Elevated Doctor-Patient Interactions to Enhance Your Medical Practice

Dr. Hopkins: Welcome to Prescriptions for Your Practice, a podcast by Doctors for Doctors. Here we delve into game-changing approaches in patient care and practice management and well-being, brought to you by Hill Physicians Medical Group. I’m Dr. Tom Hopkins, independent physician, and your host on this unique journey. And I am thrilled to be able to introduce you to someone I just met. And he’s got a great history of how he practices medicine. Dr. Tommy Anker is here with us to talk to us about compassion in healthcare. So what I would like to do all the time on the podcast here is just you know a lot of folks don’t know who you are, don’t know who I am. So it’s going to be just an introduction. Tell me about yourself.

Dr. Anker: Well, I’m a married father and local community physician. I have my private practice in Sacramento. And after graduating residency, I wanted to formulate a practice the way I felt it should be best done. And so that’s what I currently am striving to perfect. My background is before medicine, I did genetics. And I also did a theater degree at UC Davis. And I’m from Los Angeles originally.

Dr. Hopkins: Okay. Yes, that’s why I found interesting because I think whether you’re talking about meeting your colleagues you a lot of folks do a lot of interesting things and bring a lot of a great background to what they do in the delivery of healthcare. So we’re really going to really just jump into really kind of that first impression that a patient has from our physician and our dealing with them with their medical with their medical care. So I really want to start off with that. Here’s a question I have. How does the initial introduction between healthcare provider and a patient really set the tone? What’s your opinion about that?

Dr. Anker: Well, I think that the physician and the patient are coming from two really different places when they meet at that first moment. For the physician and what I found the more I practice and the more I saw my colleagues practice even in medical school and that short residency we become a little bit desensitized to going into a room and taking care of the next patient whether they be new or a follow up but for the patient I mean you got to think about how much time effort and thought has gone into the culmination of this moment. There are finally for some of them they’re finally seeing the doctor that they’ve been wanting to see. And so when you walk in if you don’t have the right mindset and you don’t respect that you could win or lose that relationship and that connection with that person. You can either disappoint or you can fulfill all those expectations. So this is a great opportunity. It’s like saying you don’t get a second opportunity to make a good first impression.

Dr. Hopkins: That’s absolutely true right? But for those doctors who might have messed up that first time and God knows I may have messed up a couple of times I’d like to think that having the humility and the humbleness to speak about that with the patient I’m sorry. I think we got off on the wrong foot. I think there’s a lot of value in that too.

Dr. Anker: Yeah. And you talk about if you can elaborate with a specific example if you’d say like I would say for me when I always understand that when I go into the room there’s someone behind that door the more I know about them the better it is. And I know that when you go in rushing in a visit you kind of enter in a visit rush. Tell me some things about the importance of how you first present in that first impression. I think you’d agree the preparation right? Like you said how much do I know about the patient? Nowadays I think a lot of patients don’t expect that doctor to know a lot about them. I have had patients say wow you know about my history. And I think there’s another saying in medicine right? The physician is only as good as their staff. And I met a lot of your wonderful staff that you have such a great relationship with.

Dr. Hopkins: Yeah they’re really cool.

Dr. Anker: And so the staff my staff helps me prepare for that patient. They give me what I need. They understand how important it is for me to read about the patient and know about the patient before I meet them. So yeah so I strive to walk into the room and know everything about the patient and get to know them even more. Things that may not be on paper. What hobbies do you have? What did you eat for dinner last night? What is your role in the community? How did you sleep last night? Where are you from? You know I like doing that. You know I use that tool that just happens to be an epic but it’s a little box. And so every patient I see it’s box only I see it’s you know where they’re from. Are they married? What are their hobbies? What do they like doing? And I tell you I found out a lot of things about my patients just by the fact that I keep that. So every time I come in I always know that I’ve seen that patient and I have information about them.

Dr. Hopkins: What do you think strategies for someone? I think you really get it. I’m really intrigued by your acting background and what you’ve done and how you’ve brought that into the care. But for some docs what are your how do you tell docs and recommend them for them as they go into that office to be able to each time every visit have that warm friendly introduction? Explain that more to me.

