Wendy Lewis explores the root causes of why cosmetic patients often vote with their feet.
The idea of losing a patient is not something any doctor likes to think about. Sometimes it happens naturally because the person moves, changes jobs, or passes away. But sometimes the patient is just not happy with the practice or didn’t like the doctor or staff. On these occasions, patients may be less likely to complain directly and will simply not come back and find another practitioner. In extreme cases, however, they may turn to Yelp to express their dissatisfaction.
Keeping your practice busy depends not only on being a good practitioner and delivering beautiful results, but also on patients being satisfied with the care and service they receive. Patients will rate you on their entire experience in the practice.
Cosmetic patients who leave fall into two general categories: those who come once and never return, and those who just stop coming abruptly after a relationship has been established. In some cases, the reasons a patient does not return are unclear and may have little to do with your performance. They may leave you for practical reasons, like switching to a clinic closer to home or work, going through a job loss or change that necessitates cutting back, or they may find cheaper cosmetic services somewhere else.
Understanding why patients leave is the first step in learning how to prevent attrition. Aside from the obvious, such as waiting times, bedside manner, overcharging, appointment snafus, and sloppy front desk treatment, there are more subtle reasons patients jump ship that you may be overlooking.
The first step is to talk to your team about any patients who seem to have disappeared and see if anyone knows why and check their charts. Consider anything that may have affected their decision, and if there is something you need to worry about. Was there a dispute over a bill? Were they unhappy with their last treatment? Or did the patient move or have an illness? There is nothing more unsettling than receiving a letter from a patient with a request for their records, especially if there is an ESQ. on the masthead.
Patients may also leave without any notice or explanation. Unless they miss follow-up appointments or do not reschedule for their next filler or IPL treatment, you may not even realize that they have left you. It is reasonable to send a courtesy email or friendly follow-up letter that is not too intrusive; for example; ‘We noticed that you missed your last appointment. Please contact us at your earliest convenience to reschedule.’
Occasionally a patient will simply vanish for a few years and then reappear when they move back to the area, get a new job or are finished raising a family. They may also come back to you because they couldn’t find anyone they liked better.
Another way doctors lose patients is to break up with him or her. Think of it as the ‘It’s not you, it’s me’ strategy. This doesn’t happen very often and needs to handled carefully and sometimes with advice of counsel. Discharging a cosmetic patient can be a lot harder than it seems. In some cases, the patient you wish would leave the practice on her own wants to stay with you forever. If the relationship isn’t working, it is a lot better for the doctor if the patient simply goes away. Think about the patient who causes you to hyperventilate when you see their name on your schedule. As with all human relationships, sometimes the doctor-patient relationship just wasn’t meant to be.
Below, we examine the most common reasons why cosmetic patients tend to move from doctor to doctor, and how to minimize the risk so it doesn’t happen to you too often.
1Doctor no personality
Cosmetic patients have a lot of choices today, and they won’t keep coming back to a doctor who doesn’t listen to them, treat them with respect, or pay attention to their needs. The truth is that they don’t have to. The doctor-patient relationship is built on trust and mutual respect.
Showing some empathy can go a long way in fostering a bond between the doctor and patient. According to a study published by Dr. David Jeffrey in the Journal of the Royal Society of Medicine in December 20161, ‘Doctors need to imagine being the patient undergoing the patient’s experience, rather than imagining themselves undergoing the patient’s experience. This more sophisticated approach requires mental flexibility, an ability to regulate one’s emotions and to suppress one’s own perspective in the patient’s interests.’
Pay careful attention to the kind of feedback you get from patients. Are they happy to see you? Do they refer their friends and family to the practice? Are you getting mostly 4 and 5 star reviews? If so, your communication skills may be just where they should be and patients are connecting to you personally. If this is not the case, it may be time to make some hard changes.
As Gregory James Warth. MD, FACP, who practices concierge medicine in Virginia writes2, ‘If patients perceive that the doctor is concerned for their welfare, they are much more likely to follow the doctor’s plan. The trust and confidence that patients have in their physician is directly related to the degree of concern that they believe their physician has for them.’
Although you may be practicing aesthetic medicine primarily, cosmetic patients have many of the same fears and anxieties of medical or reconstructive patients. This worry can manifest as disappointment and anger, which can be displaced onto the doctor and staff. They may feel that no one is listening to their concerns or cares about them. Patients want to be part of the decision-making process and be involved in their own care.
