1. Rebekah Bernard MD

2.  Make patients love you  Improve productivity and office efficiency  Reduce burnout

3.  What do patients value in a doctor? 1. Availability 2. Affability: “being pleasant, at ease in talking with others, and characterized by ease and friendliness.”

4. ◦ Empathy ◦ Confidence ◦ Humanity ◦ Personal Touch ◦ Honesty and Forthrightness ◦ Respect ◦ Thoroughness http://www.mayoclinicproceedings.org/article/S0025- 6196(11)61463-8/abstract

5.  Showing that you care ◦ Smile ◦ Eye contact ◦ Personal touch ◦ Listening  “You are the most important thing to me right now.”

6.  SMILE as you enter the room  Immediately apologize if you are late  Personalize the visit ◦ Check the chart before entering the room ◦ Shake hands  Sit down ◦ Make small talk like this is an old friend

7.  Allow patient to complete their opening statement without interruption (average 29 seconds)  Listen ACTIVELY ◦ Sit at eye level ◦ Eye contact ◦ Demonstrate interest ◦ No interruptions from outside

8.  Listen to and acknowledge the patient concerns ◦ Repeat and clarify understanding ◦ You don’t necessarily have to solve all of the problems today, you just have to HEAR them  Encourage written lists

9.  Chronic conditions  Abnormal lab results  Preventive care

10. Typical Problem List ROCK STAR Problem List DMII W/O MENTION OF COMPLICATIONS DM2, A1c 7.3 (3/14)  6 (6/14), ophth Dr Jones, foot exam 3/14 HYPERLIPIDEMIA NEC/NOSHyperlipidemia, intolerant of all statins AB MAMMOGRAM NOSAbnormal MMG, due to recheck 2/14 (XYZ Radiology) ABDOMEN/PELVIS SYMP NECChonic abd pain, GI w/u/CT normal 5/12 ABN FUNCTION STUDY NECElev LFTs, recheck normal (2/12) ADJUST DIS W ANXIETY/DEP Situational anxiety (husband ill with cancer) ABN CNS FUNCT STUDY NECMRI brain – small vessel disease (9/10) VASCULAR DEMENTIA,UNCOMPMild dementia, MMSE 27/30 (1/11)  26/30 (2/14) CRBL ART OC NOS WO INFRC Hx TIA 2004 GENERAL MEDICAL EXAMWellness visit done 8/10/14 SCRN UNSPCF VIRAL DISHepatitis C negative (8/11); Hep B vaccines completed ABN KIDNEY FUNCT STUDYCRI, Neph Dr A; NO NSAIDs**

11. ◦ You are examining a patient even as you look and talk with them ◦ Don’t waste time - only do what is necessary and indicated for the patient’s situation ◦ PE is not always needed for coding, especially for established patients

12.  Give patients options for treatment http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3061374/  Don’t get frustrated if your patient doesn’t take your advice… this time  Keep cost in mind – use resources like GoodRx.com when prescribing

13.  Use forms and handouts ◦ Always give a written summary  Use your staff as a bridge  Always schedule a follow-up visit ◦ This is the KEY to coping with emotionally challenging patients

14.  Schedule follow up visits for ALL clinical issues  Schedule follow up visits for lab results and after patient sees a specialist  Avoid uncompensated telephone calls, paperwork, emails, etc.

15.  Remember who the note is actually FOR ◦ Yourself ◦ Your staff ◦ Your colleagues ◦ Your payer ◦ Your malpractice carrier ◦ Your patient

16.  Get your notes done in real time as much as possible  Make your own templates or dictations  Try not to be a perfectionist  Look for the positives  Always be thinking bout how to outsmart the system

17.  Don’t sell yourself short  Be aware that perfectionism adversely affects mental health  Be aware that loss of control (like in a corporate job) can adversely affect mental health  Have a “Plan B” so you aren’t trapped in a job situation you hate ◦ Don’t be guilted into staying in a bad situation

18.  Take care of yourself – physically and mentally  Take time off for things you enjoy  Get a great psychologist and go regularly – if not for yourself, you will learn tips for working with your patients

19. www.RebekahBernard.com rebekahbernard@hotmail.com