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.

You’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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