Questions and Answers / GP Doctor Consultations #Guest Post


I would like to recommend a brilliant site called GP Doctor ( http://www.thegpdoc.com )who have kindly allowed me to share with you one of their posts. As a Receptionist you will all be very familiar with many of the questions below, and maybe even some that you have not come across or had the answer before.

I hope you enjoy it.

Guest Post

GP Doctor Consultations – Question and Answer Session
BY GP DOCTOR · MARCH 7, 2015

GP Doctor Consultation Q&A
Patients often have many questions about the GP Doctor consultation process and all of the questions asked below are genuine questions posed by patients. Hopefully it addresses some misconceptions about the GP consultation.

How long does my GP Doctor have to see me? It seems very rushed.

10 minutes. Realistically 7 minutes as the 10 minutes includes calling the patient to the consultation room, referring if required, prescribing and writing our notes (which is very important for your records so there is an accurate picture of your medical history which helps in future consultations).

Why not offer longer appointments?

There is already a recruitment crisis in GP and currently there are not enough GPs in the UK. If we offered longer appointment times, fewer patients would be seen in the day, contributing to longer waiting times for appointments.

Why have I been waiting to be seen? My appointment was 15 minutes ago.

The patient before you may have been very unwell with multiple complicated conditions requiring more time. Furthermore your GP may be running a little late if they had to discuss a patient with hospital specialists or had to deal with other emergency situations or telephone calls. It could also be simply that the patients seen before you presented with multiple issues that they wished resolved.

Is your time more important than mine that I have been waiting so long?

No GP feels their time is more valuable than the patient’s time. We do try to keep to time. However situations out with our control contribute to sometimes running late as also mentioned above.

I am only 5 minutes late. Surely this is not an issue?

Bear in mind that you may only feel it is 5 minutes. However if lots of patients attend late for their appointment your GP is then automatically running late for patients later in the day.

What if I have a list of things?

You may have a list. But if you tell me this at the start of the consultation, I may be better able to help you. Mentioning this at the last minute makes it more difficult as we may have spent a large proportion of time on only 1 issue.

I don’t come to the GP often. Surely I am entitled to have longer or discuss all my issues?

We try to discuss and manage as much as we can in 1 consultation. However bear in mind that there are other people waiting so it doesn’t mean I can solve all your problems in 1 appointment especially if they are more routine matters and you have, for example, 5 things you want addressed.

Years ago my GP had time to have some social chit chat. Why not now?

It’s not that your GP is not interested but is pushed for time and the next patient will already be waiting to be seen. We feel it is important to actively engage with patients and firmly believe that part of this is building a good doctor-patient relationship. Unfortunately due to time constraints we may not be able to talk to you for as long as we would like.

The waiting room only has a few patients in it. Surely the GP must not be very busy?

This shows an effective appointment system that is working well and not large queues still waiting to be seen.

Why can’t my GP see patients constantly in the whole day?

See the other related post “GP Myths – Appointments” which answers this question.

Why do you not know all my medical history when I come to see you?

It may be the first time you have met the doctor and he/she will not have had time before seeing you to go through all of your notes in any great detail. In addition it is better for us to ask you to get accurate information rather than just rely on the notes.

Have you read my notes before seeing me?

With anywhere between 5,000 – 15,000 patients we can’t know everything about your medical history off by heart. We probably haven’t had a chance to look at your notes in great detail before seeing you. However if we need to know more we can ask you or look at your medical notes during the consultation.

The GP called me back today. Why is he/she asking me what I wish to discuss?

We cannot assume why you are here. You may be attending to discuss something else and that’s why even if we have asked you to come back we ask at the beginning the reason for your attendance.

My GP is looking at the computer during the consultation. I’m sure he/she is using Google to diagnose me?

No we are not diagnosing you using our computer. We need to look at the computer for your medical notes. We also may use the computer to check doses and local guidelines regarding drug prescriptions.

Why is my GP asking me what is wrong? Doesn’t he/she know? I just want a diagnosis.

If your GP asks something similar to “What do you think may be causing your symptoms?”. It isn’t because he/she wants you to self-diagnose. You may have thoughts about what you feel may be causing your symptoms or condition. Everyone has thoughts about what may be wrong. If we know this we can answer questions you may have regarding this or to address misconceptions you may have. Furthermore it also helps us identify how much detail we need to give as you may already know a great deal about your symptoms/condition. If we don’t know what you think may be causing your symptoms you may leave the consultation feeling that your questions haven’t been answered or that you are adamant it is something else. We don’t want you to leave thinking “My GP told me I have X condition. I think I have Y condition”.

Why does my GP ask so many questions rather than just tell me what is wrong?

