The Importance of a Timely Note

Lou Holtz Coached At Notre Dame

In my medical practice, I’ve used note writing extensively, to communicate with patients, with families of patients and with referring physicians.  And yet, when I received a note, which is not related to patient care, it is always a little surprising and uplifting, and emphasizes why note writing (and note receiving) is so appealing.

In this Internet age and the age of information, we are bombarded with electronically conveyed messages, television and radio broadcast, faxes and even computerized bulletin boards.  There’s a generation of young people that do nothing but text each other and seldom make use of the phone or face-to-face interactions with peers and friends.  A hand written note is now a rather novel, and therefore, powerful method of communication.  It tells the recipient that you thought about them following your face-to-face or telephone encounter.  A note tells the person you value them and allows you to reinforce the points discuss during your encounter.  Let me give you an example.

Several years ago I had the pleasure of a five-minute meeting with Lou Holtz, who at the time was the head football coach at Notre Dame.  One week after meeting the famous coach, I received a personal note from him, acknowledging our meeting and highlighting several points we had discussed, including our mutual interest in motivating others to reach their full potential.

I called Coach Holtz and asked him how he was able, with his busy schedule, to not only find time to write such a personal note, but to remember details from our brief conversation.  During our subsequent conversation, Coach Holtz revealed some of his note writing secrets, and illustrated how notes can have a similar empowering impact on people in your life.  We covered the following points:

To whom should you write?  Coach Holtz suggests writing to anyone to whom you want to express thanks, appreciation, congratulations or acknowledgment. Coach Holtz writes his barber or a waitress if he is receiving good service.  If someone goes the “extra mile” for Coach Holtz or his family, that person receives a personal note.  Coach Holtz is so committed to note writing that he encouraged his coaching staff and all his players to write at least one note a day.

How do you remember to whom you will write?  The best way to remember seems to be to write yourself a note!  I use a cell phone and a free app, Dragon Dictate, to record notes and reminders to whom I will write.  When you write or dictate the names of people to write, you can also record a key word(s) that will jog your memory later about your conversation.

How long showed your no be?  According to Coach Holtz the shorter, the better.  The person to whom you are writing may be overwhelmed with junk mail, faxes and letters that must be read and respond to.  If you’re note is short, you can be sure that your note will be read.  A long letter may be skimmed over, as the reader feels pressed to get on to other tasks.  A concise note delivered in a timely fashion is better than a longer note that takes days or weeks to arrive.

In addition, Coach Holtz recommends brevity and relevance.  Don’t ramble.  Be personal and sincere.  The best style is a simple, conversational manner.  Unless you are generally a formal person, avoid formalities such as “I’ve acknowledge the delivery of your parcel” or “It was indeed a pleasure to have made your acquaintance.”

What should the content of your note include?  You want to immediately grasp the attention of your reader.  Coach Holtz suggests that the first sentence give the reason for your note.  He usually begins his notes by simply stating, “The purpose of this note is…” or “I just wanted to say thank you for…” and then give the specific reason he’s writing.  You might not begin a note this way, but Coach Holtz is a direct and honest man, and his opening fits his personality.  When you write a note of appreciation or thanks, you’ll want to do it any style that’s yours and with which you are comfortable.

Why is timing important?  As with all forms of communication, promptness is important.  The sooner your note is on the desk or in the hands of the person to whom you written, the greater is its impact.  Think of the difference between and note arriving 1- 2 days after you communicated with someone, and a note arriving weeks or months later.  If you’re serious about incorporating note writing into your business or into your personal life, you will have to prioritize and organize your day’s activities to make time for it.

Why are timely note so important in building your network?  Social psychologists report that written communication is one of the best ways to enhance a relationship.  Everyone enjoys receiving mail, and the thoughts enclosed in a timely, appreciative note can be read and savored her for a long time.  My encounter with Coach Holtz underscored for me why so many business people and professionals should make use of timely notes.

Coach Holtz believes that the few minutes you take each day to write a note of thanks, congratulations or acknowledgment to a friend or colleague is in investment in your friendships and in your business or professional practice.  Networking is predicted to be the contact sport for the new Millennium.  My encounter with Coach Holtz emphasized that successful professionals, whether in coaching or medicine, have discovered the importance of a timely note.

The thank you note I use is a “Thanks a Million” check shown in Figure 1.

