Communication Skills / Office Suite - February 1998 Family Practice Management

February 1998 Table of Contents

COMMUNICATION SKILLS

Reducing New Patients' Anxiety During the First Visit

Sloan Robinson, MD,
and Joseph A. Lieberman III, MD, MPH

Tool inside

Today's new patients carry an extra set of worries when they walk into your practice for the first examination. Not only are they dealing with the natural anxiety of meeting you, their family physician, for the first time, but many new patients are also dealing with anxiety brought on by managed care. The American public has been vocal about its concern that patients' health care needs are being compromised to control medical costs, and as family physicians, we often find ourselves at the focus of this concern, trying to balance costs and cures. In our role as patient advocate, it is important that we find ways to set new patients at ease during the first visit and begin to establish a bond of trust.

The waiting room is the perfect place to begin this process. Here, you can give new patients information on your practice to answer some of the first-visit questions to lessen their anxiety. You can even develop a first-visit handout (page 57), a one-page document that describes your practice philosophy, tells what patients can expect during the first examination and offers a brief biography of each physician. The best physician biographies describe not only professional achievements but physicians' personality traits as well, allowing patients a glimpse at the human side of the physicians. This often helps new patients open up, which makes it easier for you to uncover health issues during the encounter.

A first-visit handout

This handout can be downloaded in MS Word format.

To acquaint new patients with your practice and its physicians, consider developing a first-visit handout like the sample shown here.

Your first visit
Thank you for choosing ABC Family Practice for your health care needs. During your first visit, you will meet our staff, complete a few brief forms and, of course, meet your doctor. As family physicians, we will try to solve your current medical problem and detect or prevent other health problems. We hope to make the first visit not just an opportunity to deal with any medical concerns you may have but also a time to get acquainted with you.

The first examination
When you enter the exam room, you will be asked to fill out a health questionnaire by a staff member, and he or she will measure your height and weight and take your temperature. Your physician will review the health questionnaire reviewed with you. Depending on your medical problem, you may be asked to undress and put on a gown in the privacy of the exam room. This enables the doctor to better evaluate your health. After the examination, your physician will suggest a treatment plan and future visits, if necessary.

We hope that after your visit you will feel confident that you've made a wise decision by choosing our practice. If you are not comfortable with one doctor's practice style, you may reschedule your next appointment with another doctor in our practice.

Respectfully,

ABC Family Practice

Our physicians
Dr. A is board certified in family practice with a certificate of added qualification in geriatric medicine. He is the founder and senior physician in the practice and is a "no nonsense," straightforward individual who leads by example. Outside the office, you're likely to find him coaching children's sports in our community.

Dr. B is board certified in family practice and also has a certificate of added qualification in geriatric medicine. He is the intellectual of our practice and is chairman of the Department of Family Medicine at our hospital. We are all proud of Dr. B for serving our country during "Desert Storm."

Dr. C is board certified in family practice and also has a certificate of added qualification in geriatric medicine. She is a working mother with two children and offers patients the warmth and grace that only a mother can provide.

Another tool you can use with new patients is simply a short medical questionnaire (page 61), which provides a quick medical history and can "jump start" the first examination. The questionnaire not only helps you gain valuable background information on the patient, it also sends a message that you are interested in the patient's total wellness and want to know something about him or her. The health questionnaire should ask standard questions regarding medical history, along with questions that get at the emotional state of the patient and other issues important to your practice.

Adult health questionnaire

Using a health questionnaire with new patients serves several important purposes. It helps your practice learn more about the patient's history, it can jump start your conversation with the patient during the exam and it sends a message to the patient that you are interested in knowing something about him or her.

Welcome to ABC Family Practice. We greatly appreciate your choosing us to provide care for your family. Our physicians will be asking you about your present medical condition and problems, but to allow us to learn more about you, please fill out this questionnaire. Although some questions may be a little starling, please understand that they address current health issues. For confidentiality, please complete the questionnaire in the exam room and give it to your physician. Once again, thank you for choosing our practice to handle your health care needs.
1. When was your last comprehensive health examination (blood tests, EKGs, etc)?	Date: ____ / ____ / ____
Note: We recommend a comprehensive evaluation for healthy individuals every three years until age 40, every two years from ages 40 to 50 and annually after the age of 50. Patients with a chronic medical problem should have an annual health evaluation.
2. Do you have a family history of medical, mental or hereditary problems?	Yes	No
3. If you were born after 1957, have you had a second measles, mumps and rubella vaccination? If you are at least 65 years old or have a chronic health problem, have you received the pneumococcal and flu vaccines?	Yes Yes	No No
4. If you are a female, do you do a monthly self-breast exam? When was your last breast exam by your physician? Date: ____ / ____ / ____ Date of last mammogram: ____ / ____ / ____ Date of last pap smear: ____ / ____ / ____ Note: One out of every 10 women will get breast cancer. The best approach is early detection by doing a monthly self-breast exam, an annual breast exam by your physician and periodic mammograms.	Yes	No
5. If you are a male, do you do a monthly self-testicular exam? Note: Testicular cancer is a leading cause of cancer for men under the age of 50.	Yes	No
6. Do you practice "safe sex"? Are you at risk for AIDS? Have you used illegal drugs?	Yes Yes Yes	No No No
7. What is your occupation? ___________________________________ Have you ever been exposed to chemicals or radiation at the workplace?	Yes	No
8. Do you have a living will?	Yes	No
9. If there is a gun in your home, is it out of children's reach and unloaded?	Yes	No
10. If you ride a bicycle, do you wear a bike helmet?	Yes	No
11. Is your home tobacco- and smoke-free?	Yes	No
12. Is your time well balanced between your job, family and hobbies?	Yes	No

As the new patient's physician, think of this first visit as the combination of a traditional exam and a social encounter. Before entering the exam room, briefly review the patient's registration, which can provide some initial insights. When you first enter the room, offer a handshake and a few simple words of thanks to the patient for selecting your practice. Then, before delving into the chief complaint, take a moment to review the health questionnaire with the patient. Be particularly careful that you allow the new patient to complete his or her thoughts before you comment.

This first visit can almost be compared to a blind date, in that you never know what to expect. The new patient visit can range from a patient wanting simply to meet his or her new physician to the classic HMO patient presenting with a laundry list of complaints. Most patients, however, present with just one problem, leaving you adequate time to explore the patient's psychosocial strengths and weaknesses, essential to creating an effective plan of treatment. (See "Enhance the Patient Visit With Counseling and Listening Skills," Family Practice Management, November/ December 1996, page 70.) Discussing psychosocial issues also helps initiate effective bonding with the patient by showing that you are an educated, caring physician and that you are trying to create a plan of action in the patient's best interest.

We would be remiss if we did not acknowledge that each practicing physician also has anxiety about the present medical system -- and, no doubt, the future. The practice of medicine has indeed changed, in many cases replacing trust with anxiety for both physician and patient. While there are no sure ways to ease new patients' anxiety, the tools and techniques described here are a solid first step.

Dr. Robinson is in private practice in Marlton, N.J., and is assistant clinical instructor of family medicine, UMDNJ-Robert Wood Johnson Medical School. Dr. Lieberman is chairman of the Department of Family and Community Medicine, Medical Center of Delaware, and is clinical professor of family medicine, Jefferson Medical College, Thomas Jefferson University.

Copyright © 1998 by the American Academy of Family Physicians.
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