Most diagnosis by all doctors is reached from information gathered from the patient. Therefore it is important that we gather as much relevant information as necessary to do this. Investigations can be helpful to diagnose but remember most diagnosis is reached from talking to you. In addition we do not have access to immediate scans and blood results.

My GP looks at a book for drug doses. Why?

We can’t remember all drugs doses and sometimes have to look these up. It’s better to be accurate if we are unsure. In addition there are multiple doses for children depending on their age.

I have been asked to come back for a follow up. Should I?

Yes. If your GP feels you should attend again to review your condition it is important to do this. This will also prevent asking for an emergency appointment in case things haven’t improved. If your GP has asked that you come back in a few weeks he/she may also want to see how your condition is evolving or discuss blood results that you have yet to have done.

I came back a few weeks later and another GP said I had something else? Was I misdiagnosed?

Not necessarily. Symptoms evolve. We can only base our diagnosis based on what you present with at the time of seeing us. Symptoms and conditions evolve over time.

I came about my sore foot. Why am I having my BP taken or asked about smoking or if I am up to date with my smears?

We may try to opportunistically help with health promotion. You may not attend to see us often and it may be the only chance we get to discuss these areas which can help improve your health.

Communicating with your Receptionists #Managers


Being a doctors receptionist is no easy task, and certainly not the job some people seem to think it is, some think it’s sitting at the desk booking patients in to see the doctor and handing out prescriptions, oh no it’s so much more and more again. Being a doctors receptionist is a bit like marmite, you either “love it or hate it”. The receptionist that ‘loves’ his/her job will be loyal, hard-working and very proactive. They are the ones that can see problems ahead, make the best suggestions and really want the best for the practice. They are the ambassadors of your practice.

It saddens me when at some of my training sessions I hear that they sometimes do not feel appreciated and they don’t feel part of the team. They often blame Management for lack of communication who are occasionally not caring and unapproachable. This might not be true, but it’s how they feel. Lack of training is also another complaint that I hear of often. Many Receptionists feel that they could do so much more in their role, if only they had the appropriate training. This is where I step in and defend the managers! I know how hard the role of a manager can be, often being piggy in the middle; the Partners shouting on one side and the Staff on the other. There are budgets to follow and targets to hit, whilst trying to stay loyal to both sides. Being a manager can often be a very lonely job. Who is there for the Manager when it gets tough?

My role of manager soon taught me that communication is key. In communicating with the receptionists I came to learn, first hand, what the problems in reception were, before it got too late and became a bigger problem than it already was. Receptionists need to know what is going on, if they don’t they often jump to the wrong conclusion. They will often gossip between themselves and make up their own minds, which can often cause bad feeling within the team. Having a team with a low morale is often extremely hard to turn around.

What is the best way to communicate with your receptionists? Hold Regular staff meetings; weekly, twice monthly or monthly.

  • Ask the staff to contribute to the agenda, make the meetings their meetings.
  • Make the meetings interesting! If they are interesting the staff will actually want to come, they will contribute and as a result they will be a success.
  • Rotate the meetings on different days and times to enable part-time staff to attend at least every other meeting.
  • It’s your chance as a manager to give the facts, to tell them as a team what is happening within the practice; it’s a great way to avoid rumours and discontent.
  • Take minutes for future reference and make copies available for those that were unable to attend. Make a copy for the partners too.
  • Ask a Partner to attend a couple of meetings a year, this shows support, and in my experience, always goes down very well with the receptionists. It also gives the Partners an insight in what is happening in reception and how hard their roles can often be.
  • Use the meeting to discuss any issues that have occurred and ask the team how they feel it could have been dealt with, often they will come up with the solution. This will help in the future as they will then start to solve problems themselves, rather than running to you every time, expecting you as the manager to have the answer. Meetings can often make the team more proactive.

Another complaint is lack of communication. Often, many of the staff will be told something but others don’t hear about it. This can lead to confusion and often anger, which can result in jobs not being done properly, as some staff have not been informed. A lot of the time this happens to staff who are on holiday or that work part-time. Memos or emails sent to every member of the team seems to work well. Having a receptionist message book works extremely well. Receptionists can leave messages that everyone can read before they begin their shift.

Communicating with your team will often highlight concerns, and often they will share good ideas,  after all they are the “experts” in their field and will often offer very productive ideas. Many of my training issues, ideas and changes came from my experiences of “walking in their shoes”

Another way of communicating with your staff is to simply show your support. Go and see what they are doing and praise them regularly. Most importantly, always remember how difficult your job as a manager would be if the receptionists did not do their job well.

 

© 2011-2017 Reception Training all rights reserved

Cancer Care At Its Best


 

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I have a friend that has recently be diagnosed with cancer and she is facing many weeks of chemo. Her hair is falling out, and she has got those dreaded mouth ulcers amongst other things. But through this she is staying positive and I must say she is pretty amazing.