Figure 1.

Thanks a Million Check

The Janus Principle and Your Medical Practice

Janus-The Good Of Beginnings and Endings

Janus is the Roman god of doors and gateways but also the god of beginnings.  Interestingly, good beginnings are required for good endings.  The Temple of Janus had doors facing east and west, which allowed illumination of the temple at the beginning and the end of the day.  Most statues of Janus show him with two faces facing opposite directions.

The Janus principle in your medical practice is the idea of creating a favorable beginning of the doctor-patient interaction which culminates in a favorable ending.

How to get off to a good a good beginning?

It all starts with the first impression.  There’s a world of difference if the doctor enters the room and launches into medical questions versus the doctor who uses the first few seconds to talk about some non-medical topic such as the patient’s family, work, or last vacation.  This information can be obtained by keeping social progress notes on the written chart or on the first screen of the EMR.  Now the doctor demonstrates his interest in the patient and not an organ system, a diagnosis, or lab or X-ray report.  You can be sure that this registers in a positive way with your patient and well worth the few seconds it takes to demonstrate caring for the whole patient.

The Janus Close

Closing the office visit is the natural conclusion of every patient interaction.  Every patient visit needs to terminate with a successful close.  You will know you have closed successfully when the patient agrees to your advice, promises to take the medication, obtain the studies you suggest, or accept the surgical procedure you recommended.  Most patients leave without any physical evidence of their commitment to the doctor.  The close is intangible but you can recognize the signs of agreement or rejection very easily.

The Janus principle focuses less on rote formulas such as ending each visit with, “Is there anything else I can answer for you today?”  It does take into consideration the general tone and feel of the conversation with care and attention to begin well and to close well.  If it is done well, you have buy-in from the patient and a greater likelihood of enhanced compliance from the patient and improvement in patient outcomes.  You increase the buy-in if you learn to listen to what the patient says and pay attention to both verbal and non-verbal clues, which provide you with the feedback of the success of your close.

Doctors have the luxury of asking probing questions.  I am always amazed at the depth of questions that I am allowed to ask in areas that no other person could ask another individual.  After meeting a patient for the first time, I am able to ask about their personal life, their sex life, and their bowel habits.  No other professional could possibly accomplish this except a physician.  In order to be successful at asking probing, we must appear genuine and that we are caring and avoid making the patient defensive.  The best probing questions are open ended and not answered by mere yes and no questions.  It is a far better question to ask how the chief complaint is impacting the patient’s quality of life rather than is the pain mild, moderate or severe.

Next make sure to validate or acknowledge probing question that you ask.  This can be a head nod or use the echo technique of restating the last phrase of the patient’s response to your probing question.  For example, if I ask a man about his ability to engage in sexual intimacy with his partner and he responds that the problem is upsetting his partner.  I would counter with “How is this upsetting your partner?”  This clearly lets the patient know you have heard his response and you are paying attention to the discussion.

Psychologists point out that 70% of the population respond better to suggestions than to warnings.  Nearly 80% of patients’ buy ins are made emotionally and then they use logic to defend their behaviors.  You might approach the close by asking the patient what they feel about the lifestyle changes you might be suggesting they make.  If the patient agrees to the plan of action, you can ask for agreed upon goals.  Perhaps you can ask the patient to join the YMCA or a local gym and commit to an exercise program with the goal of losing two pounds in the next month or before their next visit.

This brings the Janus close to a successful conclusion.  You use the probing questions, provided the patient with motivation, and then receive their commitment and buy-in resulting in improved compliance.

Bottom Line:  We have less time to spend with patients because of the greater volume of patients that most of us are going to be seeing in the near future.  We will have to be experts at communication in order connect with our patients which begins with great openings and positive clsings. The Janus close starts with a good beginning and then has a happy ending.

Powerful Tool for Patient Compliance

There are many reasons your patients don’t do what you ask.  Maybe they don’t want to or maybe they can’t remember what you told them to do and they’re too embarrassed to ask.  Another reason is they never even heard you in the first place. Somehow, their mind drifted off or they were intimidated by you or they were distracted and it just never registered.

 

You can talk louder. Or you can yell.  Or you can try screaming but I’m pretty sure you shouldn’t. Might I suggest storytelling to get your message through?   Story telling is seductive. It’s personal and it’s memorable. If you don’t believe me, just think back how many cliffhangers kept you coming back week after week to your TV set.