Dr. Anker: Okay. So for me it was yes theater. I was able to incorporate my experience with theater and that made it easy because of the theatrics of being in the patient room and what I learned in the theater. And most of that is how to be in the moment be present and listen. A lot of improvisation for example on stage goes off of that. And for physicians who don’t have a theater background I’m surprised that many do actually but for those who don’t I would just say what is your other passion? And is it baseball? Are you coming up to the play preoccupied or are you waiting for the right pitch? Is it dance you know? And are you listening to music? Or is it an instrument that you play? And can you find other musicians and are you able to just jam? Are you able to get into the room and just jam with other musicians?

Dr. Hopkins: Right.

Dr. Anker: And if you don’t have anything yet I would encourage the physician to find something that they’re passionate about and get into it and watch how it bleeds and translates into their patient encounters and how maybe even there’s opportunity to connect with patients. You play baseball I play baseball. You act I act.

Dr. Hopkins: Yeah. And I find that for myself that I found out that I have similar hobbies as some of the patients. So something I think that really when you talk about delivering compassionate care it’s really for us as physicians it’s important for us to do it. But tell me what do you see as the value if you will and how do you spend any time with training that the people on your staff? Like were you developing a culture of compassionate care? Tell me more about that for your practice.

Dr. Anker: Well my practice is small and young. So who was my first partner in my practice? My mom. She still answers the phone once in a while. Who came in after my mom my wife and then my mother-in-law retired and wanted to see if I could provide it with some out. So the culture is family-oriented already in my office. And I don’t have a lot of experience of hiring outside of that. But I would imagine that it’s really going to what takes precedence is that the doctor’s demeanor the doctor sets the example. The staff will see how much the doctor cares what the doctor wants to know the compassion the doctor brings to the patient care should be felt in the communication that he expresses to his staff. And that in turn translates to how the staff answers the phone for the doctor and speaks to the patient’s poor the doctor on the doctor’s behalf. So I could only say that there is this trickle-down effect right? How does the physician might have you know I think we’re desensitized. I think that the physician has more power and more power than they realize in their presence and how they create an atmosphere. So it all starts with us. So we need to be well. We need to be I don’t know how to we need to be well-rounded. We need to feel happy. We need to be enthusiastic. We need to love what we’re doing.

Dr. Hopkins: Absolutely. And it shows. I think that’s what I’m hearing you say is that you know the patient we need to show that. You know one thing I admired about your history is the acting. One of my nurse practitioners said “Dr. Hopkins the U-Co on the Room is theatrics.” And I really love that because you know when you go on the Room you’re on stage. And it’s how you are going to project that experience. And for them on stage knowing who your audience is and the audience is going to receive what you’re saying. So it really is important. And I think that my staff we do the same thing. So now we say that theater it’s like when someone walks in the door it’s game on. But we have to put forth our best efforts and that effort. One could argue that our profession the roots are from performance from way back then. We are the performing healer. I’ll tell you how often do you really need to do a reflex hammer on the patient? But I do it. Because for the patient it’s a ritual. It’s a performance. It’s a it’s they expect it. Nowadays some I’ve seen doctors argue “You don’t need the stethoscope anymore. Okay maybe you’re right.” But how does the patient feel when I don’t listen to their heart?

Dr. Anker: Absolutely.

Dr. Hopkins: You know I’ve talked to that’s a great point. I mean some of that whether it’s theatrics or not it’s it’s really what patients come in to expect over time. They’ve been doing it for a long time. They expect us to listen and listen to their heart and their lungs. So I don’t care if a patient comes to my office with a cold or flu tote pain. They’re going to I’m going to put a stethoscope on them. And I told my nurse practitioners every visit it was my experience I found that if you don’t do that people can leave and feel like they didn’t have a good experience because they didn’t feel like you quote unquote doctored them. So sometimes patients’ doctoring is about doing those simple things. It’s a dance. We’ve got to remember the steps of the dance. We’re both there they’re dancing.

Dr. Anker: And I love that by the way that you talk to your nurse practitioners and cause I don’t see that a lot. I see a lot of doctors with nurse practitioners and they don’t maybe they don’t even have a relationship with the nurse practitioner.