What keeps her so positive?

It’s the support she has from her family and friends. But that’s not all, she has shared with me the support she has received from everyone involved in her treatment and the care she has received has just been incredible, she has found every single person caring for her in the NHS just amazing.

From the Receptionists at her doctor’s surgery, to the doctors and nurses, hospital transport and volunteers at the hospital she has found every single one of them helpful and informative.

It’s not just the treatment that plays a big part in someone getting better and staying positive, it’s a lot to do with they support that they received from every single healthcare professional that is involved in their care.

Being a Medical Receptionist is more than customer service, its patient care at its best.

You could make someone’s treatment just that little bit more bearable in the way that you deal with them when they visit your surgery.

Always treat someone they way you would want to be treated.

 

© 2011-2017 Reception Training all rights reserved

The Sunshine Patient


 

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Working on the front desk as a Receptionist you deal with thousands of patients over the years. But there are those few patients that will always stay in your mind for different reasons. If I think back to the many lovely patients I use to deal with one that automatically springs to mind is Andrew (I have changed his name for this story).

Let me tell you about Andrew and how he used to lighten up my day when he came into the surgery. He was like a ray of sunshine.

Andrew used to come in on a fairly regular basis with his Dad. Andrew was 25 years old and had Downs Syndrome.

It was just Andrew and his Dad – on getting to know them more I found out that sadly Andrew’s mum had died in their house due to Carbon monoxide poisoning. Andrew and his dad were extremely lucky to pull through – but it was so obvious how they missed their wife and mum.

When I first started dealing with Andrew and his Dad on the front desk it was always his dad that made the appointments, did the talking and insisted on going into see the doctor with Andrew.

The doctor that Andrew (and his dad) used to see on a regular basis was concerned that Andrew was not being allowed to be more independent and do more for himself – but the Doctor also identified that this was mainly down to Andrew’s dad not wanting to “let go”. Andrew was all he had in the world. But at the same time it was not fair to Andrew he was being held back.

After some months getting to know Andrew and his Dad Andrew started to really come out of himself and would chat away at the front desk to me he would joke and laugh with me. I always got a great big beam from him when he came into Reception.

Andrew would happily tell me about his day – what they had done that morning and what there were going to do that afternoon. I always looked forward to his visits and the stories he had to tell.

Then Andrew starting to hold the conversation more every time he came in. Andrew even started to book his next appointment by himself and actually started going in to see the doctor on his own. I seen Andrew grow with such confidence. The doctor that Andrew was seeing was extremely supportive and understood Andrews needs so well.

When Andrew was in with the doctor one morning his dad was chatting to me at the desk. He opened up to his fears about Andrew, and confessed that he actually felt that he was holding Andrew back, but Andrew was all he had.  He confessed that he had even put a block on Andrew attending a day centre as he didn’t want to let go. I felt so sorry for his dad and for Andrew too. His main fear was that Andrew would die and he would be left with no one. The love he had for Andrew was amazing but he was holding him back.

Andrew continued to flourish and he even got a bit bold at times – in a nice way. The cheeky chap even tried to chap me up for his dad once and asked if I would go to their house for fish and chips that Friday night – it was all in good fun and he understood that I couldn’t go as I had to get home to my two girls.

Andrew’s confidence continued to grow, with the help of the GP his dad finally agreed that Andrew could go to a day centre – Andrew just loved it there. His eyes would sparkle when he told me about his days there and the friends that he had made.

But his dad’s fears of loosing Andrew never went away.

Life continued in the surgery and Andrew and his Dad’s visit became less frequent. Andrew was becoming much more independent and loved his days at the centre.

Then one Monday morning I was checking through the out of hours reports and to my horror seen that there had been a death at their address – Andrew’s dad had died of a massive heart attack.

I never got to see Andrew again – and never knew what happened to him, but one thing for sure I know that wherever he went he would have brightened up their days just like he had done to mine whenever he came into the surgery.

I would like to think that the independence that Andrew gained over the years would have given him some strength to get through the loss of his Dad.

 

© 2011-2017 Reception Training all rights reserved

Managers Training: The Other Side of the Desk


When managing staff it is always good to give them feedback. Yearly appraisals are a good opportunity for this but why leave it once a year?

Here is a little exercise I used to carry out on my Reception staff.

Sit in your Reception area at the busiest time of day. Observe what is happening in your Reception area – see how the receptionist deal with patients how they cope with the busiest time of day and how they copes with the pressure that the busy time can bring.

Put yourself in the place of a patient – see it from their eyes and ask yourself how do they see our Surgery?

Have a note-book with you and take notes – but the most important part of the exercise is not only to pick up on any negative issues but also highlight the positive issues too.

