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For the past several weeks, we've been examining critical moments of truth for your patients. These are points in time or interactions where everything you stand for as a practice culminates in a single, binary response from your patients to a simple question: Did this practice deliver quality service to me?

Studies have shown that the response to this question impacts patient satisfaction, and more broadly impacts your business through patient retention, patient referrals, and even malpractice claims. This week, we're looking at the exam room experience as three different, but interrelated, parts.

1. Nurse call back. Great communication skills are vitally important during this experience. Your nurses need to make sure they pronounce patient names correctly, and if they're unsure, ask the patient to clarify — it's an embarrassment to your practice repeatedly mispronounce a patient's name. Patients will be evaluating the sincerity and pleasantness of how they're greeted. Training your nursing staff to make solid eye contact with patients rather than looking down at a faceless chart will improve this facet.

It's also important that the nurse explains where they are taking the patient and that you have created directional signs leading to and within offices with neat, large print to reinforce the destination. Upon arrival at the exam room, the nurse needs to set expectations for when the patient should see the physician. Lastly, if the nurse hands the patient off to any other clinicians, they need to warm up that hand off by introducing the patient to the clinician and vice-versa.
2. Exam room wait. Just like lobby waits, exam room waits afford patients a lot of time with very little to do but to observe the environment around them. Be sure that the environment you've created is purposeful and intentional. What activities can you provide for the patient while they're waiting, maybe a health or activity profile or some other self-assessment diagnostic tool? Are patient education materials accessible and up-to-date? Do you have seating availability for companions? Patients will be evaluating the cleanliness of the exam room and whether or not they can hear activities in adjacent rooms. You should provide clothing hooks and storage areas for patients to place their personal items. What is your lighting like in the room? How about the decor and style of the room? Is it a comfortable temperature? You obviously need to create a way to measure the wait time in exam rooms — both the averages and the amount of variability from patient to patient. And one of the more uncomfortable aspects for a patient is the amount of time they are left undressed or partially undressed in the room. Work to minimize this as much as possible.
3. Clinician first impression. From the patients' point of view, the long journey of getting to your office and waiting has finally ended and they get to spend time with the object of their visit — the clinician. The first couple of seconds of this interaction will define the relationship going forward. Make direct eye contact with the patient when entering the room and use their name in your greeting. A firm handshake is good manners and appropriate physical contact for an introduction. You need to introduce yourself, "Good morning, Ms. Smith, I'm Dr. Allen and will be examining you today." Your approach needs to be warm and friendly — most patients are already on-edge and intimidated by the interaction.

At the same time, it's important for you to project authority. Do this through professional attire, eye contact when speaking, listening actively to the patient, and being free of distractions and focused on the particular patient in front of you. If you catch yourself being distracted, ask to be excused for a moment, take care of the distraction, and then return to the patient with focus and purpose. Be knowledgeable of the patient's presenting issue and apologize for your tardiness if you're late. You and your practice will be judged within these first 30 seconds of interactions.