Practice owners and office managers are rightfully concerned about the patient experience throughout an office visit. We know that a pleasant and impressive experience leads to good reviews on social media and more word-of-mouth referrals. So here is a factor you should consider and work with your staff to improve upon: asking patients for the same information multiple times.
I first noticed this when I was the patient seeing a physician in various settings and I became acutely aware at how commonplace it is and how annoying it is. It occurs in office visits with various medical specialties, dentistry, hospitals, outpatient centers and optometry. Front desk staff, nurses, technicians, and doctors all ask the patient the same questions, which were also usually asked on an intake form of some sort that the patient just completed.
When I encounter service problems in my own life, I routinely ask myself how my own practice handles the issue. I must admit that we have room for improvement here.
The medical staff does not realize the issue in most cases, because each person involved thinks they are the first to ask the question, but the patient giving the answers is keenly aware of the duplications. Patients usually comply and just give the information again, but an impression is formed that the health care delivery system was poorly designed and that one hand does not know what the other hand is doing.
Review what you ask
I recommend you gather all your office forms and medical record templates and meet with your staff to review the questions you ask of patients.
Here are a few common questions that are asked repeatedly:
• Current medications
• Allergies: general allergies and allergies to medications
• Date of birth
• Name of other medical providers and date of last visit
• Medical history
• Ocular history
• Family history, including glaucoma and macular degeneration.
• Smoking habits
• When are glasses or contacts worn; how old are glasses or contacts?
• Chief complaint
• Occupational visual needs
• Lifestyle visual needs
• Questions about medical insurance or vision plans
Next, review who, when and how the questions are asked. Here are some typical interactions:
• Patient history questionnaire. Some practices use a very detailed form, covering a review of systems and past social and family history, but it is very rare that anyone actually reads all of the answers. This long history form is just to have in the file in case the practice bills medical insurance for a 99 code.
• The clinical technician may take the history again in pretesting.
• Many practices require the patient to complete the history intake form every year. It may be reduce duplications if the technician just reviews the history data verbally with established patients and updates aspects like current medications.
• The tech may ask family history questions again when screening tests are done like macular pigment density, tonometry or Optomap.
• The OD may repeat questions at his or her initial encounter with the patient.
• Questions about allergies and meds may occur again when drops are instilled or when other therapies are started, like contact lenses or drug prescriptions.
• The OD may ask medical history questions again while performing an exam of the fundus or anterior segment.
• The optician may repeat questions about occupational or lifestyle needs at frame selection.
• Many staff members may ask about insurance plan coverage throughout the visit.
Consider how you ask
If a technician takes the case history in pretesting, the optometrist generally wants to review it verbally with the patient to gain a true understanding of the details. That does not mean it was inefficient for the tech to ask the questions and record the answers. But it might be helpful if the doctor would say something like: “Mary (the tech) indicated that you sometimes see floating spots, please tell me more about that.” That approach is much preferred over the doctor simply asking (for the second or third time) “what brings you in today?”
It’s just easier to ask
If I consider why the staff members in any practice might ask for the same information repeatedly, the main reason I come up with is that it is easier and quicker to just ask. If that is the cause, let’s make it easier for doctors and staff to find the information in the patient record. Some of the issue may simply be training everyone about where to look. We may have to break some bad habits. We may have to provide more workstations or tablets so the record is more accessible. Or consider printing some key information so it is easily seen during the visit and the paper can be shredded afterward.
In some cases, new procedures are implemented in the office for good reason, but old ones are not purged and eliminated. Redundancies are created. That is why a complete review of a typical patient visit is a good idea.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.