Monday, November 20, 2017

Likability

Because Press-Ganey is such a big deal lately, I've been trying my best to be more likable to my patients.

I've been mostly trying to be an attentive doctor, because I think that's the right way to be likable.  But I think there's an element of charisma that adds to likability, in spite of any medical care you provide.  That's not something that comes natural to me. 

So I've been trying to be as NICE as I can.  I've been trying to smile a lot... I literally am constantly aware of whether there's a smile on my face, and if there isn't one, I try to put one there, unless we're talking about something sad, in which case, I furrow my brow attentively.  I feel like a freaking saleslady.

Tips? Tricks? Advice?  How do I get people to like me? 

(Story of my life...)

19 comments:

  1. Being sincere. If you are not sincere, not caring of your patients genuinely, it will show. Then again there is patients who will not like us despite our best intentions, effort and going out of the way for them.

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  2. Exactly what anonymous said. I really resent that this is how doctors and medical staff are judged. My OB patients always preferred the not so great Dr that schmoozed with them and their families. I just shook my head.
    The biggest problem I see has to do with the EMR. Pts complaining that we're more interested in the computer than them. So a lot of looking back and forth and letting them know you really are listening...

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    1. I don’t have the EMR problem because I just carry around a clipboard.

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  3. I don't spend a lot of time smiling at my patients, but I think I have a pretty good rapport with most of them. I think being attentive and listening to patients' concerns is one of the best ways to get them to like you. And sometimes that means looking at the weird rash that doesn't relate to your area of expertise. It takes 10 seconds to look at it and say "Hmmm....I don't think it's related to what you're here for, but I don't think it's emergent, go see your family doctor", but I find being willing to do that makes the rest of the visit goes a lot smoother.

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    1. What bothers me is my impression of whether or not I have a good rapport with a patient is not always accurate.

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  4. Can a patient weight in?

    Here are some things that have endeared particular doctors to me:

    (a) They remember me or pretend to, even if it is because they made a note on my chart ("How's the house sale going?"). And greet me like they are happy to see me.

    (b) They have a sense of humor, whether they themselves joke or just tolerate my jokes. It means we're not going to take everything excruciatingly seriously. It lightens the atmosphere (when appropriate, of course).

    (c) They let a small personal thing about themselves into our interaction. Like the doctor whose office was plastered with very childish drawings and who confided to me that they were his kid's, who clearly was no Da Vinci, but he wasn't about to tell him that. It showed me that he was a family man with regard for that family.

    (d) Has time to answer questions if I have them. And shows by body language that he has time (as opposed to answering while half out the door).

    (e) Yes, smiles at least some of the time. If that's uncomfortable for you, do it when you can. But it does help to smile once in a while.

    And, yes, if I were deathly ill and the best doctor had the personality of Charles Manson, I'd want him because competence counts and I would NOT dis him on a survey just because he had an awful personality, but rarely are our interactions only life and death and people we like or who appear to like us are preferable for regular encounters.

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    1. Speaking as a different patient than Hildy, if the best doctor had the personality of Charles Manson I wouldn't go to him or her, especially if I was deathly ill. The reason is because I would put off going to the doctor and I would be unhappy about every interaction. Any doctor you actually see is better than any doctor you avoid seeing.

      Regarding being more personable: I'm not a doctor, but here's how I approach things: it all begins in my own brain. I approach everyone from a baseline position of respect and wanting to like them and make their day better. My daily philosophy is that we're all in this together, so we might as well be nice to each other. I personally am not a good enough faker to make people believe things I don't genuinely believe or think. If I went into interactions thinking "how can I make this person think I'm likable," I'd be sunk before I started.

      If you can, try to want to be nice for reasons other than Press-Ganey. Go into every interaction with a goal of improving the patient's day in some small way.

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    2. Do you see patients in both hospital and clinic settings? When rounding I prefer a doctor that doesn’t hover over the bed, standing above me and talking down to me (whether they mean to or not). Pull up a chair and sit down at bedside.

      As a previous patient mentioned many things already I’d add apologize for delays. Don’t make excuses for them but let me know that you know that you are late.

      But I’d also say if patients notice an extreme forced change, I know I’d think, “More bad surveys?”

      Take care!

