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8 Business Lessons I Learned From My Patients

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When I was a young woman living in New York City, I made a check-up appointment with a medical doctor whose office was two blocks away from my Bay Ridge apartment.  My appointment was at 3:00 and as I already knew that doctor office appointments in New York were historically lengthy, I took a ½ day off work to accommodate the doctor. I showed up 10 minutes early to fill out paperwork.  I was surprised to see the office filled with patients, wall to wall.  I asked the front desk attendant when she thought I was going to be seen.  She said she didn’t know; that the doctor wasn’t in the office yet and some of these people had been there since 12:30.

I looked around and replied, “You know; I live two blocks from here.  How about I go home and you call me about 10 before you think I can be seen, and I’ll come right over.”  The front desk attendant didn’t like that idea at all, and told me I’d have to wait in the doctors office or reschedule, but I’d be charged for the appointment regardless.  I couldn’t take another day off my new job, so I waited.

It wasn’t until after 5:00 when I was finally allowed to see the doctor.  In the examination room, I waited another 15 minutes until the M.D., head down, asked why I was there.  I said I was there for my annual check-up, and he promptly scribbled something on his chart.  Without saying another word, he left.  Ten minutes later, presumably a nurse or physician assistant came in and quickly drew my blood and took my blood pressure.

That was it. I had questions and thought I would have another chance to converse with the doctor, but know. At 5:30, I was shooed out of the room to the front desk where I was told, “That’s it.”

I don’t remember who the M.D. was, primarily because I never really saw his face.  I don’t remember who the staff was.  But I do remember that my time and my health wasn’t respected.  I never returned. That was 1990.  It is now 2013.  Twenty-three years have gone by and I can’t remember what my concerns were, but I remember well how little I was valued.

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How do you want to be remembered?

That question follows me into my office every day.  The lesson I learned in Bay Ridge Brooklyn in 1990 has never left me.  I try to do everything I can to respect my patients time and personhood. I spend quality time trying to understand their concerns and goals, and to let them know they are more to me than just a commodity on an insurance submission.

Still, if I were perfect, I would have sublimated from this world into the starry heavens by now.  My wonderful patients teach me every day lessons about life and business that are invaluable to me.  They are my greatest teachers in life, love, and success.  I’d like to share some of their wisdom with you so that you might benefit from them as I have.  So, without further ado, here are 8 business lessons I have learned from my patients.

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1. Patients (and Customers) Come First

This should be just rote common sense, but when you and your staff is faced with a full schedule of meetings, marketing, records, chores and district manager evaluations, it can sometimes be easy to overlook the very reason you exist.  This is never a sustainable policy..

Chances are you work either directly or indirectly for a service industry.  Unless the client or customer is clearly unreasonable, If a client or customer request comes your way and your task is to take care of a question, concern, or job order, that request comes first, no matter what.  Either you fulfill the request yourself or you make sure that members of your team fulfill the request.

This is never more imperative than for a doctor’s office or hospital.  We provide a service for which the need is often immediate.   All-too-often we hear stories of insurance hang-ups, passing-the-buck problem solving, and just plain dropping the ball somewhere in the line of patient management. When it comes down to priorities, the person who has an appointment at 4 is not an item on a “to do” pile.  It is a person who needs our help, and the entire reason our jobs exist.

No matter what, in whatever profession, never forget that the whole reason your job exists is because someone needs your help.  Paperwork be damned!  Meeting with sales rep: I say nay!  If someone somehow made it to your office for help and you’re open, then go help them.

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2.  Be Honest

Patients know if you’re not sure about a diagnosis.  They can smell it on you.  They whisper about it in the examination room and discuss it with friends and family.  However, they’ve been trained to obey your assessment, even if they sense that you’re not sure.  So you have a duty as a caregiver to be honest with them and tell them how sure you are about their diagnosis.  Patients, in the long run, just want to know you care enough to be honest with them.  If I’m not sure of an assessment or outcome, I will admit it.  At least they know where I am and we can work together to find a solution from a basis of trust.

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3 Avoid the Offensive and the Defensive.

Back in the day…you remember: pre-Bauhaus…there used to be a saying: “The Customer Is Always Right.”  Well; of course the customer is not always right.  The customer is not always well-informed, so they cannot always be right.

The statement is more of a guideline than a rule (thank you, Captain Barbossa).  It is a guideline to help you listen to your customer, client or coworker. We often develop a knee-jerk defensive attitude when a person comes at us leading with disapproval.  It is easy to react by saying, “you should have done this,” or “That’s not the way we do things around here, Sir/Mam.”

