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Fulfilling patients’ expectations regarding cosmetic procedure outcomes can sometimes prove to be challenging. According to one physician, using two simple mnemonics can be instrumental in satisfying patients, and for diffusing potentially uncomfortable scenarios if expectations are not met.
Waikoloa, Hawaii - Fulfilling patients’ expectations regarding cosmetic procedure outcomes can sometimes prove to be challenging. According to one physician, using two simple mnemonics can be instrumental in satisfying patients, and for diffusing potentially uncomfortable scenarios if expectations are not met.
“In order to keep patients happy, the physician must either meet or exceed their expectations. However, some patients may have unrealistic expectations and therefore it is paramount for the physician to clearly establish, together with the patient, the achievable goals of treatment,” says Howard K. Steinman, M.D., DermOne Skin Cancer & Surgery Center, Irving, Texas. He spoke at the 38th annual Hawaii Dermatology Seminar in Waikoloa, Hawaii. “This approach will help to keep patient satisfaction level high and leave little room for post-procedure surprises.”
Beyond the prerequisite of fulfilling expectations, Dr. Steinman says keeping patients happy also requires knowledge, judgment, technical skills, diagnostic skills, interpersonal skills, favorable billing, and an effective and efficient staff and office.
In order to help ensure that each patient receives the highest level of care and treatment, Dr. Steinman says he often will use AIDET, a mnemonic that stands for Acknowledge, Introduce, Duration, Explanation, and Thank You.
“This is a practical evidence-based method that is increasingly being taught at many medical centers and lectured on in many major hospital groups, and is used for effectively communicating with patients, families and staff. Ultimately, it serves as an important template for providing overall excellent customer service,” Dr. Steinman says.
The AIDET mnemonic is a kind of scaffold for proper bedside manner, he says, and its use can help decrease patient anxiety and increase patient compliance - both of which can help lead to improved clinical outcomes and increased patient satisfaction.
Following AIDET, physicians should always clearly acknowledge the patient’s presence - as well as anyone accompanying the patient - upon entering the examination room, using eye contact and a smile. Physicians should introduce themselves and describe their role, background and experience.
The physician should also be very clear on the expected duration of a procedure and common time frame estimates, such when the results could be expected, how long until resolution of a given condition, or how long until the patient can resume normal activities. The physician needs to listen to the patient and explain each step of the procedure, and try to identify any areas of concern that the patient may have before the commencement of treatment.
According to Dr. Steinman, keeping the patient informed along every step of the way before, during and after a procedure is equally essential, and can help to calm those patients who may be apprehensive regarding the office visit and/or procedure performed. At the end of the visit, the physician should always thank the patient for their trust and the opportunity to provide care for them.
“AIDET can help prevent the patient from being unhappy, because unhappiness nearly always comes from unmet expectations,” he says. “If you continually let people know what to expect on all different levels of patient care, then they are going to be ‘happy’ and satisfied because their expectations have been met.”
In contrast, Dr. Steinman said that the BLAST (Believe, Listen, Apologize, Satisfy, Thank) mnemonic can be extremely useful when treatments, procedures and outcomes do not go as expected or intended. The brainchild of Albert Barneto, a consultant to the restaurant industry, BLAST was originally developed to train cashiers and young receptionists at restaurants to help them better deal with unhappy customers, and retain them as customers. In the medical arena, the technique can help physicians and their staff much better manage uncomfortable scenarios in which the patient is unhappy regarding treatment and outcomes.
“For the past three years, we have incorporated the BLAST technique in my practice - training residents, dermatologists and office staff - and have found the technique to work very well. ‘BLASTing’ patients only takes about five minutes or so, in which time you can build, repair and maintain a good relationship with dissatisfied patients,” Dr. Steinman says.
All aspects of the BLAST mnemonic are critical in diffusing an uncomfortable situation and soothing the unhappy patient however, Dr. Steinman says the belief that the physician should show in the patient’s expressed concerns regarding their problem is perhaps the most crucial aspect of the mnemonic and the cornerstone of the “healing” process.
“Many physicians may want to avoid dealing with unhappy patients. The BLAST mnemonic is a human relations technique that provides structure, confidence and effectiveness to an uncomfortable situation/conversation,” he says.
According to Dr. Steinman, it is crucial that the physician sit down with patients and evoke belief in what they are expressing about their dissatisfaction or grievances regarding outcomes, regardless of whether they are exaggerating, lying, incorrect, or acting overly emotional or irrational.
“It is important to remember that an unhappy patient believes that you have harmed or wronged them, and physicians must refrain from trivializing the patient’s feelings,” Dr. Steinman says. “Expressing belief in their worry and disappointment will convey understanding, support and empathy. This, in turn engenders trust, and trust will eliminate adversarial feelings and any need to argue.”
Actively listening to the patient (the “L” in BLAST) will not only prevent facial expressions and postures of disbelief, but will allow time for the patient to vent his or her frustrations. Here, the physician must remain calm and relaxed, maintain eye contact, and be attentive to the patient’s concerns, while offering expressions of understanding and agreement.
After carefully listening to the patient’s grievances, Dr. Steinman says the physician can then clarify and repeat back to the patient his or her concerns without trying to defend or justify - as the patient is in search of solutions, not excuses. The physician should listen and clarify (i.e. actively listen) more than once to convince the patient they understand their concerns.
The physician should then apologize (the “A” in BLAST) for what the patient is experiencing and for their unmet expectations, even if the physician did not do anything wrong. Apologizing is not an acceptance of responsibility, Dr. Steinman says, but merely a gesture conveying empathy and understanding.
“The apology is the avenue for explaining without appearing defensive or accusatory. Although it may seem counterintuitive and unwise, a sincere apology will help diffuse fear, frustration and anger that the patient may be feeling. It also builds trust and strengthens relationships, and mitigates the likelihood of litigation,” Dr. Steinman says.
The physician must then try to satisfy the patient (the “S” in BLAST) by offering two or three solutions that are convenient and amenable to the patient, and finish off by thanking the patient for giving them a second chance, presenting an opportunity to maintain a good reputation.
“When dealing with upset patients, we often become anxious, defensive or angry. BLAST is a very effective technique for diffusing, redirecting and correcting these situations, while keeping you calm and in control,” Dr. Steinman says. “It creates a harmony in the room within a few minutes, and transforms a bad situation into an advantage and an opportunity to fix it for both parties.”
Disclosures: Dr. Steinman reports no relevant financial interests.