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![Page 1: Magical facts about patients satisfaction and pearls of medical practise::Doctor-Patient Relationship & Medical Professionalism dr.sandeep c agrawal agrasen hospital gondia india](https://reader031.vdocuments.mx/reader031/viewer/2022030304/587a4c0c1a28ab00148b6803/html5/thumbnails/1.jpg)
Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Patient Satisfaction and Pearls of Practise
Doctor-Patient Relationship & Medical Professionalism
Magical Facts
About Patients Satisfaction That you would die to know
Dr.Sandeep Agrawal
Consultant Orthopedic Surgeon
MS,DNB
Agrasen Hospital
Gondia
Maharashtra
India
!www.agrasenortho.com
!09960122234
![Page 2: Magical facts about patients satisfaction and pearls of medical practise::Doctor-Patient Relationship & Medical Professionalism dr.sandeep c agrawal agrasen hospital gondia india](https://reader031.vdocuments.mx/reader031/viewer/2022030304/587a4c0c1a28ab00148b6803/html5/thumbnails/2.jpg)
Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
![Page 3: Magical facts about patients satisfaction and pearls of medical practise::Doctor-Patient Relationship & Medical Professionalism dr.sandeep c agrawal agrasen hospital gondia india](https://reader031.vdocuments.mx/reader031/viewer/2022030304/587a4c0c1a28ab00148b6803/html5/thumbnails/3.jpg)
Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
![Page 4: Magical facts about patients satisfaction and pearls of medical practise::Doctor-Patient Relationship & Medical Professionalism dr.sandeep c agrawal agrasen hospital gondia india](https://reader031.vdocuments.mx/reader031/viewer/2022030304/587a4c0c1a28ab00148b6803/html5/thumbnails/4.jpg)
Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Behave Professionally
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Practise management skills
Every doctor is an entrepreneur !
Needs to run a business !
These skills are never taught in medical college !
Some doctors never learn them and struggle to manage their practise
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Patients satisfaction
Satisfied patient 3 other people !
!
Dissatisfied patient 20 others !
Satisfying unhappy patients 50 others
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Medical Professionalism : Deprofessionalism Causes
● Technology – Depersonarlise medicine & deprofessionalise a physician !
● Corporatization of Medicine !
● Specialization – Most patients identified by disease rather than human beings who happens to have disease !
● Patients knowing limitation of modern medicine !
● Greed
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Being a doctor today is not easy
!
too much work too much hassle too much competition too much despair; and too little reimbursement ?
![Page 9: Magical facts about patients satisfaction and pearls of medical practise::Doctor-Patient Relationship & Medical Professionalism dr.sandeep c agrawal agrasen hospital gondia india](https://reader031.vdocuments.mx/reader031/viewer/2022030304/587a4c0c1a28ab00148b6803/html5/thumbnails/9.jpg)
Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Physician motivatorsIntrinsic
Serving people Work interest Career growth
Ability to support oneself & family Autonomy
Empowerment Socio-cultural
Respect Social rewards
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Physician : lets take lead
● Leadership – genes, charisma, education, wealth, luck, training, experience
Ethics do right
!
Reality Greatness vision Have no think big & new Illusion
Courage act with sustained initiation
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Patient Autonomy
Autonomy = freedom to decide !Doctors need to : 1. present the options to the patients and 2. allow patients to choose for themselves !Informed choice means patients need
information
![Page 12: Magical facts about patients satisfaction and pearls of medical practise::Doctor-Patient Relationship & Medical Professionalism dr.sandeep c agrawal agrasen hospital gondia india](https://reader031.vdocuments.mx/reader031/viewer/2022030304/587a4c0c1a28ab00148b6803/html5/thumbnails/12.jpg)
Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Educating patients
Most doctors do not spend much time educating their patients
!Primary role of a doctor should not be
merely treating an illness, but helping people remain healthy
Patients are the practise !
Everything else is just paper work !