If a patient is mad at you, try to look past the anger and identify what is really going on so you can address the underlying reason for it. The first step for a physician encountering an angry patient is to remain calm and allow the patient to express his or her concerns. If you can distill the patient’s anger, you have an opportunity to turn it around and retain the patient, that is, if you want to. However, if the anger festers, there is a danger of letting it infect other patients in the waiting room and online.
2 Lack of availability
How long does it take an existing patient to get into see you? If it is more than two weeks, there is a chance that you are losing patients without even realizing it.
Minimising waiting times goes a long way to keep patients coming back to you. Consumers are programmed to wait for potentially life saving medical appointments, like mammograms, a colonoscopy, and skin cancer checks. However, they tend not to plan far in advance for follow-up visits for repetitive treatments, such as injectables, lasers, and peels. Today’s cosmetic patients want their BOTOX® when they want it, and they won’t wait too long to get into see the doctor. If your practice cannot fit them into the schedule in a timely fashion, they can easily find someone else who can accommodate them. In many markets, there are medspas and clinics who take walk-in appointments for non-invasive cosmetic procedures.
Your patients are busy people too and their time is valuable. While they may be willing to make some sacrifices, they also have busy work and family schedules. Maintaining flexible hours can go far in retaining patients. It is essential to offer early mornings, evenings, and occasional weekend appointments to cast the widest net. Patients who cannot get the appointment times they want may end up leaving your practice eventually. This can be avoided by offering more appointment times and being willing to make exceptions for loyal patients and VIPs.
For a busy cosmetic surgery practice, the lead time for a new consultation may fall into the range of three to six weeks. Savvy practices will make exceptions for special circumstances, such as personal referrals that want or need to be seen quickly. Another good strategy is to maintain a waiting list for patients who want to come in on specific dates in the event of cancellations, which are bound to happen. This demonstrates that you are willing to go the extra mile to accommodate them and also allows you to keep your schedule full. You can avoid patients leaving your practice by giving them the appointment times they want whenever possible.
Technology is your friend. Using an updated scheduling system is worth every penny to help get patients in when they want to come and maximize patient flow. Appointment snafus are a major gripe among cosmetic patients. Automating your appointment scheduling, confirmations and reminders can greatly improve efficiency and avoid mishaps as well as cut down on cancellations and no-shows. Similarly, if there are too many hoops to jump through for patients to come to see you, they may opt out. Anything that can be automated through the use of a patient portal on your practice website is another treat time saver for your staff and patients alike.
When it comes to scheduling appointments, ZocDoc.com has got this down. As a member, I can schedule an appointment online; provide the reason for the appointment; fill out the forms required electronically; confirm, cancel, and change an appointment on my iPhone; and send my insurance card via text to the practice. Customer service is exemplary; I get follow-up emails for every appointment booked or moved and if the practice cancels, ZocDoc reach out to find out why and get feedback about my experience. If there is a cancellation generated by the practice, ZocDoc sends a $5 Amazon gift certificate for the inconvenience.
Having simple, streamlined processes in place will help patients to feel that the practice values their time, and can make them more likely to stay on and refer others
3 The doctor is delayed
If you think that your patients don’t mind waiting for you, regardless of how long they have to wait, you are, in a word, WRONG. This attitude can create the perception that you don’t care about them. You are providing a service and cosmetic patients have many options.
Delays are often unavoidable in an aesthetic practice and, of course, patients do not like it. However, their dissatisfaction can be mitigated if you do your best to work with them and keep them informed. When there is a delay in your office for whatever reason, an emergency, surgery running late, device failure, or simply a scheduling problem, it is important to manage the situation professionally and courteously.
Most reasonable patients will understand a delay for an emergency or other reasons, and they will appreciate it when you work with them to accommodate their busy schedules. The worst thing you can do is to fudge or guess at a response to questions about waiting times or lie to them. Be honest at all times or you risk making a bad situation worse. Don’t make lame excuses or attempt to shuffle patients away into treatment rooms to wait there. Patients will get angry and it will come back to haunt you. Just look on major review sites at how many comments there are about long waiting times and delays. Patients will not tolerate being neglected and they do not want to be lied to.
4 Front desk faux pas
The front desk is the lifeline of any practice. The reception staff are the first people patients see on the way in and the last people they deal with on the way out. The way they treat patients sets the tone for the entire practice.