By the way: just a regional note regarding the terms, “Sir” or “Mam:” I grew up in North Carolina and spent a few years in the Midwest, so I know that the use of the formal address in these regions is traditionally employed as a respectful way to address someone.  However, I’ve lived in the Northeast now for close to twenty years.  If you are from the Northeast – in particular, New York – using those terms to address someone is viewed as a passive-aggressive insult, and is usually met with a bristling retort. It doesn’t matter if you are fifteen and the person you are addressing is eighty; take note of the accent of the person you are addressing and respond accordingly.

It is no fun to take it on the chin, and very emotionally gratifying to put people in their place – but it is not the smart thing to do.  Winning the battle is not worth losing the peace, unless the person you are dealing with is truly malicious. Most times, the people with whom you deal are simply carrying around injuries that pop out from time to time.

As a doctor, I find that people in pain are usually quite pleasant when they first meet me, mainly because they really hope that I can help them.  I’ve been lucky in that there has only been one patient in my career who read me the riot act, and it regarded an employee who worked my front desk.  This person perceived that this front desk person was rude to him, and I am the one who received the resultant rage.  I gracefully dealt with it calmly and to the satisfaction of everyone involved *whew!*; however, I have colleagues – particularly my medical colleagues –who have not been so lucky.   What they experience is that the minute a patient in pain suspects that their needs are not addressed thoughtfully, they turn and attack likes a wounded animal.

Confusion often leads to emotional hostility because our brains are primarily information-gathering devices.  The brain has one directive: to seek out problems wherever we may find them in order to protect ourselves from that problem.  Luckily, we have developed forebrains that help us filter input and learn peaceful responses, but our hindbrains are much older than our forebrains. Millions of years of evolution have led the human animal to react to perceived injuries first and ask questions later.

Without enough information and when left to their own devices, our brains can imagine all sorts of creative oddities, like conspiracies and thoughtlessness and outright malice.

It is well for doctors to remember that a patient in pain is a wounded animal.  It is well for business leaders to remember the same can be true of a reactive client or coworker.  Make sure you’re not adding to the problem as one of walking wounded throwing your pain vicariously on them.  The only time I’ve have gotten away with occasionally flying off the handle verbally is with people who love me and who care enough to work things out with me (thank you, family!).  Clients and coworkers do not always care that much for you, and sometimes it is hard to keep your trap shut…but keep your trap shut.

Our problem is not whether or not we are right.  Our problem is a customer, boss, client or coworker who feels they have been wronged, and they will most definitely show you how they feel.  If we are lucky, they will calmly try to resolve the misunderstanding, but we are not usually that lucky.  Usually, when people are confused, they formulate opinions based on an archetype they have developed.  When people objectifying us like that, they end up either talking (or yelling) at us instead of with us; voting their confidence with their feet; and complaining to at least ten different people what an awful experience he or she has had with you.  Worst-case scenarios are physical confrontations and law suits.

It takes thoughtful leadership to recognize that sometimes, when an angry customer, client or coworker who presents him or herself in a manner you find displeasing is just suffering from misunderstanding. It takes thoughtful leadership to listen artfully to their position before telling them yours, and to find a solution cooperatively.

You can start by not jumping right away to a defensive or offensive position.  Take note of the person’s stance and do more listening than talking.  Take time to get past their attitudes.  Get to know them, their expectations, their history, and their pet peeves.  Through active listening, you can better determine where the miscommunication occurred.  Chances are you have the solution they are looking for but for which they just don’t know how to ask.

Which leads us to #4.

4. Ask meaningful questions.

I was reminded of this lesson after reading John Cramp’s Riverstone Group blogpost: “The Simplest Leadership Lesson I Ever Learned but Use All The Time http://www.theriverstonegroup.com/2013/07/30/the-simplest-leadership-lesson-i-ever-learned-but-use-all-the-time/.”  In the post, he describes using the 1-10 scale to measure the subjective weight of a problem among his team.  1 stands for horrible, and 10 stands for perfect.  When someone comes to him with an issue, he asks him or her, “On a scale of 1 to 10, how critical do you feel this problem is?”

The reasons he uses this scale is to help clarify the weight, height, and width of the issue in the eyes of the complainer.  It gives him an idea the weight he needs to give to the issue.  He then responds in kind as to where he is on the scale and why, so the person understands where he’s coming from.  In doing so, they can work on solutions in an integrative manner with increased clarity as to how to address one another.  It is just one tool in the toolkit of a skillful leader, but an effective one.