![Page 13: Magical facts about patients satisfaction and pearls of medical practise::Doctor-Patient Relationship & Medical Professionalism dr.sandeep c agrawal agrasen hospital gondia india](https://reader031.vdocuments.mx/reader031/viewer/2022030304/587a4c0c1a28ab00148b6803/html5/thumbnails/13.jpg)
Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Benefits of patient education :
Happier patients
practice promoter
Increase patient compliance
Improve public health
Overall :Helps to improve empathy
Reduce risk of complications
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Communication skills
“ Patients don’t care how much you know them, until they know how much you care”
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Communication skills in clinical practice :
“Its an art to talk medicine in the language of a non medical men” !
✓ separates successful doctors from unsuccessful ones !
✓ include ability to engage with patients
at emotional level, to listen, to convey
information with clarity & sympathy
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Patient education – key component of informed consent
Don’t tell the patient what to do Present the information and the
treatment options – and allow them to make up their own mind ! Empower patients with information –
they will respect you for this !
Information therapy - “ Prescribing the Right Information to the Right Person at the Right Time” is
the best way of bridging the doctor-patient communication gap today !
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Start your own website !
Patients are hungry for reliable information Internet :Excellent source of
information, but this can be wrong and dangerous !Provide reliable information to your
patients through your own website Very cost effective !
Think global – act local !
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Improving Doctor-patient relationship
Based on TRUST Trust needs to be earned ! !Patients feel exploited and believe
medical profession has become crass and commercialized Doctors feel unappreciated,
overworked, victimised and threatened.
Foundation of the relationship
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Become a Professional – Trust Equation
T = C + R + I/ S, where T = Trustworthiness C= Credibility R= Reliability I = Intimacy S= Self-orientation
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Become a Professional – Trust Equation
Credibility =patient trust what you say ? Reliability = he trust your actions,
confident that you will act honorably ? Intimacy = is he comfortable discussing
his feelings and emotions with you ? Self-orientation = can he trust your
motives, knowing that you care about him, and will act in his best interests ?
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
What do patients want
- Patient dissatisfaction relate to problems of communication rather than clinical competence !
- They want ● - quality information about their problems ● - risks & benefits of treatment ● - relief of emotional distress ● - to be active participate in medical
decision making
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Educate All Informations to Patient
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Benefits of doctor patient communication
- communication with personal touch provides treatment beyond drugs !
- Patients more likely to comply !
- Overall quality of care & patient satisfaction improved
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Answering skills
▪ weakest communication skills among Indian Medical Professionals !
▪ In Indian context patient satisfaction is largely decided by the quality of answers & explanation given by doctors !
▪ Understand the question clearly, answer fully, & clearly but briefly !
▪ Avoid major technical terms
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Barriers to communication
● Work over load on doctors !● Shortage of man power- less time for
individual patient !
● Lack of training in communication skills during medical education !
● Individual attitude & personality traits !
● Under utilization of paramedical staff
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Communication
● 7% - Spoken words !● 38% - Voice quality like Tone, Tempo,
intonation !● 55% - Body language
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
How do we fix the problem ?
Two players: Doctors Patients !
It’s hard to change anyone else – you can only change yourself !
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Today’s Health Care System
Patient
Health Insurance
Government
!!
Information Overload
Media
Doctor
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Patient Experience is all about bottom line
LEAST PROFITABLEQUARTILE
MOST PROFITABLE
QUARTILE
PATI
ENT
SATI
SFAC
TIO
N
1 2 3 4
82.2
83.583.7
84.3
!In research conducted by Press Ganey, hospitals were divided into four groups (quartile) based on their profitability. !The least profitable hospitals had the lowest patient satisfaction scores (out of 100 points). The most profitable had the highest patient satisfaction !!
Source: HFM Magazine, 2008 : Looking to improve financial results ? Start by listening to patients : By: Melvin F Hall PhD
As patient satisfaction increased, the average hospital profitability increased
Without a quantifiable link to profits, the push for patient satisfaction is based on nothing more than the moralistic view that “it’s nice to be nice”
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Patient Experience is a lot more than clinical outcomes
How well staff worked together to care for me
Overall Cheerfulness of the Hospital
Response to concerns/complaints made during my stay
Amount of attention paid to my personal and specific needs
Staff sensitivity to the inconvenience of hospitalization
How well nurses kept me informed
Staff’s effort to include me in decisions about my treatment
Nurses attitude towards my requestsSkill of the nursesFriendliness of the nurses
Press Ganey Satisfaction Report , August , 2003
0.79
0.74
0.68
0.650.65
0.64
0.64
0.640.630.62
When hospitals spend most of their efforts in clinical results & process improvement, their data are defined by outcomes and thus can be measurable objectively.
