Are We Violating Patient Trust Through Poor Time Management?

Nov. 1, 1996
Florida`s late-spring weather conditions remind me of the movie "Groundhog Day;" extremely predictable. Sunny, hot and humid throughout the day and then, at precisely 4:30 p.m., the skies turn charcoal-gray, interrupted with bolts of lightening and thunderous crashes, before the clouds burst into a driving downpour.

Barry Polansky, DMD

Florida`s late-spring weather conditions remind me of the movie "Groundhog Day;" extremely predictable. Sunny, hot and humid throughout the day and then, at precisely 4:30 p.m., the skies turn charcoal-gray, interrupted with bolts of lightening and thunderous crashes, before the clouds burst into a driving downpour.

Taking a tip from Bill Murray in that hilarious movie, I thought I would use that predictability to my advantage. A new steak house had opened recently with excellent reviews, but there was always at least an hour`s wait and they did not take reservations. As the clouds gathered, I summoned my family for an early dinner. We were only a short drive from the restaurant.

Directory assistance connected my car phone at no extra charge. A refreshing feminine voice answered. She said that there would be immediate seating if we came over at once. Because of the rain, the people were staying away. This was unusual, so I had better hurry.

"We`re only five minutes away and if I can navigate through this deluge, we`ll be there. Can you hold a table for us?"

"I`m sorry, but we don`t take reservations, but I can assure you that if you come over right now, we have a table," the hostess said.

My job was to steer my white, rented Toyota through the driving rain and flooded streets. I could smell the New York strip even now, right through the humid air and new-car upholstery. I couldn`t see a thing through the windshield; I think we got there like blind mice using an imagined sense of smell. Funny how the weather is in Florida in late spring, but just as we were pulling into the parking lot, the sun poked its head out and the weather was clearing up. Just like in that Bill Murray movie. Only now, unlike in my imaginary scene, there was a large group of people swarming outside.

Instantly, I was overcome with emotion. Anger! Yes, it was definitely anger, and it was building by the moment. An attitude was growing inside me and I feared I would react inordinately. I approached the hostess. Robotically, she turned toward me, clipboard in hand, and said, "How many of you will there be?" Calmly, but expectant of the bad news, I prepared myself for a major confrontation. "There are four of us. How long will it be?"

Curtly, and without ever looking up, she asked for my name and said there would be a 50-minute wait, but we could just relax at the bar until we were called. She handed me a beeper in case we decided to stroll outside.

"Excuuuse me!" I said, "but I was just told on the phone that there would be immediate seating and that was just five minutes ago. It`s hard to believe that all of these people showed up within the last five minutes. Do I look that stupid to you? Really, how do you expect me to believe that story. You know what I think? I think you lied to me to get us over here, so that we could just hang out at the bar and drink for an hour. I think that stinks! Where`s your manager?" I was steamed and losing control quickly. The hostess had come to a newly-found attention. I broke her rhythmn and she ran out of script. I was now what businesses regard as a difficult person and her job was to deal with me.

There I was, standing in the middle of a gathering crowd, giving my theory of their dishonesty, when the manager came over. A look of sudden relief came over the hostess, as if the bell rung to save a heavyweight from being knocked out.

"Excuse me, sir, is there something I can help you with?" he said, obviously thinking that just his presence would calm the storm like some kind of super hero. King Solomon to the rescue! After all, he was probably hired for his great wisdom in affairs of this nature.

"Absolutely! You can explain why a reputable chain like yours would reduce itself to lying to customers? Do you need the business that badly?" I went right for his carotid. I read lots of business books and know that in an esteemed restaurant of this caliber, the word "honesty" would be found somewhere in the mission statement or Customer Bill of Rights. I knew that Tom Peter`s seminar would come in handy one day. (Con`t. on Page 21)

I proceeded to tell him that I was lied to over the phone and thought that one of the values that a chain like this taught its employees was honesty.

He was a manager and my words were just not generic complaints. I had raised issues that are discussed at every corporate meeting that he attended. He looked around for help. There was no script that he could refer to, just his own sense of right and wrong.

At that point, I felt that I struck a chord in him, because he had been trained by corporate that, of all things, never lie to a customer and that his company was extremely sensitive to that. He apologized and asked me to trust that, for some reason, the rain had stopped and the crowd came very quickly. This has happened before, as unlikely as it seemed. He promised that he would try to have us seated within 30 minutes. He offered us drinks. Within 30 minutes, we were seated and enjoyed a fabulous meal.

As unlikely as it was, I considered the possibility of his explanation being totally true. But I still was very much in touch with my immediate emotional reaction and my subsequent response. I was angry. I felt I was treated unfairly. Dan Goleman, the author of the bestseller Emotional Intelligence, refers to this as an "emotional hijacking," an instantaneous, emotional response in which we lose control because our brains have been programmed to respond this way from past experiences. Emotional hijackings can be very serious problems or just everyday events.

This experience made me stop and think how dentists and other health professionals routinely abuse the bond of trust known as an appointment. I was furious-and that is how our patients feel when they are made to wait for an appointment. Marketing health care today is very difficult and if we as a profession are to keep our credibility, then we must respect this bond of trust. How many emotional hijackings can your practice tolerate?

The perception of our relationship with our patients is the key to marketing. How many times have we all heard the story of the patient who wanted to charge the doctor for his time. This has become a worn-out joke, but let me tell you there are some strong feelings behind it that are no different from the way that I felt in that restaurant. People are people and they are very sensitive to feeling that someone is better than them and that they can be manipulated.

Integrity, to me, means treating people exactly how you would want to be treated. To treat someone any less would be a lack of integrity. I know this sounds strong, but at a subliminal level, I feel that is how the professions have lost their respect.