 

People crave great stories. That’s what Hollywood is based on. So wrap your instructions in stories about other patients and what happened to them (of course no names should be mentioned). Or tell a story about you or a family member who did or did not listen to you – just be creative so your patient not only listens to you but can even recount the story when they get home.  Just try it.

Where the *^&%$# is Your Office?

Don’t you hate when you have your first appointment with someone and you’re lost?

You’re typically running late anyway. Then you know you’re in the right neighborhood but can’t figure out which building it is. Or, you figure out the building but now you can’t figure out how to park.  Or you you find the building and you figure out how to park but now you can’t find the right suite.  Isn’t that frustrating?

Well, the same process is probably happening with your new patients.

Make it as easy as possible for a new patient to have a great experience the first time they meet you. When they call to make the appointment, be sure your receptionist is scripted to easily explain exactly where your building is and how to park and then how to get to your office from the parking lot or garage. And you can even email them directions along with a picture of your building so they have a landmark to watch for.

Taking this extra care upfront will help lead to a happy ON-TIME patient.

Which Key Employee Can Make You Money?

This one employee can make you money or lose you plenty of money if they are not on their game.  Who is it?  It’s your receptionist.  IF she’s got the right attitude, she’s good at multitasking and she’s well-trained, she can act as the gateway to the rest of your practice and run it like a well-oiled machine.

Your receptionist can streamline your processes so your practice runs smoothly by:

–          Answering the phone and efficiently booking the appointment or directing the caller to another part of the practice

–          Handling each call so efficiently, follow up calls and “phone tag” are greatly reduced

–          Welcoming visitors and directing them to the next step in your process so your patients are happy and comfortable

–          Schedule future appointments at check-out to avoid even more follow up calls

Do not take this position lightly. The right person in this pivotal role could keep your practice humming nicely all day – every day.

How Responsive Are You to Your Patients?

I happen to be in the marketplace for a car.  From my past experiences with car dealerships, I would rather go to the dentist for a root canal than go to a car dealership and get sold a car with high-pressured sales people who aren’t listening to me.

So I think I can do this over the Internet. This should be easy. You see the cars online and it says make an offer and you would think that would get the ball rolling.  I’ve done it twice now. One dealership has me on an automatic response system so it’s just telling me to come in and be sure I mention someone’s name when I do and the other one hasn’t responded yet.

Then I decide to call and speak to the manager. He’s busy right now so she’ll leave him a message to call me and then I say I’ll take a sales person. Now I’m told he’s also busy so I leave my number for TWO people and I’m still waiting for a call back and that was day and half ago.

I’m hoping you’re more responsive to your patients.

 

Try Storytelling

If your patients forget what you told them or ignore your instructions – try storytelling.

It has been documented that we can’t remember details about a lot of things but we can remember stories we hear.
I’m pretty you remember childhood stories you heard decades ago, don’t you?  It’s because we are wired to hear
and remember the beginning, the middle and the end of a story involving a character.

Use that to your advantage. Tell your patients about another patient that’s just like them. Of course, don’t
mention the patient’s name. Just talk about how that patient was in the same situation and this is what happened
to them when they followed your advice.

Storytelling eliminates barriers and encourages your patient to listen and learn from another patient.

Want to Elevate Your Communication? Pick Up The Phone

According to a survey from Accountemps, a temporary personnel service based in Menlo Park, California, nearly half of all business people dislike talking to someone calling on a speakerphone. Doctors and your patients are no different from businesspeople. The complaints range from poor voice quality to lack of privacy. If you still want to talk and free up your hands to sign letters, sort files, or even doodle, get a phone with a headset. Headsets do not distort the speaker’s voice in you will never hear the complaint that you sound like you are speaking from a well, as is the situation when using the speaker function on your landline. In addition, your staff will appreciate headsets that allow them to answer the phone and maintain correct posture. It is better for your neck and back to avoid holding the telephone handset between your shoulder and your ear.

 

Bottom line: we need to do everything that we can to enhance our communication when talking to our patients and our colleagues. You create an aura of being focused and in the moment when you lift up the telephone and speak through the handset rather than the speaker.

Thank You! Merci! Gracias!

No matter what language you use, be sure to say thank you every chance you get to whomever you can. They will feel better and you will feel great.