!! Patient however,
judge quality by his/ her perceptions, something that is subjective and cannot be verified in the same way as outcome.
!
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Patients expectations from their doctors ?
Expertise ( be well-informed and uptodate) !Professionalism – look out for the patient’s best interests !Accountability – be answerable; say Sorry ( if there is a mistake) !Transparency – no unnecessary tests and referrals !Respect their desires and their time !Treat them as intelligent human beings
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Types of Patients
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If you can’t measure, you can’t manage
2 3 4 5 6 7 81 90 10
Never Absolutely
Detractor Passive Promoter
Detractors are customers with the lowest rates of repurchase and referrals. Detractors spread negative word-of-mouth comments about the company
Passively Satisfied customers stay with a company more due to inertia than true loyalty
Promoters have the highest rates of repurchase and referral.
THE NET PROMOTER SCORE
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It’s all about word of mouth
!!
0
100
200
300
-100
-200
AVERAGE CUSTOMER BASE
AVERAGE CUSTOMER BASE
RETENTION
MARGINS
ANNUAL SPEND
COST TO SERVE
Economic benefits
NEGATIVE WORD OF MOUTH
! COST TO SERVE
ANNUAL SPEND
!MARGINS
! RETENTION
Economic penalties
Patients who spoke bad
Patients who spoke good
POSITIVE WORD OF MOUTH
Each one point decrease in satisfaction is associated with a 6% increase in complaints Stelfox, et. al. (2005) AJM 118
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What’s bad about good service quality
A satisfied person has no story to tell. Everything went just as expected. It is the unexpected event that makes a stay memorable. !For every loyal customer, there is usually a special story
!Fred Lee , Author of award winning book If Disney Ran Your Hospital
Touch Point 1
Touch point 2
Touch point 3
Touch point 4
Touch Point 5
Touch Point 6
Touch Point 7
TO
UC
H
PO
INTS
What made them feel bad and at
which touch point?
What created tears of joy and at which touch point did that happen ?A good story to tell
A bad story to tell
Satisfied Person
Hyper Satisfied Person
Dissatisfied Person
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
5 Things that Matter Most to Patients
1. Doctors treat patients with courtesy and respect.
2. Doctors explain the facts in a way that patients can
understand.
3. Doctors, nurses, and other hospital staff do everything
they can to help patients with their pain.
4. The hospital room and bathroom are kept clean.
5. Patients get information in writing about symptoms or
health problems to look for after they leave the
hospital.
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Patients’ Expectations
• Experience + Needs + Communication = Expectation
!
– If Perception exceeds expectations: Satisfaction !
– If Expectations are less than perception: Dissatisfaction
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Patient Satisfaction: GREET Tool
GREET – 10/5 Rule: At 10 feet acknowledge; at 5 feet greet/speak – Call patient by name (If known) – Make eye contact , Smile – Let the patient(s) know they are important
RECOGNIZE – Welcome them to Hospital – State your name, department, & role in the patient’s care
EXPECTATIONS/EXPLAIN – How long a procedure or test will take & why… – How long a patient should be expected to wait before getting results & why…
EDUCATE – Explain the role of medical staff involved in providing care – Explain if the test or procedure will cause pain or discomfort, or if any post procedure instructions
are necessary – Offer to answer any other questions, concerns, or resolve any complaints… you do have the time
THANK YOU – Let your patient & family members know “Thank you for choosing me for you healthcare needs!” – Exercise courtesy by using words “Please” and “Thank You” in conversions
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○ Mayo Clinic conducted a research involving 192 patients and conclude that a model doctor should be:>>
EXPECTATION OF PATIENT FROM DOCTORS
○ CONFIDENT ○ EMPATHETIC ○ HUMANE ○ PERSONAL ○ FORTRIGHT ○ RESPECTFUL ○ THOROUGH
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Factors Influencing Patient Satisfaction
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BalancePatient experience = service quality + clinical quality
Service Quality
Clinical Quality
Interpersonal skills/ Communication
• Engagement • Empathize • Educate • Enlist
Clinical Knowledge/
skills • Find It • Fix It
Adapted from Institute for Healthcare Communication
Process Skills • Technology • Process Improvement • Care Coordination
Patient Experience
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Be a Committed Professional
• Staying Work-Focused. Not letting your private life needlessly have an impact on your job, and not spending time at work attending to personal matters.
