Thursday, April 15, 2010

Things not to say to your massage therapist. Part II: Appropriateness

This June will mark my fifteenth year in the medical field, and I've managed to collect a pretty sizeable trove of stories (some inspirational, some cautionary) regarding medicine in general.  Many of you may remember this post from back when I worked at Peak Performance about how to act when you're getting worked on by your massage therapist.  Since it's one of my old favorites, I figured I'd start a semi-regular column on the subject. 

Today I'd like to say a few words about appropriateness when visiting your doctor's office.  I've worked in musculoskeletal medicine for my entire career, but the same concepts hold true across disciplines.  So let's just jump right into it.  Please note: The opinions I'm expressing here are my own and not those of my past, present, or future employers.  This is meant purely for entertainment, and isn't a reflection of any official business policy I've ever had, spoken or unspoken, though I will be as flatly honest with you as possible.

So let's start by going through a typical office visit and what's appropriate for each stage.

Scheduling:
Appropriate: Asking "how much time should I leave myself for the appointment?"
Not Appropriate: Asking "how long will I have to wait?" 

The Logic: Doctors and their staffs have little control over their daily schedule once it's underway.  They can occasionally bring things to a screeching halt or they can speed it up (usually by skipping their lunchbreaks or walking around with a full bladder for a few hours), but in general there's not much they can do once the day starts.  It's fine to want to know how long your appointment will take, but please understand that this is, at best, a rough estimate.  You're just as likely to be in and out almost immediately as you are to be stuck running behind.  Every day is different and there are always unforeseen problems.  If you ask how much time you should leave for your appointment, the receptionist should be able to calculate in their head the amount of time it will take you to get settled, get paperwork filled out, wait, see the doctor, and check out, and give you an estimate that will approximate the entire visit length.  If instead you ask how long it will take to see the doctor it (1) makes you sound like you have better things to do than seeing a doctor for your excruciating pain.  You don't.  Plus if you wouldn't waste your time getting yourself well, why should your doctor?  It also (2) doesn't take into account extra time spent doing administrative things, scheduling follow-ups, or if the doctor decides to spend extra time with YOU, which they often will during their first appointments.  A receptionist should be able to tell you these things immediately.  Which leads me to the next part...

Reception Desk
Appropriate: Schmoozing, bantering, and having fun at the front desk.
Not Appropriate: Being a douchebag to the receptionist.

The Logic: The reception desk actually has a surprising amount of control over the day-to-day operation of a medical office, and their job is one of boredom and tedium punctuated by putting out the fires of pissed-off people either in the waiting room or in the actual office.  While I would strongly advise against flirting openly with front desk staff (who in addition to their experience are in truth often chosen for their attractiveness and social aptitude), it is perfectly OK to show them pictures of your kids or chat about American Idol or tell them about the Marathon you think you're going to try this Spring.  In fact, virtually any conversation about food, vacations, or pop culture is a welcome break from being shouted at and/or taking care of an endless stream of brain-numbing administrative tasks.  If you can talk to the receptionist about something other than their job, they're much more likely to give you extra consideration when you need an emergency visit or a last-minute reschedule.  We also are only human.  We love funny jokes, videos, cartoons, etc.  Keep it clean though.  If it wouldn't appear in a newspaper or magazine, don't bring it into a doctor's office.  We occasionally tell off-color jokes or watch videos of people lighting their farts, too, but it's indescribeably  awkward if it comes from a patient.

It's absolutely not ever OK to give your receptionist a hard time.  Yes, I have worked with some collossal assholes that represented an office from behind the front desk, and I've experienced some appaling behavior from them as a patient myself, so I know they exist and it seems sometimes even as if they're pervasive.  The person to tell this to is your doctor, and no one else.  Smile, and deal with them, and then tell your doctor exactly what you think of them.  The doctors in private practice are ultimately the ones in control, and believe me, they are VERY concerned about how their practices are being represented by their staff.  While truly great receptionists are rare and coveted by both doctors and patients, lousy receptionists are legion, and can be replaced easily in a week.  And they often are.  This is doubly true if your receptionist is good at what they do. Tell your doctor this, too, and the fast-track to easy medical experiences awaits you.  Which leads nicely to the next point...

