Medical Practice Management, Health Information Technology | Community Healthcare

I’ve been sharing an experience over the past several months that my family and I are sharing with a senior member of our family recently diagnosed with vascular cognitive impairment.  It continues to be another step in a journey everyday that can change from one hour to another.  There is only one person who understands what this experience feels like every hour of every day, which is why as a caregiver I spend a significant amount of time listening to her.  It is more than just being attentive, but paying attention to the context of the experience as it happens.  The best way I can describe it is being present in the moment.

For her, remembering recent information has become a challenge.  She uses a small notebook/calender to keep track of conversations, upcoming events with friends, and other appointments.  We shared some time during her recent appointment for an eye exam that represents the typical approach to patient engagement in the clinic.  Its a story that represents both competent medical care an missed opportunities for client care by also being present in the moment.

The check-in process was just what you would expect as described by the medical billing consultant.  Before we sat down the receptionist made copies of the insurance cards and collected the copay for the exam.  So the diligent documentation was now complete, since we had completed the HPI info online a few weeks in advance.  With the mechanical aspect of this patient engagement check-in event complete, it was time for us to take a seat and wait.  We struck up a conversation with another patient who was waiting for the eyedrops to take effect to dilate his eyes.  As we were talking, I tried to include either of the two receptionists who were sitting only a few feet away at crescent shaped desk waiting for the next patient to walk-in.  No sliding window in front of them to act as a shield toward the patients, and yet no interest in interacting us either.

Then stage one of the exam began, and we proceed down the hall for the initial screening and imaging of the eyes.  All goes well and we’re continuing down to the exam room where all the information will finally come together with the doctor.  A bit more of wait in the exam room before the doctor walks in, but that’s how it goes.  The doctor comes into the exam room and begins interpreting the results of that preliminary exam.  He does a great job of translating the medical terminology into layman’s terms and, after conducting his own exam, gives reason to change the script from the current lenses.

Dilation of the eyes was an afterthought to this part of the exam.  Of course there is reason to be thorough so we decided to add this to the visit and go back to the reception area to wait for the dilation to be complete.  After we complete another stop in the exam room with the doctor, we proceed back to the reception desk where we are introduced to the staff member who specializes in the eyeglass sales.  At this point, the duration of our visit in the clinic is nearly 90 minutes.  As the salesperson talks about the features of the current lenses and how those would apply to the cost of new lenses, I ask her how much of the cost would be covered by the patient’s private insurance.  Her response was that she did not know but we could always try to submit a claim later and see what, if anything, is covered.

This patient engagement event lasted about 90 minutes, and yet with the insurance information in hand within the first minute of the visit no one thought that it might be worthwhile to use that information as an advocate to understand out of pocket and covered costs for the patient.  This is the opportunity of real patient engagement that can separate one clinic from another in the community.  The competent and complete exam by the doctor was certainly at the core of this experience.  But in terms of the engagement from the patient’s perspective, this is the minimum expectation for someone seeking this service from a doctor.  The face time with the doctor lasted about 20 minutes.  However, in the remaining 70 minutes worth of time all of us, including the reception/eyeglass staff, were waiting for the doctor.

People who approach the patient experience from either side of the reception area in the clinic know that healthcare costs can be both confusing and intimidating at times.  When the patient experience is defined by those minimum expectations for competent care by a doctor, there is plenty of reason for patients to shop around before that next visit.  This competent care, that in this story represented less than 30 percent of the time in the clinic, can easily be viewed as a commodity by a patient.  Too often, patient engagement is viewed as an event that is limited to the doctor’s time, in this case 30 percent, with the patient.  The remaining time, other people in the clinic who could do something to contribute to this experience are too busy trying to stay out of the way.  Being social in the medical clinic is about recognizing how to appropriately participate in the patient experience.  A great starting point might just be helping those reception staff in the clinic understand that their job has more to do with patient than documenting their current insurance coverage.  A fully engaged staff who can confidently participate appropriately in a social interaction will prove to patients that their engagement is not just an event, but rather a process of inspiration and education with reason to talk again soon and maybe even sell more services.