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  5. Okay. So why did I switch doctors a few years back?
    First, he'd been irritating me for years, halting an exam to discuss Medicare while I'm sitting there in my little paper gown, shivering. He seemed more interested in his opinion than my exam.
    Mostly, though, due to the last time I saw him when as far as I could tell, he hadn't paid much attention to my chart. He was going to re-up a medication I'd had a reaction to, but best of all was when he moved to exam my Frankenbreast with its implant thanks to a mastectomy.

    I like my current doctor. He's always serious and business-like, but is careful to ask if I have questions, and once even shared the fact that no, I wasn't nuts to take Glucosomine, admitting that he took it, too.
    And he'll outlive me - always a plus.

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    1. Did you ever say anything to the other doctor?

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    2. Nope. Just called a few days later for my records and never darkened his door again.
      My brother in law switched from him a few years back, too, but funnily, my husband still goes to this doctor.

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  6. Ask about their pets. If there is any way to work it into conversation, do it and watch them open up and talk about something other than being sick that isn’t political or religious or potentially a landmine of family drama.



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  7. My theory of life is your always going to piss someone off while making someone else very happy. In other words: you can't please everyone so you just worry about yourself and be the best clinician you can and move on.

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    1. Yes, but this isn’t like making friends at school. Our jobs depend on these scores. What’s really frustrating is the majority of patients don’t even fill out the surveys, so you only get the extremes or else people with a lot of time on their hands.

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    2. I get it and I am judged from pt evaluations as well. I still use the above logic. No one is perfect just do your best at doing your job well.

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  8. Vi the psychiatristNovember 25, 2017 at 9:30 PM

    In psychiatry, a better alliance with the patient is associated with actual better outcomes, even if the physician's skills aren't amazing. So it's good for your patients themselves, too, even if your main motivation (lolsob) is Press-Ganey scores.

    Mirroring body language is a good one. Also physically putting down the clipboard when they're telling you something important/sensitive.

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  9. Being sincere? You can fake that. My reports for patient rapport are always glowing, and I am a miserable misanthrope. The reports always say how kind and empathetic I am, always with a reassuring smile.

    Now, as to how to pull that off, you need to know your audience. There are cultural differences to be aware of (my patients from the low socio-economic sleeper city are culturally very different to my patients from the very rural areas). What works in general for one group simply won't work for the other. I spend most of the time in a poor rural area, and if I forget to adjust it can upset people when I do my city rotations (if that happens I play upon the hick stereotype and just say I'm in the city for a few days but I usually work in the hills, and they forgive the situation).

    Body language is important. Open stance is a great starting point for body language.

    As for smiling make sure you smile with your whole face. You will probably need to practice in the mirror to get it right (also practice your sad face). Took me several months to get this bit down pat and not feeling like my face was going to crack. The mirror bit is very very important.

    Small talk. Goodness knows why people value small talk, it drives me nuts. I now have a repertoire that can be produced reflexively. For example when an older person is taking a while (for example, to do an activity I want them to safely complete, rather than them doing it quickly) and starts apologizing for taking so long my reflexively reply is "Don't worry, I get paid by the hour, so you're doing me a favour by taking your time". It has been a long time since I have been paid per hour, but they don't need to know that. Cultivate based upon your particular communities sense of humour (cheat: try out the lines your colleagues use and see the response).

    Try and steal bits and pieces from colleagues to try out (note: colleagues of the same age and gender as you are better, as the patients are affected by gender and age biases when it comes to interpreting your behaviour). For example when talking to a family about an unexpected death my colleague asked the wife "And what would you like me to call you" after ascertaining the wife's legal name and status. I now use this line for those type of conversations.

    Perhaps less in your role (I work mostly in emergency), but being able to develop a rapport rapidly with a patient is an invaluable skill. Where are you from? What do you do with your time? Chances are these things have zilch to do with their broken leg, but developing that rapport means they are more likely to trust me, to believe I have their best interests at heart.

    All of the above is why I go to a terrifying Russian trained doctor. I'm pretty sure he wouldn't know small talk if it slapped him in the face, rapport is not something he seeks to build. Which just goes to show that no matter how much you work on the other things, it will just rub some people (misanthropes like me) the wrong way.

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