We health care providers are trained to ask a patient to rate on a scale of 1-10 how pressing their health issue is to them, so that we can gain insight into the seriousness of the issue. It is often difficult for a patient to articulate the personal importance they place on a particular issue to their health care provider, mainly because they just don’t know the nature of the problem they are facing.  The rating scale helps them to do that.

It is one of a number of tools we use that help us fine-tune accurate diagnoses and develop appropriate treatment plans. It also helps us evaluate the effectiveness of a treatment plan when we revisit the issue later and evaluate the level of progress by comparing scores.  When I read Cramp’s blog post, it reminded me that I could integrate that tool in regular communications with my team and even my personal relationships.

Other examples of meaningful questions to patients include: “What are you expecting to gain from your experience with us?” “How important to you is it that you meet your health objective?” “What is the primary reason you wish to succeed in meeting your health objective?”  The last one may be tricky, because a patient may not know how to articulate the real reasons behind wanting to get better.  For instance, they might articulate that they want care in order to feel better, but the real reason is because they want to be able to sit on the floor and play with their children or grandchildren.  Try to guide their evaluation of their expectations toward a truly meaningful reason to get better, and have them revisit this reason when commitment becomes difficult.

In the same way, we can come to understand the expectations of your client and coworkers. “What do you want this item/experience to do for you?” “How important is getting the right experience to you?” “What is the primary reason for which you need this to happen?” When we determine clear reasons for our objectives, we can articulate them back to them in order to show them we understand their needs. In this way, they will be more willing to work with us toward attaining these positive outcomes.

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5. Use the three-times rule.

People remember things in threes.  When patients come in, I tell them what is going to happen during this visit. “The purpose of this visit is to determine what is happening with you and whether or not you are a candidate for chiropractic care.  You will receive full orthopedic, neurologic, nutritional, fitness, and chiropractic evaluations.  If we determine that your case is appropriate for chiropractic care, we will determine together a treatment plan that meets your health care goals.  If not, we will refer you to a health care provider that we think is more appropriate for your case.  Sound fair?” The last question is important, because it will encourage active engagement from the get-go.

Then, as the examination progresses, I tell them what we are doing.  “All right; now we are performing the neurologic examination.  Now we are moving on to the orthopedic exam.  Now we are…” and so forth.  When we are done and I’ve determined a report of findings, I start with, “The purpose of the exam was to determine if your case is appropriate for chiropractic care.  We performed an orthopedic, neurological, nutritional, fitness, and chiropractic exam.  Based on my findings, I am recommending…” and then I go over the findings to explain.

Again, people remember things in threes.  When people are in pain they are scared. They won’t remember what happened later and may think that nothing happened.  By telling them what is going to happen, what is happening, and what just happened, there is a better chance that they will retain the information the way you intended to deliver it.

This is the same in business.  While your position may not carry the same level of emotional authority as a doctor’s might, they still may be intimidated given a new situation, especially if they aren’t sure what they want nor how to proceed yet.  The “Tell It In Threes” rule lets them absorb the information better so that they can respond in a more informed way. Ultimately, it builds trust.

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6. Ask them to repeat what they just heard and to ask questions about what they just heard.

This is critical: get them to repeat what was covered so that you know if you were understood, and ask them if they have questions about what was covered. When they respond with questions, listen to the whole question without interrupting and take a breath before answering.

It may sound silly to proceed this way, but people get confused in a new situation and are easily intimidated by doctors.  Most people are eager to please, and sometimes they will agree to treatment without fully understanding what happened to them and why they agreeing to a certain course of care.  It also fools the practitioner by thinking that their patient is on board with them, when really they are just too overwhelmed to take in what is happening to them.

Don’t rush this last step. For doctors, this is the most important step in successfully concluding an examination and gaining their commitment to a course of action. The breath will allow you the moment you need to take in the fullness of their question.  Early on in practice I found that I was so eager to help, I sometimes jumped in and finished their questions for them – often with the wrong conclusion.  They wouldn’t correct me; they were too intimidated and they wanted to please me.  But they didn’t quite trust my opinion after that experience, and rightly so.  People need to know we care about what they think; and if we answer a question they didn’t ask, they will understandably distrust us.