What do doctors/clinical staff like?
Appropriate: Food, small thoughtful gifts, compliments, and referrals
Not Appropriate: Large or expensive gifts, invitations

The Logic: Let's say you've got your appointment scheduled and managed to meet a doctor that you really like.  You dig their credentials, their office is convenient, their front desk staff seems professional and this doctor communicates with you in a way that makes you feel very seen and heard.  In short, you like this doctor and you want to stick with them.  You want your experiences with them to continue being as painless as possible, perhaps you even want to bypass some of the scheduling wait-times or waiting-room boredom that pervades their office.  This is perfectly understandable.  Many (not all, but many) great doctors like this have hideous wait times both to see them and to wait for them in their waiting room.  This is misery, we know, and we absolutely do NOT want you associating our office with misery because for 99% of medicine early treatment is dependent on you coming in sooner rather than later. You coming in sooner is dependent on our office not being a hateful pain in the ass to come into.  So you're patient and you understand that sometimes a long wait can't be helped, but what can you do to speed things up?  Be friendly, of course, and make yourself somewhat special to your doctor!  We're people too, and we try hard not to play favorites, but we do inevitibly have patients that are special to us.  People we like immediately, or who make us glad that we chose the career we did.  Those patients get the medical equivalent of a business-class flight upgrade.  The waits are a bit shorter, the rules can be bent ever so slightly for them.  So how do you become one of those patients?  The answer is as close as your nearest Panera bread store or Einstein's Bagels.

Medical people have a variety of interests, but none quite so consistent as golf and food.  We fucking LOVE golf and food.  Some of us like music and nice pens, too.  So let me break this down for you:

You go to a doctor to have them help heal your (insert nasty persistent problem here) and they treat you well and give you a cure that helps immediately.  You feel like they've done you a solid service and you're going back for a follow up or to have them look at something else and you want to show them that "hey, I'm not just a nobody, I'm a happy customer and I think you're doing a good job, and by the way can I please have an appointment this month instead of next season?"  When you go in for your next appointment (NOT the first appointment), take them a bag of bagels from Einstein's with some cream cheese.  It's like $10, but you will never be able to buy with cash the sort of goodwill that bagels can get you.  Here's the kicker: don't give it to the doctor, give it to the front desk and tell the doctor that you gave it to them to share.  This is a no-lose situation.  The front desk will never refuse this.  If your doctor doesn't want bagels, they'll just let the front desk have them and it's still a good showing on your part that you took a minute to think about them as human beings, which they very much are. 

If your doctor does something particularly special for you (saves your life, cures some bitchy-miserable disease you have), it's also appropriate to give them a small gift.  Remember, though, the key here is thoughtful, not expensive.  Doctors and most clinical people have everything they need, and it's foolish to think that you could buy them something they couldn't buy themselves (except lunch, lol, because that's often the hardest thing to get during a busy day).  It's just the thoughtfulness they appreciate.  Hence, a nice small box of golf balls for a doctor that enjoys golf is appropriate.  Golf clubs are not appropriate.  The same is true of food to a lesser extent.  Bringing them bagels for breakfast or a pizza for lunch is absolutely perfect, but inviting them out for lunch is not appropriate.  It's not that we don't want to go out with you or that under different circumstances we'd refuse, but our jobs force us to keep a certain personal distance from you when it comes to socializing.

A lot of doctors and medical people are into music and a $10 iTunes gift card is a great, great gift.  That's a great one because if you give it to a doctor and they're not into music, they can easily re-gift it to their staff.  You cannot go wrong with pens.  Every clinical person likes pens, and we go through them constantly.  Go to Things Remembered and have their name (including the M.D. or whatever their suffix is) engraved on a $10 stainless steel pen.  Virtually every doctor and medical person I know has at least one of these and it's like a medal of honor for them.  They get lost and stolen sometimes but then other times I see them in the pockets of clinical people who say they've had them for decades.  If they say "you didn't have to do that.", just say "ah, it's nothing, I insist."  Suddenly, you've gone from "another pleasant patient that comprises 80% of my patient base" to the person that pinned that particular medal of honor to their lab coat.

