The unforgettably positive office visit

Key Points

Nowadays, dermatologists have a lot to gripe about. There are government controls over medicine, hassles with health maintenance organizations, angry patients, malpractice, overflowing schedules and more. But these challenges need not take the joy out of medicine, according to Steven Shama, M.D., M.P.H., a dermatologist in private practice in Brookline, Mass.

"We can either be miserable or stressed in our professional lives, or we can actually look at how to make each day really fulfilling. We have a choice," Dr. Shama says.

Focusing on the problems in medicine today has a cumulative effect on physicians, their staffs and patients.

By improving the environment in the office, physicians not only become more satisfied in their own practices, but patient care tends to improve, according to Tena Brown, who co-presents on the topic of "How to have an Unforgettably Positive Office Visit" with Dr. Shama at physician meetings.

"The more conscious, positive and present the physician is with the patient, the better the outcome for both patient and physician," says Ms. Brown, a psoriasis consultant and patient advocate.

"The patient is more likely to return to the physician for continued care, and the patient is more likely to be compliant with physician instructions.

"The National Psoriasis Foundation has stated that some 60-plus percent of psoriasis patients do not return to their dermatologist to receive the care they desperately need. There are many reasons for this, but the most significant is poor communication between physician and patient," Ms. Brown tells Dermatology Times.

Dr. Shama offers these tips for having that unforgettably positive office visit and workday:

Just shut up and listen

One of the most important things physicians can do when they walk into a patient's room is sit in the presence of that patient and let the patient talk. Then interject with 'Would it be OK if I stop you at this point and took a look at the (patient's source of concern)?'

This kind of exchange sets the tone for a good interaction between physician and patient, Dr. Shama says. It shows interest, empathy and understanding.

Be realistic, set boundaries

Know there is just so much you can do in a day, and have a realistic schedule, Dr. Shama says.

Also, realize that you cannot please everyone. If patients ask more questions than time allows, let them know that you will have to reschedule them for another appointment.

Ideally, have your office staff prepare patients by saying that you will address those issues for which they have made an appointment and will discuss other issues during future appointments.

Anger is not usually directed at you

Dermatologists might be hesitant to set boundaries with patients, for fear that it might make for an angry patient.

"You have to realize the anger is a cry for help. It is not necessarily directed to you. People come in with all kinds of baggage. And you come in with baggage," Dr. Shama says.

'I hope this is OK with you ...'

The "I hope it's OK ..." is asking for permission. When it comes from the heart, it puts the patient at ease.

The 'Snoopy lick' theory

The 'Snoopy lick' theory is basically this: If you want to say something to someone that is going to be perceived as negative, say at least one positive thing about that person first.

Some examples of the positives are: "You look lovely today,"or "You are always such a wonderful person when you come in," Dr. Shama says.

Have the mind of a Martian

If you were a Martian, you would enter the earth without preconceived notions, and this is the way dermatologists should enter patients' rooms.

Rather than profiling patients and anticipating trouble, walk into patient rooms with an air of naivety.

"If you do not come in with preconceived notions about that person, it often works out better, because you come in with an innocence rather than a judgment," Dr. Shama says.

These tips make a big difference in quality interactions from patients' perspectives, according to Ms. Brown:

Make eye contact with the patient and sit at eye level; offer patients your smile; be in the moment with each patient; touch patients - physically and with your words and tonality; offer hope; and be honest with your patients.

Using these simple steps, physicians have told Dr. Shama during workshops that they feel calmer, and that their staffs and patients are happier and more likely to be appreciative and grateful for the doctors' work.

Even the doctors end the day more refreshed, less angry and looking forward to starting over again, Dr. Shama says.