A legal encounter with a patient led this podiatrist to rethink how and what he communicates with patients.
By Donald Pelto, DPM
Many of us are increasingly pushed to provide a greater amount of care along with reducing costs or increasing the value of each patient office visit. There are many thoughts about how to increase the per-visit value, but the key is to provide more value in the form of products or services. One way to do this is to build on the ideas of scripting patient visits and patient protocols.
As a young doctor, many of my older mentors recommended developing a script for the most common patient interactions. Few doctors actually take the time to write down what they say, much less practice these scripts. However, when shadowing more experienced doctors, it was clear they always repeated the same explanation for common conditions such as how orthotics would help, how to deal with plantar fasciitis pain, and the logistics of bunion surgery. These doctors naturally used these scripts and many of the “pearls” I learned as a young doctor came from listening and writing down how these explanations were done.
However, there was still some complexity that came from a variety of treatment options that are available for each condition. Many diagnoses, such as plantar fasciitis, can have 20 to 30 treatment options and as a young doctor I didn’t know what to offer first, what was the most important. Many times patients became confused about all the different options as I “educated them” about treatment options. Other more experienced doctors recommended using treatment protocols.
Treatment protocols delineate how each individual condition would be treated on the first and subsequent visits. This includes different categories such as office visit billing codes, in-office dispensing, durable medical equipment, and time frames between visits. I spent many hours developing all of these protocols before I even started in private practice only to find that often I didn’t follow them, and the patients were still confused even when I did.
Early in my career I brought up the idea about doing a presentation to patients to go over treatment options, but I was always discouraged from doing so because “it took too much time” and the doctors were “too busy” and “it wasn’t practical.” I found that, like most busy doctors, I offered my patients what was most convenient to me in terms of reimbursements, what I’d seen work well, and, most importantly, what I had time to explain based on the time constraints of private practice.
Then, I was sued for a poor surgical outcome. One of the allegations was an improper pre-surgical discussion and informed consent prior to surgery. After that episode, I was motivated to have a thorough pre-surgical consent and thus was formed my first patient presentation. Using a PowerPoint presentation, I went over all the aspects that I typically went over prior to surgery. Using this format, I found I was more thorough and never missed any part of the presentation even when I was rushed for time. The presentation itself slowed me down and made me more thorough. I started doing these presentations for every surgical patient and many were appreciative of the thoroughness of the discussion. Furthermore, the informed consent was easier to obtain from patients since I had already gone over the procedure, alternatives, and possible complications.
After a few months of doing these presentations and really enjoying them, I realized that certain diagnoses were difficult and frustrating to explain due to the complexity of the condition and treatment options combined with time constraints. Patients would come in with plantar fasciitis and I would groan just thinking about explaining the condition again, or if I had been seeing someone for a number of weeks without improvement, patients were confused as to the next steps for treatment.
This helped to develop this idea I call “Patient Presentations.” This idea is more than a PowerPoint presentation; rather, it’s a mixture of scripting, treatment protocols, and patient educational materials plus a way to reduce complexity for the doctor and the patient in terms of treatment options. Let’s look at how this could be used in your practice.
Our next patient is coming in for plantar fasciitis, a condition we’ve already seen 20 times this week. We all think we are great at treating this condition. We typically talk to the patient about plantar fasciitis and they nod their heads saying they understand…but do they really? How many times do they leave thinking, “I have this condition because I am fat!” While we never said that, that’s what the patient will say they heard.
Consider this alternative. We go in to visit the patient, Mrs. Smith, and listen to her concerns with a growing sense she indeed has plantar fasciitis. We perform a physical examination and watch her walk. Next we review the x-rays with her, and she asks if the spur is the cause of her heel pain. But before going any further, we open a presentation on plantar fasciitis on the computer screen right in front of her. This presentation will go over the cause of the condition and provide an organized approach toward treating the condition. As we sit together, Mrs. Smith has the chance to ask questions and we can reinforce certain points we want to make sure she gets. We can let her know that she doesn’t need to take notes or remember everything because she will be given a paper copy to review or share with a family member after, or she can receive a copy by email. When the presentation is over, we can go over a checklist of treatment options and together with Mrs. Smith determine what the next steps are.
This is the idea of “Patient Presentations.” It is a way to help explain diagnoses, slow down the doctor to be more thorough, and make certain all the treatment options are included in the discussion. What I have found in the past 6 months of using these presentations for practically all conditions are the following:
For Me, the Doctor
Greater enjoyment in treatment of complex conditions. Using these have made explaining treatment options much more enjoyable and I have been more comprehensive. Patients are more involved and engaged.
Slow down. Doing a patient presentation or simply reviewing a treatment slide slows me down and helps me not to forget any treatment option due to other distractions or time constraints.
Simplicity. It is easier to treat patients as I know what I am going to say. These are similar to the patient protocols but can be continually tweaked and the presentations can be adapted and improved as needed.
For the Patient and Family Members
Increased understanding. Because the presentation is visual, patients and family members come away with a greater understanding of their condition, plus, they can review the presentation again in their own home. The program I use, Patient Education Genius (patienteducationgenius.com), can be uploaded with your information for your patients.
Homework helpers. In addition to the presentation, videos of the recommended exercises and other educational materials can be made available for patients to use at home and study at their leisure. This improves their retention of exercise instructions and, at least for me, has increased compliance with follow-up visits.
For the Practice
Increased billing. In our office, we both sell and dispense durable equipment. Many times in the past, these were not offered because we were too busy or forgot. When the items are included in the presentations and patients can see how they are used by others, patient acceptance of durable medical equipment and products is greatly increased. For example, with a plantar fasciitis patient, the checklist slide at the end of the presentation jogs my memory to offer a night splint or walking boot as an option, if they are not getting better.
Referrals and reputation. On each of the educational pages that are made for patients, the software program we use includes an area where a chat bot asks for an online recommendation. We have found it improves our social media rankings tremendously on Google.
For the Healthcare System
Wow. Patients are wowed and many times say, “I have never had any doctor be so prepared for my visit.” The preparation starts before and takes some additional upfront work on your part, but I have found that patients do appreciate it and hopefully will stick with treatment longer, improving outcomes all the way around.
Donald Pelto, DPM, has been a podiatrist for more than 10 years with Central Massachusetts Podiatry in Worcester. A selection of Dr. Pelto’s Patient Presentations can be found at the link below. To discuss these or others he has available to share, reach him at firstname.lastname@example.org.
Patient Presentation Link – https://drpelto.thinkific.com/courses/new-doctor-resources