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Good Doctor Skills
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Be you are remembered for Principles and Integrity
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What do doctors expect from their patients ?
Patients will: !• Treat Doctor with respect • Will say “Thank You” when things go well • Will have realistic expectations of treatment • Will not unfairly blame doctor anytime
there is a problem • Will pay their professional fees promptly
and gracefully
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Respect others and other Respect you
• Respect For Others. Treating all people as if they mattered is part of your approach.
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Having Positive Attitude - Benefits
!• Pleasing personality !• Energizing !
• Inspiring !
• Problem Solving !• Increase work output ! ! - 85% Attitude - 15 % Intelligence & knowledge of specific facts $ figures
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Elements of success Attitude
SkillKnowledge
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Be Confident
• Be confident. Others will sense your confidence when they see or meet you, and they will think better of you. Also, if you always wear a sly smile, like there is a joke you get but no one else does, people will think you are above them in your knowledge
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Non-verbal communication - SOFTEN
S- Smile O - Open posture F- Forward lean T – Touch. This is a privilege – use
it ! E – Eye contact N - Nod
Polish your bedside manner
How to perfect non verbal signal
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How to talk to your doctor –SAFEly !
Story: Symptoms
Assessment: Problem
Fears: Overcome Patients fears by Discussion
Expectations: What patient want from doctor ?
Patients don’t care how much you know – until they know how much you care !
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BATHE technique
B = Background. What’s going on ? A = Affect. Feelings. What do you feel about it ? T = Troubles. What troubles you about this ? H = Handle. How are you handling this ? E = Empathy. It must be hard.
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Joy of practising medicine – how to be a happy doctor
When it comes to getting positive feedback, no profession in the world comes close to medicine !
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Employees !
Can be your biggest asset – as well as your biggest problem ! Keep your employees happy, and they will
keep your patients happy Don’t skimp on their salaries Train them well Key test – how well does your clinic run
when you are not there ?
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OPD SUBUNITS:
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Many other issues
Time management Learning to keep upto date How to buy medical equipment How to keep medical records How to grow and expand Balancing family and career Retiring Ethics
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Communicating prognosis, hope & risk
➢ Misunderstandings in these areas can lead to patient dissatisfaction & litigation !
➢ Prognostication is like weather forecasting uncertain but based on sound scientific principles
Stage of illness at presentation of patient! Curability of disease!
!➢ In face of uncertainty there is nothing wrong with providing hope
!➢ Provide evidence based risks
!➢ Never create guilt for negligence on part of patient
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● If too many anxious attendants, send them one or another job. eg. Bringing medicines, arranging blood- Energy utilization
!● Never argue with attendants !● Argument will trigger them, at the same time your calmness and
promptness will even calm down a triggered person. !● If patient is sick, attend patient periodically and talk to
attendants. !● Check emergency tray for drugs. !● Try to solve/resolve crisis immediately
Do’s
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Do’s
● Patients should be attended promptly: - Error in Decision making is Excusable but not attending
patients timely is not. !● Identify a Prominent Person: - Important person/relative and explain initial assessment of
patient immediately. - Explain them management has started. !● Ask if they have any questions !● Call senior consultant as per requirement, talk to them
telephonically if possible delay in arrival.
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Physicians should Behave Professionally
Physicians are capable of acting unprofessionally, but cannot act unethically, as ethical standards are part of their profession. Therefore, it behoves all patients to educate themselves on what constitutes “professional” and “unprofessional” behaviour for those involved in health care. -
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Don’ts
● Never argue with attendants. this situation teaches you how to remain calm in provocative circumstances. No book in the world can teach this.
!
● Never overlook a call, especially if call is by a attendant.
