How a doctor’s office can affect patient trust

Originally published in MedPage Today

by Marianne Mattera

Trust is an essential element in the doctor-patient relationship.

How a doctors office can affect patient trustYou’re well aware of how important it is that you can trust the history the patient gives you. You know the problems that can arise in planning and managing care if you’re working with only part of the story. And you probably even feel a twinge of disappointment if a patient questions your diagnosis or management or wants a second opinion.

You may not have thought, however, about the things that can shape or shake a patient’s trust in you. And you may never have realized how much a patient’s trust in your skills can be influenced by the outward appearance of your office and your staff.

I’m not sure I realized it myself until a few weeks ago when, for the first time ever, I walked out of a doctor’s office not trusting a thing he said and vowing to find another physician fast.

That decision was based not so much on the 10 minutes the doctor spent with my son, but on the hour past our appointment time that we’d spent soaking in his dingy waiting room and observing and interacting with his staff.

The doctor in question was an orthopedist. We’d sought him out as suggested in the ED where my son was initially treated for a sprained ankle sustained during a volleyball game at school. He’d suffered a similar sprain several years ago, so I’d grabbed the big black boot and his crutches and met him at the ED.

My son is in college (close enough for me to make the trip) and the sprain occurred in the last week of classes before exams. So it was a bit tricky scheduling a timely appointment with the orthopedist – grist for another post – but suffice it to say that after calls to the three recommended by our PCP, I was forced to start at the top of the insurance company’s list of participating physicians and work my way down.

I took the first appointment I could get, three days after the accident.

I admit to being taken aback when we entered the waiting room. I’m not very good with estimating distances, but this room couldn’t have been much bigger than 8’ x 10’, maybe 10’ x 10’. Gray walls, dull carpet, seven or eight straight-backed chairs lining the walls and a small portable television on a table next to the reception window blaring a Food Network cooking show.

There was a narrow door at the corner of the wall with the reception window and next to it on the adjoining wall an equally narrow door to what turned out to be the one examining room.

The three people behind the glass reception window all wore jeans and the one who sat at the window was the least knowledgeable and least courteous of them all. Go figure. When one of them needed to discuss something personal with a patient, she came out into the waiting room and brought the patient into the common hallway shared by all tenants in the building. Unbelievable!

The two patients ahead of us when we got there each got about a half hour with the doctor. My son came out 10 minutes after going in to the exam room, having had a cursory examination of his foot and being told to get an MRI and come back the following week. He later told me that the doctor devoted several of those 10 minutes to taking a phone call.

Because my son hadn’t had an MRI for the previous ankle sprain, he and I were both perplexed as to the need. So I asked to speak with the doctor myself. I was ushered into the doctor’s office and found a similarly small, shabby room. The quick explanation the doctor gave me didn’t make me feel assured that the costly test was, indeed, called for.

So we left, neither my son nor I satisfied with the visit or confident that this doctor knew what he was talking about. We sort of felt as if we’d been seen by the infamous Dr. Nick Riviera of “The Simpson’s” fame – a sleazy character, graduate of the Hollywood Upstairs Medical College.

So I made an appointment for the following week with another orthopedist, one of the three originally recommended by the PCP.

Interestingly, the second exam took about the same amount of time as the first and this physician, too, also ordered an MRI, nor was the reason he gave for needing it much different from the first doctor’s.

But the wait to see the doctor was much shorter and was spent in a large, pleasant, bright, clean room, with lots of chairs – with arms for orthopedic patients who might need some support to stand – a television that could be ignored easily if you wanted to, and a staff that was cheerful, courteous, and appeared to know what they were doing.

If these doctors were books, I’d pick up the second one again and again. I never even finished the first one and certainly wouldn’t recommend him to a friend.

Marianne Mattera is Managing Editor at MedPage Today and blogs at In Other Words, the MedPage Today staff blog.

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  • http://mtexchange.com JulieW8

    My last HMO PCP not only had the ratty office, but his office staff was never at the front desk to greet patients. While you waited for someone to notice you were there, you could hear them arguing in the back. On my first visit, the nurse hit me up to sponsor her in a walkathon and the doctor told me how important it was to him to be able to have an erection.

    On my second visit to the office of the head of oncology at a well-known university medical center, the sole purpose of which was to get results of lab tests, the office staff (a) drew more blood, but couldn’t explain why it was necessary and (b) wanted me to completely undress for an exam, the necessity of which they also couldn’t explain. I chose not to comply with the latter. The doctor came in and announced that the lab results weren’t back yet, so I’d have to return. I wonder if he even gave a second’s thought to why I never returned.

