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Finishing Touches


Volume 39 Issue 6 November/December 2006

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Finishing touches

Top off the visit with stellar service

By Rachel Sobel

You’ve eaten a wonderful, leisurely dinner at a nice restaurant. You enjoyed a fresh salad and an inventive, delicious entrée, brought by an attentive waiter. You cap the evening off with dessert, which, unfortunately, falls flat of the expectations the rest of the meal created. And when you are ready to get your check, your waiter seems to be on break. You lie awake that night wondering if your cappuccino wasn’t decaf, as you had asked for. An otherwise delightful evening has soured in your memory. You decide, around midnight, that you won’t be going back to that restaurant.


A patient’s opinion of an office visit also can change when the ending does not go well. A 1997 study found that more than one-third of encounters ran into a snag toward the end. (1) Fortunately, there are ways you can help ensure the patient leaves satisfied and likely to comply with the doctor’s orders.


Begin with the end in mind


The road to a happy ending begins before the patient even steps foot in the office. When patients have clear expectations of what will be covered in a visit, they are more likely to leave feeling that their needs were addressed.


“Make sure you understand what the patient expects and thoroughly explain what is going to be done on the visit,” says Amy Fine, CMA, who works at Winston-Salem Womancare PA, S.C.


Repeat the purpose of the appointment at the end of the call; for example: “Dr. Smith will see you Wednesday the 29th at 3 p.m. to check how your new medication is working for you. We’re looking forward to seeing you.”


Also, when scheduling the appointment, encourage the patient to write down any questions they may have prior to the visit, recommends Rosemary Steffens, CMA, from the Kidney Transplant Program, Medical College of Georgia, in Augusta. This can help prevent the “hand-on-the-door,” last-minute questions that can frustrate doctors and leave patients feeling rushed at the end of the visit.


Steffens adds that it’s important to make sure you have test results and labs ready and available so the doctor does not have to spend time tracking them down. “Our practice relies heavily on labs and test results,” she explains, “rather than a hands-on assessment with the patient. Without the results, valuable time is wasted.”


Be honest with waiting patients if the doctor has had an emergency to handle or gotten behind, Fine suggests. “That way the patient won’t think it is their fault if the provider ‘rushes’ through the appointment,” she says.


Use subtle cues


“We see a lot of patients that just need to talk,” says Margie Tysinger, CMA, from Primecare of Southeastern Ohio, in Chandlersville. “We’ve all had that happen where we’re thinking, ‘Is she ever going to come out of that room?’ and we fall behind.”


Cynthia Grosso, founder of the Charleston School of Protocol and Etiquette, in South Carolina, suggests a change in body position as a cue to end a conversation that has gone on too long. “You can do more with the body positioning and things that are not verbal than verbal things.”


For example, sit down whenever possible when speaking with a patient, even if it’s only for a minute. Sitting down with the patient shows that you are listening. Importantly, it also gives you the opportunity to stand up, which signals that it’s time to wrap up the conversation. Other nonverbal cues include:


  • Shifting your position
  • Moving closer to the door
  • Closing the patient’s paper or electronic file
  • Shaking hands or giving a pat on the back


There are also verbal cues you can use to subtly close the conversation without cutting off the patient. “Smile, and in your conversation bring on a wrap-up,” says Grosso. “Thank them for coming in. Say it was a pleasure to see them today. Ask if there is anything else you can do for them today.”


Give clear instruction


It’s a lot easier for the patient to leave comfortably if they know what is expected of them, both at the moment and at home. For example, telling patients what to do after they get dressed can prevent them from sitting in the room wondering if they should come to the front desk or wait there for someone to return.


Also make sure patients understand everything the doctor covered with them at the visit, especially new prescriptions and follow-up instructions. This is where written information can help. The doctor Tysinger works with has various handouts in the computer he can print and give the patient before they leave the exam room.


Patients who are dealing with difficult diagnoses or complicated treatment plans can be the hardest with whom to end visits. Fine recommends helping the patient find a comfort zone, both emotionally and in terms of all the information they were presented. She also stresses letting the patient know they shouldn’t hesitate to call the office if they have any questions.


It’s not over ‘til it’s over


“A lot of times the patient will get out to the window and remember something they forgot to mention,” says Tysinger. If the patient has further concerns that you cannot address after the doctor has moved on to other patients, you have a few different options, depending on the doctor’s preferences and the patient’s situation. You could offer to do any of the following:


  • Ask the doctor to call the patient later
  • Let the patient wait until you can catch the doctor between patients
  • Make a follow-up appointment to address the patient’s concerns


“What you don’t want to do is tell the patient there is nothing else you can do for them,” says Fine.


Following these techniques and treating patients with kindness and courtesy can help ensure that each patient leaves satisfied. This is so important because, says Grosso, “Patients are paying customers who have a choice.”




In today’s environment of increased competition, treating patients as valued customers has become more important. Cindy Grosso, founder of Charleston School of Protocol and Etiquette in South Carolina, specializes in teaching medical and dental offices how to provide “the total patient experience.”


“It goes beyond bedside manner,” Grosso explains. Here are her tips for medical assistants:


  • Focus on the person, not just the task or situation.
  • Speak in a pleasant tone of voice, and never talk down to a patient or be abrupt. Even if  you make a mistake, your tone will make it easier for you to recover from it.
  • It is not your actions, but your attitude that is directly related to your success. “You might think holding a door open is an action,” Grosso says, “But it’s an attitude.”
  • Follow the golden rule. “A warm handshake, a pat on the back, reassurance—these are huge,” says Grosso.
  • Go the extra mile. Offer a bottle of water as the patient walks out, or ask to see pictures of the patient’s grandchildren.
  • Smile.


White J, Rosson C, Christensen J, Hart R, Levinson W. Wrapping things up: A qualitative analysis of the closing moments of the medical visit. Patient Education and Counseling. 1997;30:155-165. Abstract.

Rachel Sobel is a Chicago-area writer and editor specializing in health and managed care.

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Author: Rachel Sobel

Source: CMA Today

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