New M.D.

Send the Right Signals to Patients

By Lauren Eckstein, M.D.

As I walked into the junior resident's exam room to meet and evaluate a patient he wished to schedule for routine cataract extraction, I found both the desk and the floor littered with tissues, fluorescein strips and other detritus cast off during the course of a day's worth of routine ophthalmic examinations.

Unfortunately, this was not the first time that I had seen such a dirty and disorganized exam lane. Indeed, it was a frequent finding among some residents. Despite my explicit instructions to maintain a clean and neat workplace, many chose the more expedient course, allowing their waste to accumulate rather than taking a moment to place it in a nearby trash receptacle. Despite the chronic nature of the problem, I was nevertheless appalled.

New M.D.s Must Earn Trust

Upon first meeting, patients have very little by which to judge a physician. Perhaps the doctor has been recommended to them by someone they trust. Or perhaps the physician has an excellent reputation and is highly regarded in the community. However, these sterling reputations only apply to experienced physicians. These a priori influences generally do not benefit a resident or fellow staffing a community or hospital-based clinic. Likewise, they would not be expected to routinely benefit young physicians just starting their practice. Absent these preexisting positive impressions, we must use all other available forms of communication (including non-verbal cues) to rapidly put the patient at ease, to help them feel comfortable with the exam and with the decision-making process, and to develop a sense of trust.

How Patients Make A Judgment

As with all physician-patient interactions, the patient will undoubtedly draw conclusions from what he or she sees, hears and experiences. A warm greeting by name and an outstretched hand go a long way to making a patient comfortable. So too does one's hygiene, dress and demeanor. Not surprisingly, these considerations also extend to the cleanliness of the examination room. The patient may have little else by which to judge a surgeon other than his or her presentation and the condition of his or her office. Thus, many patients or family members will conclude that a physician working in a messy or dirty exam room practices similarly careless medicine. Even worse, for a surgeon, the conclusion might be that the he or she is reckless or even negligent in the operating theater.

Because the success of modern medicine (and in particular elective procedures) is so often dependent upon appropriately managing patient expectations, this process must begin even before the initial physician-patient greeting and must extend to all aspects of the interaction. As is often the case in ophthalmic surgery, the results of many procedures may not immediately be evident to the patient. Indeed, due to postoperative swelling and other factors, the initial outcome may in fact be worse than the patient's preoperative condition. Helping the patient through this difficult period is often very challenging. However, if the patient's pre-operative impression of the surgeon is that he or she is thoughtful, meticulous and attentive to detail, negotiating this process may be simplified. It is far easier to provide reassurance and engender patience if the physician-patient relationship is stabilized by a foundation of trust than if there is an underlying skepticism or even manifest lack of confidence.

Cleanliness Helps Win Trust

As physicians and surgeons, patients place great faith in our insight, judgment and skill. They trust that we will make recommendations in their best interest and that we will diligently perform to the limits of our ability. Our relentless dedication to service and caring honors their trust. We may demonstrate this commitment both through the quality of the medical and surgical care we provide, as well as through the assiduous attention to the innumerable details that shape their experience and inform their opinion. Although it is a simple step, taking the time to maintain a clean environment sends a powerful signal to the patient that you will also take the time to manage all the other critical tasks that lie ahead. For the satisfied patient and the successful physician, no detail is too small. OM