What should you be looking for:

  1.  Is patient confidentiality being broken? Can people in the waiting room hear conversations from the Reception Desk? Patient confidentiality it vital in any Practice – and more so at the front desk.
    People in the waiting room can often hear conversations at the front desk. Make
    sure you staff use as little personal information as possible. Make sure that
    all your staff has the appropriate training on Patient Confidentiality. (see
    blog on A Quick Confidentiality Checklist. http://t.co/S3E94mU8)
  2.  How does the Receptionist interact with the patients? Do they have good eye contact? Are they polite and always helpful? It is easy to be short with patients when you have a queue of people at the front desk. Training in dealing with such times is vital – train your staff in dealing with such times –
    how to move patients on quickly without being rude or appearing that they are
    not caring. A smile and a thank you go a long way.
  3. How does the Receptionist answer the phone? Is it answered quickly enough? Does the Receptionist deal with the call efficiently? Always make sure that your staff answers the phone with good morning/good afternoon – the name of the surgery and their own name. Staff than give their name takes ownership of the call more than those that do not give their name. Again, if they are in ear shot of the waiting room it is important that they remember Patient Confidentiality.
  4. What are the other staff doing whilst the busy time is happening – are they helping out?  Often in Surgeries you have Receptionists at the front desk and others doing other things such as admin, typing, prescriptions – have you got a contingency plan for such busy times – if someone is busy on the front desk or on the phone do you have someone who can come and help out for short periods of time.
  5. Can you hear conversations between Receptionists behind the desk? When the quieter times come Receptionists often will have a little chat – but they should be made aware to be careful on what they are chatting about – I had an incident where 3 Receptionists were discussing a TV programme that was on the night before. They were discussing the programme about Breast Cancer and about a lady having terminal Cancer – they talked in-depth about the programme – talking about people who had lost relative/friends to the horrible illness. What there were not aware of was a patient was sitting listening to them in the waiting room that had just recently been diagnosed with Breast Cancer – she found the conversation very upsetting. Whilst I was doing
    this exercise I also heard Receptionists discussing an issue that could have
    upset a patient in the waiting room.
  6. Is the Reception area being kept clean and tidy? It is important to
    keep your reception area clean and tidy. Not just for a good impression but for
    Health and Safety reasons too – magazines, children’s toys left lying around on
    the floor is dangerous – someone could easily slip and fall.
  7. Are the patients kept waiting for long periods of time (often a problem in surgeries) This unfortunately happens in every surgery. Observe how your patients feel about it – and how your Receptionists deal with the patients if they come back to the desk to complain/enquire about their appointment running late. Do you have a policy on Doctors/Nurses running late?Do you have a surgery policy about Doctors/Nurses running late?

After you have done your observation bring them to your next staff meeting.

I always find the best way to approach this is to tell your staff that it was not an exercise to “catch them out” but an exercise to find if and where improvements can be made.

Always start with the positive notes you have:

  •  How well you thought the receptionist dealt with a certain patient/incident.
  • How good their telephone manner is.
  • How lovely and tidy the reception areas looks.
  • How pleased you were to see others helping each other at the
    busiest time.
  • How good they are with dealing with confidentiality.

Then

If there are any (and I am sure there will be) go onto the negative things that you found – discuss them and ask your team to give their opinion. Ask if there is a better way it can be dealt with. Include them in any decision-making. Include them in your findings.

Staff do not like change so I always used to say – we can change it, try it and if it does not work we can look at it again.  This always used to work.

Make minutes of the meeting – ensure that you record any changes that are going to be made and ensure that everyone has a copy – including those that were unable to attend the meeting.

Turn those negative into positives.

 

© 2011-2018 Reception Training all rights reserved

Confidentiality: Assessing Patient Information by Using DOB (date of birth)


In today’s society with confidentiality a wide and often difficult issue we often have to be seen to minimise the use of patient information. Simply by repeating a patients name or address often breaks confidentiality. Most of the time this will not cause a problem, but there are ALWAYS the exception.

Ways that confidentiality can be broken can include:

  • Asking a patient for their name or address at the reception desk and being overheard by a 3rd party.
  • Repeating a patients name or address over the telephone and being overheard by a 3rd party.
  • Writing patient information down where a 3rd party can read it.
  • Giving patient information to a 3rd party i.e. husband/wife/mother/father/son/daughter or other family members or friends of the patient without their consent. This also includes outside agencies.

By using the patients date of birth (DOB) you are not giving away any confidential information to anyone listening to your conversation. This can be a good way of dealing with such an issue at a busy reception desk.

By entering the DOB into the computer it will identify if this patient has already been registered. By entering a name onto the computer, which has another way of spelling the name to the one already registered will not identify that this patient is already registered.

