THE EFFICIENT OPHTHALMOLOGIST

Meet the cookie ladies

They help patients see us in a positive light.

By Steven M. Silverstein, MD, FACS

In this era of Health Care Reform, with annual cutbacks to reimbursement, cost containment and rules on reducing overhead, we still pay the equivalent of one full-time person, split among three employees, to work in our waiting room, every day.

Expendable? Hardly. They have proven their worth, day in, day out, since they began working for the practice in 2002.

FIRST, BAD EFFECTS

The results of these payment reductions have had a broad, negative impact on how patients view medical delivery at the point of service — namely our offices. You hear about this, as do our colleagues in every field of medicine. Our wait times have increased, while doctor-patient chair time has noticeably decreased. More time is spent dealing with running our businesses than ever before, which further diminishes the time we can spend with patients. EMR has depersonalized the physician-patient relationship, because those who work without scribes spend significant time typing, scrolling, and clicking, often with faces turned away from the patient and family. To keep up with increasing overhead and declining reimbursement, we are forced to see more patients per hour to stay even.

To combat insurance and Medicare/Medicaid cuts, doctors in nearly every specialty now turn to “selling” products or procedures that are out-of-pocket expenses to the patients; indeed, medicine has become to some extent, a cosmetic profession. Even our primary-care colleagues have given up the important (especially to the patient) experience of making rounds on hospitalized patients, turning this time of critical care over to hospitalists with whom their patients are unfamiliar, and more important, the patients and their conditions are unfamiliar to the hospitalist.

NOW, THE GOOD EFFECT

In 2002, our practice instituted a program called Patient Services, or Patient Advocates. To enhance the patient experience, we hired three retired ladies — socialites who have been involved in our community for many years, who are extroverts, and most important, are our own patients. Their primary responsibilities include welcoming patients to the practice upon arrival, helping elderly patients fill out forms, and lending an arm to those who have difficulty walking to the bathroom.

When the clinic is backed up, they escort the patients and their family members to the exam rooms, and check to see when a patient is due to be brought back. Most especially, they walk around offering fresh coffee, hot chocolate and cookies. They sit with patients who wait for their names to be called, enjoying conversation. The patients love this attention, and look for their favorite lady for subsequent appointments.

It helps the time pass in the waiting room, and more important, it returns us to an era of personalized medicine, when the perception was one of genuine caring rather than nonchalant inattention. Further, a trust is established, and patients are constantly asking them about our offered procedures and treatments. I have performed cataract/premium IOL surgery on each of these ladies, and they have become the best ambassadors we have for this procedure. Their conversations extend well beyond the waiting room, as they take their stories and message into the social gathering and events each attends. Indeed, they seem to convert as many patients to the premium channel as the doctors do.

The cookie ladies — dubbed so by the local media who wrote about them — love their jobs. (Other patients are waiting for them to leave.) They are exceptionally social, and for them, it’s like hosting a party in our “living room” every day. For us, it’s more than money well spent. OM

Steven M. Silverstein, MD, FACS, is a cornea-trained comprehensive ophthalmologist in practice at Silverstein Eye Centers in Kansas City, Mo. He invites comments. His e-mail is ssilverstein@silversteineyecenters.com.