Doctors -- certainly most of them -- are trying harder to please their patients.
Have you noticed? If not, you may want to ask yourself, "Should I find another doctor?"
Most physicians have always worked hard to do their best for their patients. I believe this is true despite all the stories -- mostly correct -- about those who do less.
Today, however, competition is making doctors try harder. There is competition between increasing numbers of doctors, competition between individually practicing doctors and a growing number of health plans and competition between the health plans.
What are some of the things doctors are doing to satisfy us?
Two medical publications have made long lists of ways in which physicians can keep and attract patients. The District of Columbia Medical Society News, in fact, headed a report on an American Medical Association marketing workshop: "The AMA Offers Nearly 100 Suggestions for Getting and Keeping Loyal Patients."
Medical Economics, an outstanding magazine dealing with physicians' purses and practices, assembled a panel of physicians and practice consultants to tell doctors "How to Keep Them in the Fold." "Them" being us patients.
The AMA workshop report put "availability to patients" first on its list. Among ways to "improve your availability," it suggested that doctors:
* "Improve your availability by telephone . . . Establish definite call-back periods . . . Consider making your home phone number available . . . Establish 'call-in' hours during which patients can speak immediately to a physician or nurse."
* "Institute non-traditional office hours such as evening hours, early morning hours and weekend hours."
* "Make house calls . . . Let selected patients know of your availability for home visits."
"Availability is crucial," Dr. Gregory Darrow of Janesville, Wis., told Medical Economics. "I urge patients to call me about non-emergency problems during the half hour before lunch and the hour at the end of the day. That gives them access to me, yet leaves the phone free most of the day for emergency calls and business use.
"I've also virtually done away with the answering service barrier. After hours, when a patient dials my office number, a call-forwarding system rings my home phone. I pick it up and deal with the problem right there. People love it."
Dr. Walter O'Donnell of Gloucester, Mass., said, "I tell my patients . . . not to feel put off if they reach my answering service, but to tell the operator they have an emergency. I assure them that either a partner or I will get back to them within minutes."
The AMA report next took up patient relations, saying:
* "Ask about the patient's family . . . Spend adequate time with each patient . . . Answer patients' questions."
* "Explain the necessity of all lab tests and X-ray examinations [and your] billing procedures" -- that is, the fees.
* "Inform patients . . . that you will follow their cases . . . Call patients a few days after their visits to see how they are doing, when appropriate."
* "Walk patients to the door or in some other way bring your encounter . . . to a cordial conclusion."
Dr. Leonard Dietz, a surgeon and former president of the medical staff at Holy Cross Hospital in Silver Spring, told Medical Economics: "We have to display some understanding of patients' anxieties . . . Frequently they don't open up. That's when it's important to take the initiative . . . When I know what they're thinking, and vice versa, we've got a rapport that gives us both peace of mind."
"Something I do to start them talking," O'Donnell said, "is ask, 'What are you afraid the problem is?' . . . It's a way of getting at their worries, which are sometimes surprising . . . I asked a woman with chest pains what she thought the problem was, and she replied, 'My aunt had these symptoms just before the doctors diagnosed her brain tumor.' "
The AMA report put "patient dissatisfaction with 'high' fees" high on its list of matters doctors could deal with. It said:
* "Price yourself effectively but also be sensitive to the financial needs of your patients."
* "Always be willing to discuss and explain your fees . . . A written fee schedule should be available to patients upon request."
* "Develop credit policies" for those who cannot pay immediately, and "make sure your patients know" about them.
* "Help patients understand their insurance . . . what will and won't be covered -- before service is rendered . . . Help patients file insurance: this is a real service . . . and it assures you that the forms will be filled out correctly."
Another AMA suggestion, but by no means a rule: "Request payment at time of service for moderate medical charges, and educate patients as to how this will cut costs for them."
This can indeed cut doctors' billing costs, but it is a controversial suggestion that many doctors -- and patients -- oppose. A more moderate AMA suggestion: "Offer discounts to patients for payment at time of service."
Do many patients ask to see doctors' fee schedules? "Not many," Dietz said, "and I wish more of them would . . . The effect is excellent, though. Those who do ask know I'm not hiding anything and don't get a postoperative shock when the bill arrives."
"High-tech medicine -- which I consider a synonym for expensive medicine -- is here to stay," Dietz summed up. "But it's also a depersonalized form of care . . . The individual physician who cares about the individual patient has much more to offer."
Next Week: Medical insensitivity. And caring, too.