Borrowing from the theater to aid your practice's patient relations

I’ve never acted but I enjoy the theater, and so in order to make each second with my obstetrics patients count, I’ve come to think of them as patrons at a show watching a short play.  In this production, I’m the playwright, director, set designer and lead actor.  If the show’s a hit, not only are my patients’ experiences enhanced but the quality of my relationships with them is, too.

Mine is a multicultural maternal fetal medicine practice near Washington, D.C. My role is to perform consultations and outline a plan of care at the beginning of a high- risk pregnancy and to interpret and discuss ultrasound findings with my patients. Like most physicians, I struggle to make patient interactions the priority with so many other professional responsibilities competing for my time.

While not everything that works in my practice may be generalizable, here are some of the ways I borrow techniques from the theater to benefit the up to 40-45 patients I see each day.

I set a welcoming and inclusive stage, starting with the waiting room:

There is comfortable seating for patients of all sizes.

I have learned that if my patients bring young children, it is easier on them and us to embrace that fact: We have toys and books in our waiting room that the children can bring throughout the unit.

Our wall art reflects the diversity of our patient population.  I enjoy sharing a collection of figurines of pregnant women or mothers with babies from around the world in my consultation office that is much admired by my patients.

Next:  I view the office staff as my stagehands

 I view the office staff as my stagehands:

While taking patients back to the examination room, nurses explain how much time they can expect with me depending on the type of visit.  They identify clinically urgent issues mentioned by the patient and let me know what those are. Finally, they flag language difficulties and have translator phones ready to go.

I make sure my staff hands out programs:

I have developed or acquired specialty-specific handouts with translated versions available as necessary. These include  frequently-asked questions that can be reviewed by the patient while receiving care from support staff or while waiting. For example, in our office we have information on testing for age-related aneuploidy, diabetes during pregnancy and how to do fetal kick counts. This will cut down on repetitive questions and leave time for
issues specific to the patient.

The curtain rises: 

Before entering the room, I briefly review the chart to remind myself of the patient, her case and personal details. Taking the time to update a problem list helps, especially in a group practice.

A first impression takes no time: I enter, neatly dressed and groomed, with a smile and an outstretched hand.

As best I can, I greet everyone in their native language: “Hola,” “Akwaaba,” “Marhaba,” and “Bonjour” are as likely as “Hello” to be my opening lines. Sometimes this is awkward and I am quickly found out when I whip out my translator phone, but at least I’ve made the effort. I then shake hands and make eye contact with everyone in the room. Finally, I sit down and look as if I have all day.

Next: Now on center stage, I act like a doctor

Now on center stage, I act like a doctor.

At a first visit I ask the patient if she knows why she is there so as to understand what she hopes to gain from the visit, and to redirect such expectations if necessary. A patient may be sent to discuss her obesity in pregnancy but thinks she is there to find out the sex of the baby.

I discuss my findings and recommendations with patients, while trying not to just talk at them. I make schematic drawings if appropriate. I show them their ultrasound images and highlight trends in their lab results with a pen. I keep laminated peer-reviewed papers and professional guidelines on certain topics, like stillbirth rates at term for high-risk populations, in the patient rooms so I can easily cite them with authority.

I am not afraid to document in front of the patient in the electronic health record. I will read over my history and recommendations to the patient as I am typing. (Note: my mother made me take typing in middle school, so I may have an unfair advantage in the “talking-while-typing” regard). The patient perception is a bit more time with the doctor, and on my end I am getting some of my work out of the way. This is billable time, by the way.

I always ask, “Do you have any more questions?” I answer them if they do.

I stand up only when the questions are answered, and I am prepared to sit back down for the “one last question.” No talking while standing up with a hand on the doorknob!

I stick to the script. The doctor’s office is no place for time-wasting improvisation.

I don’t use a patient visit to talk about my last vacation or my kids or my golf game. This is the patient’s time and there is precious little of it. Focus on them.

Conversely, I don’t pepper an “interesting” patient with questions about issues not related to their health just because I am curious-or want a tip on real estate or the stock market.

Next: Now on center stage, I act like a doctor

The show is over. My favorite trick to end the visit is to extend it:

I leave every patient after a first consultation with my secure email to use for any further non-urgent questions (and instructions to use a phone for emergency matters). I have had very little abuse of this privilege and have found it gives patients security knowing that they can have further access to me if needed.

On my end I can save any correspondence that does result for the chart. Even non-English speakers utilize this as they typically have someone in their community who can translate for them. There is a bonus for me as well of this approach, which is the hundreds of baby photos and family updates that mothers have sent in over the years.

Remember that unlike a new run of a play that may have only a couple of critics in the audience, you have dozens of potential reviewers every day. 

But there is more than preserving one’s online reputation at stake. Even on a tough day I try to see each patient as an opportunity for a personal, one-on-one connection and not as an obligation. Such bonds confirm why I chose medicine in the first place. I’m comfortably mid-career and am grateful I still see serving my patients not as a bother or means to an end, but as the privilege it is to serve people from all walks of life at the most important time in their lives.  

By seeing my patients as my valued patrons, I make time for them, and in doing so make time for my own humanity as well.