We live in such a frenzied-paced world with so much chatter and distraction that people are closing up and closing down and forgetting their people manners for lots of reasons.  They are distracted, they are multi-tasking and in too much of a hurry, they are self-absorbed or whatever.

That’s all the more reason to stop for just a second, look someone in the eye, SMILE and thank them for whatever they did.  Thank the doorman of your building. Thank the coffee lady you get your morning cup from. Thank your receptionist for being at her desk on time. Thank your staff whenever you catch them doing something right. Thank your patients for following your instructions. Thank every staff person as they leave for the evening. Thank your colleagues for their referrals. Thank your vendors for taking good care of you. This is an endless list but you get the picture.

People are so hungry for recognition and acknowledgement that this simple gesture can change their life and yours.  Just for one day, try smiling and saying thank you with sincerity to everyone you come in contact with and see what a difference it makes. I’ll bet you do it again the next day.

Thank you for reading this post!

 

More Communication Means Less Litigation

Doctors, hospitals, insurance companies, and malpractice carriers have known for years that there is a direct correlation between patient satisfaction\patient complaints and law suits.  (American Journal of Medicine 118:1126,2005)    Physicians have always prided themselves as being good communicators but surveys show that we often overestimate our ability to communicate effectively with our patients.   A well-publicized study reports that the average doctor interrupts a patient after 16 seconds during the interview process.  So what can we do to improve our communication skills and lower our risk of law suits?

1. Prepare for your visit with the patient.  Before entering the room look at the chart or the EMR and know one or two facts about a new patient.  This can be their referring physician, their employment, or where they live.  The same applies to an existing patient.  Don’t initiate the conversation talking about their medical problem.  Regardless of your patient volume and how far behind in the schedule you are, start the conversation with some topic that is not associated with their health issues.  This clearly sends a message that you care more about them than their blood pressure, their shortness of breadth, or their dysuria.

2. Sit down and don’t stand while speaking to a patient.  Make every effort to be eyeball to eyeball with the patient.  Never have a meaningful discussion when you standing and the patient is sitting or worse if the patient is lying down on the exam table.

3. If possible, don’t have any barriers between you and the patient.  If possible be on the same side of the desk or exam table as your patient.  You don’t want any barriers, either psychological or physical, to be between you and the patient.

4. Lean slightly forward when you speak to the patient.  Patients are going to notice your body language before you even open your mouth.  Leaning forward in your chair demonstrates a sincere interest in the patient.

5. Lock eyes with the patient.  People normally make eye contact 70-80 percent of the time.  If you fall below average, you come across as shifty or lacking confidence.  People who make less eye contact often aren’t’ aware of it, so ask a colleague to critique your eye contact.

6. Smile. Keeping a neutral face may feel natural, but the other person might perceive your expression as negative.  People are looking for signs of approval and the lack of a smile may even seem threatening and can make a patient become defensive.

7. Don’t spend all of your time looking at the chart or the computer.

8. Don’t turn your back on the patient.  This is disrespectful and a barrier to good communication.  Avoid placing your wall mounted computers  in the corner of the exam room that put the doctor’s back to the patient.  This is certainly one advantage for mobile tablet PCs rather than fixed machines in the exam room.

9. Minimize interruptions.  Nothing can derail your communication with your patient than to be interrupted during the visit.  It is very hard to get the train of thought moving in the right direction when you take a phone call, leave the room, or allow the staff to open the door to have you sign a prescription or an order.  Set guidelines for interruptions.  Examples include the emergency department, the intensive care unit, or the operating room.  If another physician calls, instruct your staff to say, “The doctor is with a patient and if it is an emergency, I can interrupt him\her.  If not, I can arrange for him to call you when he is between patients which will be in 10 to 15 minutes.”  Most physicians calling another physician will respect this policy and allow you to call back.

10. Always ask the patient if their questions have been answered and if there is anything else that can be done to make their visit complete.

11. If possible walk the patient from the exam room to the check out counter or have a nurse accompany the patient to the check out counter.  This assures that the patient will take care of the bill and make their next appointment.

Bottom Line:  Improving communication with your patients means making the patient feel that he or she is the most important thing for that physician that day.  Doing this will not only make you feel good and be a source of gratification, but will also reduce your liability and reduce your risk of law suits.