Yesterday afternoon I saw a new patient who had been referred to the office by someone we have seen over several years.

Mrs. Wagner presented as a very charming 84 year old and after introducing myself as Wayne Wolfson, she told me that she would like to be called Mrs. Wagner by my staff as opposed to Mary.

It seems that when she was escorted into my office, my assistant, who is some 60 years her junior, addressed her by her first name. Certainly no disrespect was intended, but it's a lesson we all need to be aware of.

Current society and culture breed a state of informality. My assistant, no doubt wanted Mrs. Wagner to feel comfortable and have a positive experience, but the patient's "old fashion values" did not translate and my staff overstepped a boundry area.

A good lesson was learned and while this individual had been helpful, congenial and cheerful, utilizing the patient's title shows a respect that Mrs. Wagner deserves and has earned.

I have asked that all staff members refer to patients using their respective titles of Mr. or Mrs. or whatever it might be. Naturally most patients ask that they be called by their first name, but until permission is granted, it's better to be safe than sorry.

By the way, I personally introduce myself to patients as Wayne Wolfson, as those who come to the office know that I'm the doctor and 99% of the time they refer to me as Dr. Wolfson.

Proper etiquette, respect and courtesy still go along way....and Happy Days!

Just for fun, if your office requires patients to gown for visits or for examinations, take a few minutes and put one of those gowns on and see how they fit, how they make you feel and how this dehumanizing event can be minimized.

There have been several movies and books written by doctors who themselves are diagnosed with serious or terminal conditions.  They write about the events that impact them and many recognize the tremendously impersonal, often embarrassing and almost frightening experience of putting on a gown.

Today there are gowns that come in various sizes, colors, fabrics and even designer touches to at least ensure that your patients will not feel that their self-esteem has been removed.

Gowns may be a small item, but it is the small items that make up the total composite of the experience of your office. In general, it is acknowledged that many people will not remember what you say, but will always remember how you made them feel.

Trying to minimize any event which reduces or removes the patient’s sense of worth must be recognized and avoided at all costs.  Your practice success will largely depend on the dozens of small things which cumulatively represent and reflect who you are.

In February 2009, President Obama signed into law the American Recovery and Investment Act (ARRA).  Part of the ARRA brought about major changes in the Health Insurance Portability and Accountability Act (HIPAA).  Certain provisions of the ARRA have impacted the insurance world and how you practice. 

The HIPAA compliance enforcement got its teeth to deliver a bite with the Health Information Technology for Economic and Clinical Health (HITECH) Act.  If you have not updated your HIPAA compliance manual to reflect these changes, you may now face significant fines.

Previously, fines up to $25,000 maximum could be levied.  Now the fines are tiered and could be as much as $1.5 million for just a single HIPAA violation.

Your Notice of Privacy Practices (NPP), commonly known as your Privacy Policy, must reflect the required changes and associated policies in your office.  Part of the NPP must address the patient’s rights pertaining to their protected health information (PHI).  The patient has the right to obtain a copy and review their PHI.  If the patient disagrees with the PHI, they have a right to request that the practice amend the PHI.

The patient also has the right to request that the practice restrict the use and/or disclosure of PHI for treatment, payment and health care operations.

On Feb. 18, 2010, the HITECH Act regulated that a health care provider is required to honor a patient’s request to restrict disclosure of PHI to a health plan for purposes other than carrying out treatment (specifically, payment or health care operations) if the patient pays the health care provider out of pocket in full. [Section 13405 of Subtitle D of the HITECH Act (42 USC 17935)]. 

This means that if a patient does not wish to use their health insurance or med-pay, they can request that the insurance not be billed.  A PPO cannot require that you file a claim for the patient, although if you do not, then you may be required to a have a written attestation that the patient requested the restriction.  Medicare is the exception for covered services.

As an example, if a patient has a $5,000 deductible and therefore chooses not to file a claim with their health insurance to obtain the benefit of a Discount Medical plan, as long as you have the statement from the patient on file directing not to file the claim, it is within the patient’s legal rights.  In my opinion, this will yield a win-win situation for the provider and the patient.  The provider can deliver health care as recommended and the patient can benefit from legally discounted fees.