Medical people love this, and there's a damned good reason why.  Virtually everyone else with only a few exceptions in today's service economy can expect some sort of gratuity tacked on to the cost of their services.  Except the people who work the hardest for you, like doctors.  Those folks are just supposed to get by without it, because supposedly their lives are all Gucci and Polo and lunches at the golf club and it's understood you're grateful, right?  Wrong.  Buy them some bagels and make sure they know you're grateful.  You never know, if the office is chaotic that day, those bagels may be all that doctor gets to eat that entire morning.

Let's say for a second though, that you don't have an extra ten bucks or you didn't think ahead of time to get something.  This is also perfectly fine because two of the most potent gifts you can give doctors and clinical staff are totally free.  Compliments, and referrals.  Compliments are music to the ears of both doctors and staff, and if you want to REALLY get on the good side of a receptionist, tell the doctor they work with how much you liked their office or their front desk staff.  The only thing that circulates around an office faster than a complaint is a compliment.  Don't be self-conscious.  Just do it.  We didn't get into this career to have people bitch at us for thirty years every day.  We got into it to help people and because it's pretty gangster to heal people that are in bad or desperate shape.  Compliments make us remember why put up with people bleeding/vomiting on us or calling us at 2 AM the rest of the time.

Finally, referrals are the ultimate compliment.  Sending someone you know or love to a doctor is the highest compliment you can pay them.  You're so confident that they're good that you want everyone to know about it.  This actually can change a doctor's life.  Going to Yelp.com and leaving them a glowing review or talking about them at a party or sending them even just one patient is the lifeblood of their practice, and referred patients are a thousand times easier to work with than people just off the street.  A loved one or friend that you've sent them comes in already knowing that they're competent and ready to help, and any goodwill your doctor has toward you will extend to them.  This is an incredibly powerful thing you can do for a doctor and it's the sort of thing medical people do for each other when there's a significant mutual respect.  No doctor will ignore or misinterpret this as anything but a very high compliment.

So we've got that, right?  Small gifts, food, compliments and referrals are perfect.  Expensive or large/awkward gifts are a no-no and invitations are awkward and inappropriate.  Wow, now you're a high-roller and you can call the office and they know you by your voice alone and you don't have to wait three months to get in and if there's an opening the receptionist will actually CALL you instead of just saying they will.  How about that?  All's going well until...

The Bill
Appropriate: Asking a coder/biller for a detailed explanation of your bill after your appointment is over.
Not Appropriate: Calling or directly asking your doctor about your bill.

The Logic:  Remember in the film The Matrix when the characters were stuck staring at a screen with cascading flourescent green coding on it.  "What's that?" Neo asked, "The Matrix," the other shrugged.  The doctors that perform your healthcare have something like that going on in their heads at any given time.  A long string of combinations of drugs and symptoms that looks like the most complex NYSE stock ticker ever invented.  They're thinking about four or five things at once for most of their workday, and generally none of them involve your finances.  Unless the practice you go to consists of just a single doctor and no support staff at all, they're not going to know the answers you want.  Coding, billing, and collections are the part of medicine that everyone, including the people who do it, loathes.  This is a job that's usually either given to the front-desk staff to slog through or a support person called a Coder or Biller.  A Coder/Biller is the person you want to talk to, if one exists, because they can tell you in very fine detail how the process works.  Yes, it's incredibly confusing, even for them, and there are times when the best they'll be able to give you are estimates of what you'll owe.  Nonetheless, it's the Billers/Coders you want, not the doctors, and only AFTER your appointment.  Unless they suggest it, don't try to spend your waiting room time talking to the billers.  It's sort of a dick move and chances are there's someone already talking to them right that moment.  If you tell them you're going to talk to them after the appointment they'll have time to finish whatever they're doing and pull up your account so they can go through it themselves before you start grilling them.

All right, that's it for today.  More next week!

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