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Dealing with mistake
● Accept responsibility for the mistake ● Discuss with trusted friend, colleague
or spouse ● Disclose & Apologize to the patients ● Error analysis ● Measures to reduce similar mistake in
future
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!! Identify & avoid negative people
Positive !• Part of the answer !• Has Program !• Let me do it for you !• Difficult but possible !• I must do something !• See the gain !• See possibilities. !• Hard arguments, Soft words
Negative !• Part of the problem !• Has excuse !• Its not my job !• Possible but to difficult !• Something must be done • See the pain !• See problem. !• Soft arguments, Hard words
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Be A Optimist• No one likes a
constant pessimist. Having an upbeat attitude and trying to be a problem-solver makes a big difference.
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Use common sense with knowledge
Knowledge Vs Wisdom
• Knowledge - Piling up facts Wisdom - Simplifying it !•Knowledge - Potential power Wisdom - Real power !• To attain knowledge - Add things everyday To attain Wisdom - delete things everyday !! !
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“ The education of the doctor which goes on after he has his degree is the most important part of his education”
John Shaw Billings
Keeping updated : Managing knowledge
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Upgrade the Knowledge or you are Lost
Self-Upgrading. Rather than letting your skills or knowledge become outdated, you seek out ways of staying current.
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TRADITIONAL CME Vs CPD
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Practice building/Marketing
● Satisfied patients ● Volunteering at community medical service. ● Organizing an event – like conference ● Attracting Media attention ● Contributing article on health to magazine ● Public lecture ● News letter ● Website ● Marketing to referral base
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Physicians: problematic spouse?
● Stage 1 -- Romance – you are perfect ● Stage 2 -- Fault finding ● Stage 3 -- Blaming ● Stage 4 -- Acceptance ● Transformation – Growing together
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Marriages
● Spend time together ● Respect each other ● Have fun together ● Treat your spouse as your most important
VIP patient -- A loved spouse is also loving spouse
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Children
● A meal together everyday ● Fun together once a week ● One holiday every year together ● Make sure children meet grand
parents, relatives periodically ● Help children honour family
traditions
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Litigation
● Be a nice person ● Be honest ● Be open ● Be accessible ● Keep up to date professionally ● Insurance
How to reduce chances of litigation
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Make connections.
• Make connections. You never know when you'll need to call in a favour from someone to get the job done help in your crisis moments, so it pays to know the right people.
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Retirement
● Don’t retire unless you have enough financial security
● Studies-Retirement has Predominantly positive impact on emotional state
● Explore you hobbies ● Explore your spirituality ● Serve other selflessly-do charity work/volunteer
work ● Physical activity/light exercise
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Take home
● Let us enjoy being a doctor/physician, let us work for joy of working, nor for a home, car or vacation !
● Don’t find faults in medicine, Identify happy doctor & follow their secrets
!● Lets love what we do, and do what we love !● Watching dying patients should remind us about our
own mortality enabling us to live each day well.
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Take Home
● Social capital is more important than financial capital at end of the day.
!● Work & practice with Medical professionalism !● Use common sense. Identify local socio-cultural
practices & integrate in your working style !● People prefer those doctors with average clinical
skills but good communication skills rather than those with excellent clinical but poor communication skills
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
Never forget Professionalism is an important component of MedicineProfessionalism is an important component of medicine's contract with society. Not only do we need to make good decisions for our patients based on the evidence in the literature, but we need to apply those decisions in a way that is professional and ultimately helps our patient
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
SUMMARY: Increase Patient Satisfaction
1.Give patient your full attention
2. Build partnership with the patient
3. Maintain positive Attitude!
4. Respect patients privacy!5. Handle complaints effectively
7. Practice good bedside manners
6. Listen to your patients
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Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com!
This presentation is for doctors and students in general. . Graphics,Images and jpeg files are taken from Google and yahoo Image to heighten the specific points in this
presentation. • If there is any objection/or copyright violation, please inform [email protected] for prompt deletion.
• It is intended for use only by the doctors of orthopaedic surgery.
. Views expressed in this presentation are personal. • .For any confusion please contact the sole author for
clarification. • Every body is allowed to copy or download and use the
material best suited to him. There is no financial involvement.
• For any correction or suggestion please contact [email protected] or www.agrasenortho.com