Make sure that you become familiar with the changes in HIPAA and incorporate policies and procedures in your Notice of Privacy Practices.  Any amendment to your policies must be posted in a prominent location and a good faith effort made to inform the patient of these changes.  In addition, it is required that all staff (defined as full-time, part-time, temporary help and volunteers) be properly trained in the HIPAA and HITECH changes.  Keep the training documentation in your HIPAA manual for six years.

A thorough understanding of the HITECH regulations may serve to grow your practice.  In this age of increased regulations, it may well be that a regulation was finally passed that can benefit the doctor-patient relationship!

Offices - like any closed room -  can get very stale if there is not someone committed to making them come alive each season. 

When is the last time you seriously looked around your office?

Make sure your office reflects the wonderful seasonal changes, holiday themes, patriotic holiday events and other such events as Good Posture Month, Founders Day etc. 

In your reception area and throughout the office, let the facility reflect the fact that someone is attentive and keeping the office alive and current.  Patients are pleased when they see that their doctor's office is current, changes with the season and there is LIFE IN THE OFFICE.

Remember the old adage: “Never go to a doctor who plants in the reception room are dying.” 

Look around for ways to keep your office changing and you will be amazed at the response from your patients and staff. 

So I was reviewing a new patient's records the other day before he came in and saw that the cause of Injury was from "bowel and bladder falling on his head." 

This was obviously not the cause of injury and after asking the patient, I realized that what actually happened was a "bladder ball" or "medicine ball" struck him on the head.

At the bottom of the notes it read, "Dictated by Dragon Naturally Speaking."

I have been using EMR for going on 4-5 years now and have incorrect words when using Dragon Naturally Speaking no matter how well I trained it. 

Let's face it, mistakes will happen.  However, when typing, I might misspell something but the reader/reviewer will still know what word I meant to use.  With Dragon, the word you meant to use is usually unrecognizable.

My favorite was this one:

Dictated: "patient was evaluated and treated."

Dragon heard: "patient was violated and treated." 

I am not saying Dragon Naturally Speaking is not a worthwhile tool...I could not imagine my EMR without it.  Just realize the mistakes made while using it can completely change the meaning of the sentence as opposed to an old fashion "typo."

Recently at the ACA House of Delegates Convention in Portland, Oregon, I met a young doctor who impressed me with his attitude on growing his business. In our conversation about his seven-year-old practice, I threw out a question that students at recent Starting into Practice programs asked me.

“Are you discouraged with this economy, and do you have a strategy to weather this storm of slow growth while everyone around you is panicking about finding new customers?”

This young doctor smiled and proceeded to tell me that his office building has no outside signage to indicate that he practices there. He does no advertising, nor does he make the usual speaking rounds of the Rotary Club, Lion’s Club, etc. He said he built his ever-expanding practice on the principle he had decided on from day one.

“I give my patients my undivided attention from the time they walk into my clinic until they leave. My first patient recommended my second patient who introduced me to a friend of his, a radiologist. The radiologist and I became fast friends. I referred to him, and over time, he referred to me.

He introduced me to several hospital staff when we would attend social functions together. I gained their respect and have been included in just about any hospital fundraiser that goes on in town. 

My growing patient base kept the referrals coming in until I realized that I was doing something that even advertising could not match. Taking care and listening to my patients. So now, even in this poor economic climate I am seeing growth.”

I realized the lesson that came from this young man was simple. Patient-centered care builds growth.  So, for you new docs, don’t sweat all the small stuff. You’ve got one task.  Care about your patients and give them your expertise and your ear. I see nothing but smooth waters ahead for you!

Anyone out there have any more tips on building up a practice in lean times?

What a great time to communicate chiropractic to an audience in grades K-6. 

Why not start a program called “Spooky Spines” where you go to the school and teachers K-6 and offer a 15 minute program on the spine. 

Make it fun! Tell the teacher you will be bringing in a plastic spine or (even better)full skeleton as well as an x-ray of a spine. Then talk to the children about The SPOOKY SPINE and make it into a story about health and the importance of posture (throw in some tips about knapsacks).

It can be a fun 15 minutes of learning about the importance of the spine and the doctor who works with the spinal column - the chiropractor. 

Make some arrangement with a local ice cream shop to purchase gift certificates for each of the children.  The store owner will get to know you (not a bad thing), the kids will remember you (not a bad thing) and the teacher may invite you back for another lesson on health.

Also consider providing the kids with a posture coloring book to take home so that mom and dad know the program you provided.