Dr. Hopkins: Yeah. It’s very important. I think that if you have a relationship it starts with us I think as the docs being responsible for especially as independent physicians we own our own practice. We should be guiding this shift in the right direction. And the most valuable people a part of that are our staff. So we have to align our goals and incentives around them so we can deliver great care. And I think that if you’re listening be attentive to patient care patient is teaching us a lot of things. So as you probably know I’ve had this background I’m very passionate about service excellence the art of communication. I always instruct more staff. You might see awards for the nurse. And I often tell you though I had a patient two days ago that I had a difficult interaction with a couple of other clinicians in my office. And it would seem like it was a simple thing a sore throat. The thing about that was after I went and told her all the stuff that we’re going to do she said to me she started crying. She said “You’re listening but you’re not hearing me.” What do you say about that?

Dr. Anker: Yeah. I think that’s a lot of what patients unfortunately might experience. They feel like they’re not being heard.

Dr. Hopkins: Yeah. So even though you can have active and what it different me is like when you just express it for yourself I’m going gosh I went through the whole aid which we’ve trained people on acknowledge introduce duration explain empathy thank you all that. But yet at the end she said “I know you’re listening but you don’t hear me.” So what’s interesting is the hearing part to me that what she said you’re not hearing is really that active listening a little bit.

Dr. Anker: That connection.

Dr. Hopkins: Yeah. She didn’t really get until so I had to step back and say “Okay now I’ve got to go further.” Sometimes I can think of the message for me is that sometimes you’ve got to go further. You can’t just stop there because what she then I said to her which I think was the most powerful thing and we don’t do enough of this because we’re scared of this question. So their patients are coming in because they’re fearful but we’re scared about some of the questions they’ll ask us. But I asked her and they asked for even the answers. I said “What is it you really want today? What do you really want?” And she told me exactly what she wanted. And I said “Which is within reason understanding of fear.” It wasn’t out of the realm. I said one of already said I was doing is referrals. So I gave her the referrals. All of a sudden she tells me “That makes me feel so much better.” And keep in mind when I saw her she had none of the she didn’t have any symptoms of anything wrong where I thought she really warranted a referral. But for her mental well-being it’s worth it.

Dr. Anker: And I had a recent patient too. I’m not a hypochondriac. I’m not a hypochondriac but you know I’ve been to a lot of doctors. And I’m not a hypochondriac. And you know I spent the time with him and I smiled at him. And I said “You’re okay. You’re okay. You’re okay.” And he said “Thank you. I think I just needed a doctor to say that to me.” I said “I’m going to be here for you. You have a worry. That’s what I’m here for. I’m here to help you.”

Dr. Hopkins: Absolutely. And I’m for myself. I always have to remind myself of that. And I tell my clinicians tell my staff sometimes we think that patients come in for very simple things. But to them it’s a big deal. It’s a huge deal that appointment. Whatever it is. And yeah they had to stop doing somebody to come to a doctor’s appointment. You know how I just try to get a doctor’s appointment or going to one. But I operate on a premise that every patient you see is coming to see you out of some aspect of fear and you’ve got to understand that and be empathetic to that and open yourself up to listening actively listening. And then once you do that like you’re ill it’s ready you come around with a great breakthrough. You really do.

Dr. Anker: Any final thoughts as we wrap up this conversation?

Dr. Hopkins: Well I’m reminded of a TED Talk that I recently saw that it doesn’t take much to connect. I think the TED Talk mentioned 40 seconds. I know the visits are time constrained but it only takes a beat a short beat a gaze into the patient’s eyes away from the computer. It really doesn’t take much. A moment of silence just sit in the silence with the patient. Just feel it for a second and then delve in.

Dr. Anker: Yeah I like that. I would end on that as a good summary that really when we’re talking about this stuff it really doesn’t take much. It takes us an awareness making an effort and bottom line there’s no substitute for just listening to the patient.

Dr. Hopkins: And that’s how they have a great experience. Well again I want to thank you for being here. It’s been a pleasure meeting you. And I look forward to the other stuff that we’re going to go as we continue this discussion as well. And of course I want to like just thank everybody who’s tuned in. I want to thank you for joining us for prescriptions for your practice. You know it’s very valuable to the things that we’re doing. And just remember your dedication to patient care through better practice management goes a long way to our collective success. So I’m Dr. Tom Hopkins your host. And thank you so much for tuning in. We’ll see you next time.