When a patient is entered onto the system twice this creates a duplicate patient – and it means that one patient will have two set of “notes” on the computer system. This could lead to serious problems because if the patient is brought up on the system by their name and accordingly to which way the name is spelt important information could be stored on the “other duplicate” set of notes. This could be blood results, letters from the hospital etc.

Duplicate patients are often created when a patient is registered at the practice before then moved away and returned to the area and wanting to re register at the practice again. If DOB was entered it would straight away identify that the patient has already been a patient and their records can be “re-opened”. If the name is entered and their original name was entered by My John David Smith and when they came to re-register and they put My John Smith this may not identify that he had been registered in the past.
This would result in them being registered again thus creating a duplicate of notes.

Below are some examples of how ONE patient could be entered into the computer system in more than one way:

  1. Carol Ann Linch          DOB 29.5.86
  2. Carol Anne Linch        DOB 29.5.86
  3. Carole Ann Linch        DOB 29.5.86
  4. Carol Anne Linch        DOB 29.5.86
  5. Carol Ann Lynch         DOB 29.5.86
  6. Carol Anne Lynch       DOB 29.5.86
  7. Carol Ann Lynch         DOB 29.5.86
  8. Carol Anne Lynch       DOB 29.5.86
  9. Carol Lynch                  DOB 29.5.86
  10. Carole Lynch                DOB 29.5.86

And so on and on…………………………

10 Ways that a patients name could be entered – BUT ONLY ONE DATE OF BIRTH

Putting in the wrong spelling will create a problem, the computer will be unable to find the patient or worse still bring up the wrong patient. Think of a surgery they could have 10,000 patients or even a hospital with thousands on their computer system – just think how many might share the same name or have similar names – but how many would share the same DOB and the same name?

By asking the patient for their DOB you can bring the patients details up straight away. If by chance there is more than one patient with the same DOB – then ask the patient to confirm their address – by asking the patient especially over the telephone you are not divulging any information – it is a bit different if they are at the front desk – so remember if you are asking them to be discreet.

Often you will have a father and son or mother and daughter with the same first name as well as their surname, this in the past has caused the wrong information to be used – for example:

  • Mr John Smith    DOB      26.5.57    (father)
  • Mr John Smith    DOB      18.8.81    (son)

Simple spelt names like Smith can be spelt differently i.e. Smyth, Smith. Green, can also be spelt as Greene, and there are many other names that can sound the same but be spelt differently.

By entered the DOB you would have brought up the correct patient.

By entering DOB when scanning will also minimise errors, in the past patient information has been scanned into the wrong patients notes.

If you do enter information onto the computer ALWAY check you have the correct spelling – please do not assume you have it right. If in doubt always ask for the DOB.

Sending out Letters to Patients


I had a frantic phone call one Friday evening from a good friend – she was in a right panic. She had received a letter from her Surgery (not the one that I worked at) asking her to make an appointment to see the Doctor regarding her recent smear test.

She didn’t know what to do; she had in previous years had abnormal smear results and of course was now thinking the worse.

I tried my best to console her – but she had made her mind up – she convinced herself that the Doctor was calling her in to tell her she had cancer.

As you can imagine she had a very stressful and sleepless weekend.

Monday morning came and she rang the Surgery – at first she was told that there were not appointments that day – but she insisted on seeing the Doctor.

Her appointment was for 11.00 – she was at the surgery at 10.00 – she sat and waited – she was called in to see the Doctor for him to tell her that the smear had not been taken correctly and it would need to be repeated. That was it – it needed to be repeated – more than likely the nurse may  not have taken it correctly.

To say she was over the moon was an understatement. But the worry she went through that weekend was awful.

So, it got me thinking – how many other people received letters at the weekend that could cause worry and concerns – having to wait until Monday morning before speaking to a Health Care Professional? Probably quite a few I should imagine.

So, I spoke to the Partners at our next staff meeting and we all agreed that such letters that were not urgent and could cause concern to patients or their families would be posted on a Monday, Tuesday or Wednesday, hopefully arriving before the weekend and if the patient was concerned at all they could phone or make an appointment to speak to or see a Doctor

If there was an urgent letter that needed to go out on either the Thursday or Friday and the Doctors felt it might cause some concerns one of the Doctors would phone and explain the letter was on its way and if the patient had any concerns they would try to answer their questions.

True Story

I recently spoke to a mum who young son was having various tests done at her local hospital. She received a telephone call from the consultant at 7.30 on a Friday evening asking her how her son was – he asked her if he had got any worse, he asked if he had been with any cattle she was a bit alarmed at the call. He asked her to bring him in again on the Monday for some more blood tests. She admitted that she was a bit concerned – more blood test – but put it to the back of her mind for the weekend. Her and her son had a fun packed weekend which she said was one of the best.