Years ago, when people believed that the doctor was king, they tolerated this behavior better, but they still were annoyed by it. Basic human nature never really changed. Today`s baby boomers do not tolerate this one bit and will move out of our practices in a New York minute and go right to a competitor, regardless of quality. Dentistry is not a steak and people cannot judge the service that quickly or accurately. Faith Popcorn`s new book, Clicking, talks about future trends in society. She claims that in the future, people want down-to-earth, honest behavior from businesses. She calls this "Clicking with Vigilantism." People in the future will look for real substance and responsibility from businesses. As Peter Finch said in the movie, "Network," "I`m not going to take it anymore." So if you don`t start treating people the way you would want to be treated (Hey, that`s the Golden Rule, isn`t it?), then your patients will leave your practices for your cheaper competitor. If you`re going to be made invisible, then why not let it cost less. Really, no one gets offended when there is a long line at McDonald`s. What do you expect for those prices?

Physicians always have been notorious for this behavior. Maybe that is why, when given a choice, so many people choose the HMO. If I`m going to wait, why not wait here; one place is as good as another. I know I am sounding cynical because I want to make a point. It is hard to run on schedule. In order not to make people wait, you must have a very clear picture of your capabilities, your staff`s capabilities and your patients` capabilities. What I am saying is that staying on time just like at that restaurant has more to do with your mission, your values, your beliefs and your general philosophy of practice. This is not a simple issue. There is more to time management than meets the eye.

Dentists are technicians and not known for their thinking. Well, good time management is not a set of rules or a list of things to do. Good time management is part of your personal philosophy. The best managers of time know how to prioritize. In order to prioritize, one must evaluate choices; i.e., place a value on things. In order for that to occur, one must think. Discern. Distinguish. There is no quick-fix to time management; it requires hard work. It requires thinking and creating a personal philosophy.

Humans only have so many resources. We have our health, our bodies and minds. This should be considered our number-one re-source; after all, your health is your life. We have our time-just the present moment which we need to use more effectively. Author Charles Spezzano in What to Do Between Birth and Death, says, "You don`t really pay for things with money, you pay for them with time." And, finally, we have the resource of money. I am most fond of what Joseph Campbell says about vocation and money, "If you follow your bliss, you`ll always have your bliss. If you follow your money; you may lose it at some time. The secure way is really the insecure way and the way in which the richness of the quest accumulates is the right way."

How we use these three resources-time, energy ( physical, emotional and spiritual) and money-is the key to a fulfilled life. This is true for all humans. We must create balance within our lives. Most people do not manage this well and concentrate on too much of one or another. An overemphasis on money usually is what occurs. We become too materialistic and, in the end, we don`t achieve the fulfilled life. Prioritizing our resources and placing a proper value on each one will prove to be a major key to a successful life.

Remember, too, that when we render service to our patients, they, too, are giving up their time, money and energy. Life really is nothing more than value for value. If our patients are giving something that is very valuable to them, then we must respect this and go beyond even the service that they expect.

Now that we know why to run on time, let`s give you some hints on how to run on time. There are many good books written on this subject. First Things First by Steven Covey and The Ten Natural Laws of Successful Time and Life Management by Hyrum Smith are two excellent accounts of basic, ethical, time-management principles that, with a little help, you can apply to your appointment book and personal life.

Essentially, what I am saying is that time management is life management. It`s hard work, but worth it! The following are some ideas that I`ve put together for you to think about for better time management. I will call them my "12 Secrets of Time Manage-ment."

1. Write a mission statement that explains to your patients and staff exactly what you stand for and why.

2. Decide the type of dentistry that you want to be spending most of your time doing. It should not only be your most enjoyable dentistry, but also that which will be your most profitable. Remember time is money ( Ha Ha!; just one of those funny little paradoxes). We may find that cliché hard to accept, but your practice won`t have it any other way.

3. Prioritize your dentistry and color-code your appointment book to accommodate for it. Color your most productive time as green, your examination time as yellow, your miscellaneous procedures as blue and your emergency time as red.

4. Hold morning huddles to help coordinate your day.

5. Decide how much money you need to make to be profitable and schedule accordingly, so that you can spend appropriate time with each patient. Create a practice budget.

6. Prepare, prepare, prepare. President Eisenhower used to say about war that "before the battle is joined, plans are everything, but once the shooting begins, plans are worthless. He understood what preparation meant to success. Learn to treatment-plan and schedule effectively. Treatment-planning, in itself, is an art.

7. Learn how to sell dentistry by continuing to educate your patients about the value that you bring to the table. Never stop educating.

8. Prevent cancellations by telling your patients how you work and that you consider an appointment a bond of trust.

9. Do your most productive work in the morning, when you are at your sharpest. Stay physically fit. Dentistry can be physically, mentally and emotionally challenging.

10. Leave enough time for patients who need your uninterrupted time for good, solid communication. Time should be allowed to discuss your philosophy as well as theirs.

11. Take time for your personal health and family.

12. Set worthy goals for every aspect of your life. Create balance.

As you can see, running on time and maintaining this vital trust requires much more than lip service. It is a total philosophy and mind-set. In the years ahead, this is what it is going to take to stay in private practice. The public is demanding your honesty and they will not settle for less in the future. Just like a steak house, it will be harder to stay in business. I am a firm believer that private practice is the best way to provide quality dentistry to those patients who want the best. I do acknowledge that the marketplace is becoming more competitive but there is always room for the dentist who not only can do the technical dentistry, but also can create a quality life for himself, his family, his staff and his patients.

The author, who resides in Cherry Hill, NJ, has been practicing cosmetic and restorative dentistry since 1973.

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