    Note to doctors: the lowest-paid people in your office can lose you patients. It’s ultimately your business and YOU are responsible for how your office is run.

  • Tom Farrell

    Medical staff, at least In the Northeast, are not well paid. A receptionist or medical assistant is lucky to get $12-16/hour (approximately $29,000/year) with about 20% benefits (worth about $6,000). The best medical practices pay their staff well in all respects. And shabby offices- well, that’s an obvious sign that someone does not know the first thing about business.
    I could go on and on.
    Check out some of KevinMD’s posts on the subject (as well as a number of others posts and articles on the Internet):
    “Why too many…MRI scans can be dangerous for patients; Do physician quality measures tell patients who’s a good doctor?; The quality of…MRI scans vary, and how old machines can affect the treatment course”.
    Tom Farrell

  • http://www.birdsonawireblog.com Paula

    I was once referred to a surgeon whose waiting room included a big, full, dirty ash tray (in the 1980s, when people smoked) and an aquarium full of brown water and dead fish. I probably should mention mine was the first appointment of the day. Needless to say, I walked out and never saw the guy.

  • Greg

    This post just underscores the narcissism in American society today. You came to the doctor seeking advice for your son. You got it. You also had the advice confirmed by another doctor later, and saw that it was reasonable. The point of a physician is this – to examine you and give a reasonable opinion as to diagnosis and treatment. This doctor fulfilled his responsibility to you.

    But you make a decision not to trust this doctor which is not based on the advice, but rather on other people. A doctor’s responsibility is not to have well-dressed secretaries. It’s not his/her responsibility to have bright colored walls. So why pass judgment on this doctor, who actually did his responsibility adequately, when others are responsible for your negative experience?

    Yet in contemporary America this is something which happens all the time. People mistake flash for substance, think “clothes make the man,” and are thus are easily fooled by marketing to their disadvantage. The worst doctor in the world can have a delightful office, and the genius can go unsung, surrounded by her secretaries in scruffy jeans.

  • family practitioner

    I do not want to defend poor office-patient relations.

    However, a dilapidated office is probably more an indicator of the poor economic state of primary care.

    When I visit a specialist office, I find myself going into culture shock, in awe of how the “other half” lives.

    Plus, I hear patients and friends complain about big, new fancy offices that are disliked because they lack a “personal touch.”

    My office could deserve a makeover, and I hope to do it when I can afford it. However, I still have patients because they like me and my staff.

  • Lady Patient

    My one pet peeve about doctors’ offices is when I arrive I am ignored by the receptionist who refuses to look up to acknowledge my presence. After I finally get their attention, I instinctively apologize for bothering them.

    Oh, and in case any doctors aren’t aware, patients in the waiting room can clearly hear any phone conversations going on behind the sliding glass partition. One memorable phone call I overheard when the receptionist put through a phone call to one of the doctors, announcing that Dr. X was calling re patient X and the results of such and such tests. You could hear the collective gasp of the waiting patients as the patient’s name was recognizable as well as their health problem.

  • http://www.cedarhillpt.com Paul Weiss

    I can believe this. I’m a physical therapist, and have recently changed practice locations. Previously, I worked in a large, busy office in a building that was in need of much repair. The TV set in the waiting room was always on Headline News. When we went to the waiting room to get our patients, we often saw how their facial expressions mirrored the (inevitably bad) news on TV. (Admin declined to change the channel.) Since then, my wife and I have opened a clinic in our home. People have commented that coming here is more like visiting a friend than going to a medical office. I have found myself able to relax more with the people I work with, and find myself enjoying my work in a way that I have never experienced before.

    My point being the office setting not only affects the patients but those who work there also.

    I think that a home based office is a cost saving measure that can allow a health care provider more freedom to spend more time with each patient, rather than having to see enough just to meet overhead expenses let alone make a living. The side effects for us have been nothing but positive.

  • brandy patterson

    this is the thing that gets me about our drs we trust the thing your telling us why is it when the patients tells you that after my child get this one year shot he starts to change and as a mom i knoe weeks later what was going on but of cause the dr will look you inyour eyes and lie telling you at this time of a childs life a person cant tell whats going on which to me is some bs cause ive never be to dr shcool but i know weeks later my son got autism from his shoot and you want me to belive my dr didnt know then bs i feel dr want you child to get sicker and sicker so that more money is comeing in to there wallest why should we trust them they dont trust our words that is coming out i think people should be scaerd to every have to take your child to see a dr