Among the common complaints from cosmetic patients are about the way they are greeted on their first visit to the practice. If the receptionist is texting her boyfriend, shopping online or putting callers on hold and acting disinterested, that sends a clear message about what kind of practice you are running. It is vital to make patients feel welcome and special, and for the check-in process to run seamlessly.
Patients should be greeted when they enter. At a bare minimum, the receptionist should look up, even if she is on a call or on her computer, and acknowledge the patient standing there. Getting patients’ names wrong or having the wrong chart pulled are other mistakes that may fly in an internist’s office but can be real deal breakers in an elite cosmetic practice.
Another equally critical function of the front desk is the check-out experience. Quoting and collecting fees in a professional manner takes a certain skill set. This should be done courteously, quietly, and discreetly. Money should be collected, receipts emailed if possible or printed if requested, and each patient should be offered the opportunity to make a follow-up appointment before they leave the practice.
Lastly, it goes a long way to win patients over to be greeted by name by a staff member who remembers them, rather than with a snippy tone from the receptionist who comes across as disinterested and distracted.
5 Neglecting patient calls and emails
Pay attention to how inquiries, questions, and follow up calls are handled. How long does it take for your practice to get back to a patient on an average day? Make it a priority and set a goal to respond to all patient queries in rapid response mode.
If the call needs to be handled by the doctor, having a physician extender or other staff member call back to do triage is perfectly acceptable until the doctor is available. Some patients will insist on talking to the doctor directly and in those cases, running interference may prove to be a mistake because the patient may begin to feel like he or she is being blown-off.
Not returning patient calls is not an option in a cosmetic practice. The same goes for emails, texts, and Facebook messages. Patients demand to be heard and they deserve to be able to reach someone in the practice within a reasonable amount of time when they need to. Typically, consumers expect to get a response in the same way they reached out, which is the way most service businesses handle inquiries. For example, if the patient reaches out via phone, call her back. If she sends a message on the practice Facebook page, respond back to her in kind.
Many physicians and physician extenders today will give some or all patients their cell phone number, which goes a long way to showing the patient that you really care about them. They may never call you at all, but just having the number at their fingertips gets high marks from patients and offers an extra sense of security. This tactic is especially helpful to manage nervous patients who need a lot of hand holding or who do not have a good support system at home.
6 Hit or miss customer service
Think of aesthetic medicine as a service, not a product.
The level of care your practice provides to patients should be consistent and an integral part of the practice culture. All staff members need to be on board with that concept for it to work. That culture starts from the top. If the physician doesn’t show that he or she cares about the patients, the staff may not be inclined to go out of their way to care for them either. Patients are very perceptive and tend to pick up on the signs. Instead of training your staff to be nice, hire nice people.
Delivering 5-star customer service is about more than just being warm and fuzzy when the patient is under your roof. It’s about the total package; from responding to inquiries promptly, billing accurately, having the right team on board, staying on time and going the extra mile. A patient may overlook an occasional lapse, if they are acknowledged and made to feel that the practice really cares.
Patients also don’t like to be sold or manipulated into having more treatments or buying more products than they really want or need. They also don’t want to be made to feel like the staff is in hot pursuit to get them to do more and spend more with you. Adopt a soft-sell approach instead. Patients will frequently complain or leave practices entirely over money matters, billing errors or misunderstandings. Payment concerns can be a big cause of doctor-patient relationships going side-ways, and also for patients to leave negative reviews. The best way to avoid misunderstandings is to be transparent about fees and billing practices up front, put it in writing and have the patient sign-off on your policies.
The landscape has changed, and patients today leave practices for many different reasons. In order to grow, you need to practice the highest level of patient care 24/7. If you treat patients well, they may tell their family, friends, and colleagues, which can come back to you ten fold in organic growth. Every special gesture, perk, and consideration counts.
The key to success in aesthetic medicine in 2017 is running an efficient practice, caring for patients well, and avoiding the common customer service mistakes. Providing the highest level of care to your patients so that they don’t leave should be your highest priority.
- David Jeffrey. Empathy, sympathy and compassion in healthcare: Is there a problem? Is there a difference? Does it matter? Journal of the Royal Society of Medicine, 2016. Available at: journals.sagepub.com/doi/full/10.1177/0141076816680120 [Last accessed 6 January 2017]
- The Art of Patient care. Compassion in Patient Care. Art-of-Patient-Care.com, 2011. Available at: www.art-of-patient-care.com/compassion.html [Last accessed 6 January 2017]