She went with her mum to see the Consultant on the Monday they he gave them the devastating news that her son had cancer – the consultant had known that on the Friday when he spoke to her.

This consultant had given this thought – he wanted to spare her the heartache for a few more days – he knew by telling her the news on the Friday that her world would come crashing down – he knew she was on her own at the time – he spared that until he had her face to face and could go through the options and treatment for her little boy. This is something she is eternally grateful to that Consultant for.

It’s not what we do but how we do it that can have such a big impact on people.

 

Does your Practice send out recall letters on a Friday so the patients will receive them on a Saturday?

Communication between the Surgery and the Hospital.


                          

As a Doctors Receptionist you will have a close working relationship with your local hospital(s). Working for both Doctors Surgeries and Hospitals I can say that their systems are  quite different. Not that anyone of them is right or wrong – it is just down to the type of work that they both do. But one thing that they both have in common is patients, and at the end of the day it is vital that you and their patients get the best possible treatment. So communication between your surgery and the hospital is vital for the wellbeing of your patients.

The surgery would often work closely with the outpatients department in the hospital, as well as the labs – checking up on patient results, sending in samples etc.

You at the surgery will all have come across the sample that has been sent in without the correct information on. The doctor or the receptionist has forgotten to enter the patient’s details correctly onto the specimen bottle – or perhaps the lab technician just would be unable to read the doctors handwriting although computers have come a long way in making this a lot easier to get right.

I have been “that” receptionist that receives the call from the lab saying that they cannot accept a sample as it was not labelled correctly – I  like many did not understand why the labs just could not take the details from me – after I had all the details of the patient in front of me.

The outcome of this would have resulted in the patient being called back into surgery to have another sample taken to be sent off to the labs again.

As I worked my way up to a Manager these incidents still occurred from time to time, I had receptionist complaining that they felt the hospital was being unreasonable when they offered to give over the patients details.

So, I arranged a visit to the local hospital. The first visit was to the laboratories – I brought along the supervisors from each team of Receptionists. We spent several hours with some very helpful members of the management team at the hospital and they went through the whole journey of when the sample reached the hospital via courier from us at the surgery.

It was amazing watching the process of these samples. What did surprise us was the amount of samples that they received in from each and every surgery in the local area – and some from outside the area too. This highlighted the importance of having each and every sample labelled correctly – and the awful outcome that could occur if one sample was given the wrong details.

Meeting the team at the laboratory was lovely; it was nice to put a face to the voice that for years we had only spoken to on the telephone. We both listened to each other’s points of view, and both sides admitted that there were definitely areas that they could improve on the main one better communication between the two units.

For us the biggest lesson learned was that each and every sample would be checked at the surgery before it was handed over to the courier before heading for the hospital. The Doctors were reminded regularly about the importance of completing the sample bottles correctly – and most importantly in handwriting that could easily be read by the laboratory technicians.

We discussed our visit at our next receptionists meeting. Because of the volume of receptionists that we had it was impossible for them all to visit the hospital, but it was important for them to learn from our visit. This was also something that I would discuss with every new receptionist.

A month after our visit I phoned and spoke to the member of staff that had been our guide for that afternoon and he also agreed that things had become a lot better, samples were being sent it properly  labelled, and if there were any queries it was a pleasure to phone and speak to someone who they knew. Our Supervisors also said that communication between the two units had improved a lot.

About 6 months later I organised a similar visit this time around the outpatients department. I took the supervisors along with me again, this time they were shown around the department and how the hospital dealt with a patient’s referral letter when it arrived from the surgery. Again, communication was greatly improved after this meeting.

So, much so we invited a couple of the ladies from the outpatients department to come and spend a few hours with us at the surgery, sitting with the secretaries and the receptionists seeing for themselves just how busy and hectic it was. They too found it an extremely helpful exercise.

They agreed that they never really fully appreciated how busy it was at the surgery, and again communication between the two departments was greatly improved.

How To Avoid Workplace Anger/Violence (part 2)


Are Patients Waiting Too Long?

Research has shown that long waiting times can lead to angry/violent behaviour. So keep your patients informed, give a reason for the delay and apologise when necessary – please do not ignore the waiting patients (see blog: When The Doctor/Nurse is running late. http://t.co/Tlnpi4OD )

Does Your Patients Feel They Have A Method Of Complaint?

Provide a well-advertised complaints procedure in your Practice Leaflet. Quite often a Receptionist can deal with a complaint before it goes to Management level.

Always offer the patient a complaints form. Ensure that all your Reception team knows where the complaints forms are kept. No complaint should go to the Practice Manager without being offered a complaints form first.