The same is certainly true in business.  If I think anyone has a set agenda they are trying to sell me, an agenda that is beyond my expectations and understanding, I personally will not proceed further without clarification.  But others will nod and act like they are on the same page as you, and then leave uncommitted to your vision because they think you haven’t a clue as to how things really are with them.  You don’t want your team thinking that, and you don’t want your customers feeling that – because they won’t be your customer for long.

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7. Mirror body language and speech patterns to engage them effectively.

Not everyone is like you.  If you are excitable and wave your hands around when you speak and you are lucky enough to be sitting across from someone who communicates the same way, great.  But if you are sitting across from a demure individual, they are going to think you are a crazy person and high-tail it out of there as fast as they can safely escape.

Or, you could be the kind of person who feels it is important to use just the right tone to communicate an idea.  However, if you lean back in your chair, stare at the ceiling to find the right words, and speak slowly and carefully with attention to your tone while they are leaning forward and looking purposefully at your face, they will either believe you couldn’t care less about the subject and are uncommitted to what is coming out of your mouth, or their brains will already be on getting out and meeting their friends for handball.

Health professionals are advised and trained to mirror someone’s behavior when they come in so that they can establish rapport with that individual.  People process information on a spectrum of visual, auditory, tactile, and kinesthetic input.  Most people are visually dominant – about 65% of the population.  They like graphics and pictures, and they like to take notes even when notes are given. They look you in the eye, and when bored, assess your hair, dress, rings, shoes, and the way you present yourself.  They are easiest to spot when they are uncomfortable about answering a question, because their eyes dart or fall to their hands.  They say things like, “I see what you’re saying, Doc; but break it down for me in bullet points.”

Auditory dominant people account for about 30% of the population.  They rely more on what you say and how you say it, as opposed to pictures and models.  They may stare past or right through you while you talk, because they focus on the sound of the message. They are often articulate and speak using a range of pitch when conveying ideas.  They might say things like, “I hear what you’re saying, and it seems you have given this a fair amount of thought; however, I wonder whether there are alternatives approaches worth exploring.”

Tactile/Kinestetic dominant individuals account for about five percent of the population.  This is the group of people who have a hard time sitting down and listening for a long time to a detailed explanation.  They fidget and move about when in a room too long; they pace and talking with their hands when conveying an idea. This is the gang who will not remember what was said, but will remember how they felt about the experience.  They appreciate models and learn best by physical examination of materials.  When they speak, they like to touch your arm while conveying an idea, and appreciate a hug or a pat on the back.  Sometimes people think they are “slow learners,” or suspect that they have attention deficit hyperactivity disorder, but this is not the case. They just like action over words. They might conclude a meeting saying, “So, what should I do?” Many chiropractors fall into this category. Little wonder, because we work with our hands all day.

This is a base minimum of personality profiling when communicating with people.  However, if you can learn to recognize just these characteristics, it will go a long way to conveying your ideas to them.  For visual people, use a lot of pictures and give them time to take notes.  For auditory people, try to vary your pitch and speak with emotion and meaning.  For kinesthetic people, make it quick and lively.  Talk with your hands and don’t be afraid to pat their shoulder when shaking their hand.

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8.  Follow up.

This is the rose on the icing.  After each initial office visit, at the end of the day, I’ll call my new patients and say, “Hello; this is Dr. Fitzpatrick.  I’m checking in because I know we covered a lot of ground today and I was wondering if you have any questions.”

When you follow up, it lets your clients and customers know that you are committed to giving them over-the-top service, and that you really care about what you say and do.  Even if they don’t have any questions or you just leave a message on their voicemail, that kind of caring goes a long way toward building trust and a positive working relationship.

A chiropractic coach named Dr. Bob Hoffman of The Masters Circle teaches his clients that people leave you before care is finished because either they didn’t love you enough or you didn’t love them enough.  At the end of the day, it’s about how someone feels about how they are treated.  Whether you have the same interests or not, everyone appreciates respect and courtesy. Old-fashioned manners go far these days in a world where manners can often seem as rare as snail mail.

so let’s repeat the eight key business lessons I’ve learned from my patients:

1. Patients (and Customers) Come First

2.  Be Honest

3 Avoid the Offensive and the Defensive.

4. Ask meaningful questions.

5. Use the three-times rule.

6. Ask them to repeat what they just heard and to ask questions about what they just heard.

7. Mirror body language and speech patterns to engage them effectively.

8.  Follow up.

What are the most valuable business lessons that you have learned from your clients, coworkers, or patients?

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