow up is very important.

Dr. Ong: I agree. Our training is to follow up with something like “Can we call you in 30 days or in 60 days and revisit this?” We also have a built-in recall system, meaning patients come back every three, four or six months for their routine hygiene visits. So it’s an opportunity for us to revisit their care because timing is important for patients, too.

Dr. Sadri : This happens, so we address it with patients up-front. “It appears that you’re not understanding or not ready to hear this or you’re afraid. And it’s okay. These are all okay things. And I just want to give you some literature. Go read it. Get another opinion if you need to. We’re happy to see you back when you’re ready because we’d like to participate in your care.”    

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