Most people when offered a complaints form will decline, and even when they do except a complaints form will probably not return the completed form. But it is important that they have that choice to make.

Are You Or Your Staff Helpful and Courteous?

An abrupt or indifferent receptionist and lack of information can often lead to frayed tempers.

Do You Think Your Receptionist Makes Things Worse?

First rule; do not get yourself into an argument. An argument may cause anger to escalate into aggression and perhaps violence. Have you as a team discussed ways to prevent or defuse such situations? Ensure that all staff have clear guidelines – this will help them deal with such a situation.

Is the Waiting Room a Calm and Comfortable Place?

Consider ways of reducing boredom, up to date magazines. Toys for the in the play area. Posters and Notices on the wall. Plenty of seating. Make it comfortable.

A local A&E Department recently spent a large amount of money re designing and updating their A&E Department and found that this reduced the vandalism by a considerable amount. Both patients and staff found it a more relaxing environment to be in.

Can Your Staff Recognise The Warning Signs?

Staff need to be aware of this at all times. If dealing with a patient who is known to be hostile, make sure you are in a position to summon help or make an escape if necessary. Bring it to the attention of others if necessary.

Does your Practice have panic buttons? Ensure that all Locums and new staff are aware of where they are situated.

Are You Aware Of Stranger Danger?

Be extra cautious if an unknown temporary resident is fitted in at the end of surgery. Warn the doctor/nurse that the last patient is a temporary patient. It has been known that a few patients are looking for drugs will book a late appointment and not complete the temporary residents form out correctly which means that the Practice has no relevant information on the patient. This is not to say that every temporary resident is like this – but there are the odd few out there.

Is Information Shared?

Everyone working in the practice needs to know which patients might pose a risk. This will apply to doctors working at another surgery for the out of hours. Especially inform all other surgeries if you have a temporary resident causing any problems. If you have a violent patient you should inform your local PCT/Health Authority.

Can The Waiting Room Be Seen and Controlled By the Receptionist?

Try to ensure that there are no nooks and crannies where people are sitting out of sight. If someone is getting agitated or poorly the Receptionist should be able to notice the signs and deal with it appropriately.

Are You Providing Weapons?

Do you equip your surgery and waiting room with items that can easily be used as weapons or missiles?

  • Paper opener
  • China Cups
  • Heavy objects such as stapler, paperweights
  • Metal toys in the children’s area
  • Sharp objects

Always ensure that potential items are out of reach.

What Should You Do If the Patient Becomes Aggressive?

  • KEEP CALM
  • Avoid direct confrontation and try to defuse the situation. Listen and show you are listening to their point of view – do not argue.

Can You Defend Yourself?

  • Avoid physical contact.
  • Call on others for support
  • Quite often if there is more than one person in front of the aggressive person they will calm down a lot quicker. If you hear a patient getting aggressive at the front desk, just go over to the receptionist dealing with the patient and just stand and observe, do not say anything, often this is enough to calm the person down.
  • If the Receptionist cannot deal with the situation then you might need to step in and take over.

People who are most effective in dealing with aggression understand something about the psychology of people. They understand why make people tick and recognise that human beings have basic animal instincts, which often come to the fore when they feel threatened or feel frightened or angry.

The options that our animal instincts provide are either FLIGHT or FIGHT.

Many things may affect which option we choose but some things which will increase the likelihood of choosing FIGHT are:

  • Feeling our personal space is being invaded
  • Feel physically threatened
  • Feel that our exit path is blocked.

One of the most effective ways of diffusing this natural response is to deliberately signal that you are not going to respond in an aggressive way. This may not be easy when you are probably feeling threatened yourself, but the following actions will help to signal non-aggression to others.

Give the other person space – If you increase the distance between you and the aggressor it will lessen the feeling that their personal space is being invaded and reduce the feeling of physical threat and open up their exit path. It also gives you a greater range of options should the situation suddenly change.

Relax your own posture – you can reduce your own aggressive signs by dropping your shoulders, adopting an open stance and allowing your arms to drop. Such action will probably feel unnatural given the situation but it will quickly reduce the aggressor’s feeling of being intimidated.

Avoid sudden movements – remember that heightened emotion will make an individual jumpy and ready to defend, and that quick or sudden movement might trigger an instinctive reaction.

Reduce eye contact – Sustained eye contact is a very aggressive signal in these types of encounters. You should avoid gazing intently into the aggressor’s eyes.

The above four behaviours will reduce the potential for aggressive situations to turn into violent confrontation. However, they do not, on their own, resolve the encounters successfully. Successfully resolution can be achieved by:

  • CALMING the individual and then building
  • RAPPORT with him/her to finally achieve
  • CONTROL over the situation

This sequence is very specific. Successful control of a situation cannot be achieved by trying to achieve rapport with a person who is still very wound up by the incident itself. You must calm the person down before he or she will be receptive to your attempts to build a rapport.

