Street Smarts for the Orthopedic Surgeon

As a doctor, you’ve taken the pulse of many a patient. But have you taken the pulse of “the street?” Dr. Robert Schultz, an orthopedist and author of the book, “Street Smarts for the Practicing Physician and Surgeon, ” thinks that some orthopedists haven’t yet had that chance.

Dr. Schultz: “While you cannot give someone an experience, learning from the experiences of others can help you prepare for unusual situations, grow your practice, and know that you are not alone. This is particularly important for young surgeons just emerging from training.”

The Fundamentals

One of the fundamental street smarts is to set your mind to “positive, ” says Dr. Schultz. But don’t set your watch when you’re with patients. “You must have an attitude of positivity and patience….and you should learn to expect the inevitable. Seeing a doctor often represents a detour in a patient’s daily life, and most likely they are not excited to be going to the appointment. This means that they might not be in the best, most accommodating mood. You, however, must maintain your composure and act in a professional manner. Surgeons coming out of training have learned how to develop a treatment plan and how to operate, but have not been exposed to dealing with people over the long term because they rotate through different services. Thus, they never get a sense of what it means to have long-term follow up with patients.”

“Once you are in practice, however, you get to know people over many years, ” states Dr. Schultz. “This can give patients the feeling that you understand who they are and are looking out for them long-term instead of being like a robot who comes up with answers but can’t relate to patients as individuals. Take two restaurants: at establishment A the owner comes to your table, asks how you are doing, provides complimentary appetizers, etc. The food is just average, however. Over at restaurant B the food is superb, but there is no personal touch. Restaurant A is consistently more successful than the other establishment.

The point is that you can be highly skilled as a doctor, but if you don’t have an attitude and self presentation that gives people a sense of safety and belonging, then things aren’t going to go well. This includes things such as dressing professionally, not getting upset with staff, listening intently, etc.

The personalities of the people doctors treat vary more than the conditions they have. And because there is such interplay between the two, it is more than a little helpful to learn some people skills. Dr. Schultz: “Whatever you do, don’t be self absorbed or aloof. That will eventually kill your practice. Solicit patients’ opinions, both in conversation and through evaluation forms.”

“In our waiting room there is a TV screen that not only displays information on orthopedic problems, but provides details on the practice. When the patients complete the post-visit questionnaire, they are asked if they watched the TV program, and if so, what they found to be most helpful. The questionnaire also has questions such as, ‘Do you now understand your disease?’ and ‘When the doctor used terms to describe your disease, was it understandable or did you have to go on the internet to learn more?’ and, ‘Did you feel that the staff was concerned about you?’ and so on. Our practice set up a cybercafé where people can get a pastry and/or coffee, and use a credit card to go online and entertain themselves while they wait.”

Problem Patients

But what if the person just wants to hang out at the front desk, ask a litany of questions of the staff, demand to see the doctor right away, etc? This is someone you may want to point towards the door. “There are patients who can end up dragging you and your practice down, ” says Dr. Schultz.

“They tend to seek out a lot of attention, are looking for certain feedback from others, and need to feel that their illness is the most important thing in the world for the doctor. They indeed may have a real illness—or they could be embellishing a minor problem. If you tell such a patient that he has tendonitis and that he need only change his lifestyle and take medication for awhile, this person will continue to make office visits and give the staff a hard time. The staff only has a certain amount of time for each patient, of course, but the person feels insulted. There comes a point where you say to yourself, ‘I don’t want to treat this person anymore.’”

“Those doctors just out of training may not realize that it’s possible to remove someone from their practice, ” notes Dr. Schultz. “While ethically or legally you cannot just abandon the patient, there is no law saying that you must treat everyone. There is a process to follow, however. First you must send a letter to the patient explaining that you don’t feel that you can adequately treat them and give them the names of three doctors they could see. Tell them that they can continue to see you until they have found another physician (the length of time you have to give them for this varies depending on the state). And the letter should come from you and be signed by you. If your staff writes the letter, then the patient will just say, ‘I want to speak to the doctor.’ This process leads to appropriately ending the doctor/patient relationship.”

Ideally, however, you will be sufficiently tuned in to who might be a problem before he or she is a problem. “There are lots of little yellow and red flags that crop up with folks like this. Perhaps they are full of praise for you (‘I have heard you’re the best’), they disparage their former physician (‘Dr. Jones down the street is awful, and his staff is really bad’), start calling you by your first name, bringing you birthday cards, etc. This person is setting you up for some bizarre interactions that can lead to lot of angst for you and your staff, who by the way, begins to complain about the person. And it is usually the case that this type of patient showers the physician with praise while complaining about the staff.”

If you recognize these behaviors early you can nip it in the bud. Instead of responding when they praise you, say nothing; be businesslike and do not give them extra time. I’m not saying to be cold, but you must distance yourself from such people. In most cases the patient will get turned off and leave the practice.

Marketing (Not Advertising)

The fact is, however, that these people will walk in the door. Especially since so many doctors are trying to grow their practices, and are using the powerful bullhorn of advertising. But don’t call it advertising, says Dr. Schultz…it’s marketing. “Marketing is a vital aspect of building a successful practice these days. But it has to be approached with caution. AAOS has provided clear guidelines on this topic whereby if a surgeon steps outside them it is unethical. You cannot make any outrageous claims, for example, saying you are world renown when you are not. But a marketing strategy is helpful, and can be altered based on what you learn from your patients. For example, you can survey patients and ask, ‘Does the fact that your doctor is on TV make you feel proud or embarrassed?’”

Dr. Schultz continues, “Part of your strategy could involve giving talks to the community, including workers compensation groups, for example. When you do these events, however, make sure that you promote the practice instead of yourself. One way to do this is to bring business cards that only have the practice name on them. Also, you have to get the pulse of the community you’re serving. Marketing your prowess in joint replacement surgery to a neighborhood or group of young people loses the audience and gets you nowhere.”

Of course, you will want to ensure this is a practice that you want to promote. If things aren’t going well, says Dr. Schultz, the seeds of your discontent may be found in your personal history book. “Avoiding divorce starts with choosing the right marriage partner. Know who you are and what you want your role in a partnership to be: entrepreneurial or simply a 9-5er. Make sure the partners are who you think they are by going into the OR or playing a round of golf with each of them. People under stress reveal their true colors.”

The underlying message? Prepare, assess things along the way, maintain a sense of professionalism whether you’re in front of a patient or a television camera, and display a genuine concern for those you treat.