CALMING

A common mistake, which is made at this stage, is trying to deal with the reason why the person is being aggressive. In fact you should try to deal with the emotions that the person is bringing into the situation. Trying to deal with the reasons why before you calm the emotions will only service to increase the tensions and set off an escalation of the incident.

It is vital that you as the person seeking to control the situation are fully in control of your own emotions and reactions. This is not easy because you are not immune to the situation and you may be feeling fear, excitement or anger. But your ability to control your own emotions, particularly your anger will have a vital impact.

Many incidents involving aggressive people take place in public places where the aggressor has an “audience” and it will help the situation a lot if you make the encounter a one to one situation where the aggressor will not be able to “play to the audience”. Most of all, do not put the aggressor in a situation where he or she will be seen as losing face to the audience.

In the early part of this stage, what you say in your efforts to calm the individual is probably less important than how you actually say it. How well you communicate non-verbally will be very important in sending calming messages to your aggressor.

There are several non-verbal behaviours which can help to signal non-aggression and encourage the aggressor to calm down

  • Move slowly – sudden, quick or unpredictable movements can sign aggression particularly to someone who is already tense and feeling threatened.
  • Allow space – respect the aggressor’s “personal space”. Moving into a person’s personal space is very intimidating and almost threatening.
  • Reduce aggressive signals – finger pointing, sustained eye contact, arms folded, hands on hips are all gestures which heighten tension rather than reduce it.
  • Deliberately adopt  “friendly” gestures – extending your arms with the palm of your hands outwards, dropping your shoulders, gentle voice tone, an open interview stance and your head to one side rather than full on – these will help to signal to the aggressor that you do not seek to be aggressive.

When you have managed to calm the aggressor to a point when you feel they are able to listen to you, then you can move into the next stage of building rapport.

RAPPORT

This is really about winning the aggressor’s trust. If you are to gain effective control of the situation then it is crucial that the aggressor feels that he or she can trust you. This will involve showing empathy towards the aggressor.

This means letting the person know that you can appreciate his or her view of the world and the particular situation they are in. This is distinct from sympathy and agreeing that their view is the right one. Showing empathy can be achieved by simply reflecting back to the person what they have said.

Be careful not to use emotive words or phrases which emphasises failure of loss of face like:

“That was a pretty stupid way of carrying on wasn’t it?”

Show the individual that you are a person too. This may involve giving a little bit of yourself away to encourage the aggressor to talk and to be more open.

By this stage you should be dealing with a much more rational person who is amenable to reason and is listening to what you are saying. If you are not – then you need to continue with the “calming” skills until the person is able to be more rational.

 

Remember: Patients are not always right but they ARE important. Show them they are important by the way you treat them.

 

 

 

Helping Patients With Learning Disabilities


People with learning disabilities are a small proportion of the population; however evidence suggests they have greater health needs, in relation to hearing and visual disabilities, hypertension, chronic bronchitis, epilepsy, cerebral palsy, gross obesity, spinal deformities, skin disorders and mental health.

Patient can often feel intimidated and often feel confused and may be happy to let their carer speak for them.

They might often see the Doctor or Nurse but leave the room without having communicated what the reason was for attending the Surgery. In addition to these problems many people with learning disabilities may not be able to understand written instruction which can cause them some distress.

Areas to be Considered

Communication

  • Use clear short sentences
  • Check the patient’s comprehension of the conversation by asking questions that will clarify that they have understood.
  • Give clear information. It might be necessary to explain in more detail because of the patient’s level of understanding.
  • If it helps the patient write instructions down.
  • When asking the patient asks a question please give them time to reply.
  • Direct the question at the patient rather than just to their Carer.
  • Use good body language and eye contact at all times.
  • Make them feel at ease.
  • Do not rush them.
  • Give them your full attention.
  • Most of all give them time.

Appointments

  • Consider booking a longer appointment to give both the GP and the patient time to communicate.
  • People with learning disabilities may become anxious in a crowded and noisy waiting room, so appointments booked at quieter times of the day might ease anxiety.
  • Some people with learning disabilities may find it difficult while waiting for their appointment; this may be overcome by booking at the beginning of the appointment list.
  • Continuity is important to people with learning disabilities – if they gel well with a certain Doctor or Nurse wherever possible please try to book them with that Doctor/Nurse.
  • Always give an appointment card for their next appointment; please do not give it verbally.

Know Your Patients

A good receptionist will know her patients – and will understand the patients especially those with special needs. She will know exactly the needs of the patient and will endeavour to do her utmost to ensure that the patient has a good experience when coming to the Surgery and this begins at the front desk.