1. They Are Informed (And Technologically Savvy)

72% – share of internet users looking online for health information¹

These days, patients are looking to the internet for health information – and for support in making health decisions (I know I did the last time I had a sore throat, or the time my husband had chicken pox). In a Journal of General Internal Medicine study, 60% of participants said the Internet information was the “same as” or “better than” that of their healthcare providers! It’s no coincidence that WebMD records an average of 156 million unique visitors per month and 3.17 billion page views per quarter.^2,3

2. They Have Options And Are Not Afraid to Change Providers

58% – patients who have no regular doctor or are willing to switch for savings⁴

While traditional reliance on word-of-mouth is the greatest source for doctor recommendations – 70% of patients aged 18 to 24 (compared to 41% of patients over the age of 65) choose a primary care physician based on recommendations from family and friends – patients also increasingly use the Internet and social networks to evaluate healthcare providers. Almost half (39%-44%) of patients search for doctors on the internet!^5,6 Among certain demographics, the share is even higher: 54% of young millennials (aged 18 to 24) say they search online for health information and rely on online physician ratings before seeing a doctor.⁶

A number of websites cater to patients searching for doctors with listings and reviews – Healthgrades.com, the AMA’s Doctorfinder, ZocDoc.com. For those who are looking online for help with minor illnesses, companies (Amwell.com, MeMD.com, LiveHealth.com and MDlive.com) also offer virtual consultations (approximately $40 each; savings of $88 per virtual visit in one study⁷) through webcam-enabled laptops, smartphones or tablets. And the market is growing – 15% of very large employers use some form of telemedicine, and 39% are considering it. There are regulatory barriers to virtual prescriptions (only 13 states allow doctors to prescribe without seeing the patient in person), but this is sure to be a growing part of the way healthcare visits are done.⁸

The competition to attract new patients is increasing… and your current patient base isn’t safe. In an analysis of 1 million patient records, nearly 16% of patients were at “high risk” of defecting from their current physician or practice, where “high-risk” was defined as patients who are not “very likely” to recommend their physician or medical practice to others.⁵ In a survey of consumers, HealthPocket, a Website that compares health plans, found that nearly one half (45%) of respondents who had a regular doctor would be willing to change doctors if it would save them money. Of those, more than one half would change doctors for as little as $500-$1,000 in annual savings. ⁴ The Health Care Satisfaction Report found the lowest loyalty in younger patients and mentioned that factors, such as patient relocation or changes to insurance plans, cause an average of 25% of patients to leave their doctors annually.¹

3. They Expect To Be Equal Partners

~66% – correlation of physician communication and likeliness to recommend⁹

This wealth of information and options encourages patients to actively participate in their own health interactions, and patients do want to be partners. In blogs, like “How to Be An Empowered Patient,” patients are encouraged to communicate effectively and advocate for their health by i) asking questions of their healthcare provider, ii) bringing health information to meetings and take their own detailed record, and iii) checking their understanding of the information provided by the doctor.¹⁰

In fact, most complaints about doctors are a result of communication breakdowns, not related to their clinical competency. Effective doctor-patient communication is determined by the doctors’ “bedside manner,” which patients consider a major indicator of doctors’ general competence. In a poll of 1.4 million patients, Press Ganey Associates found elements of  communication – information given about medications (.64), concern shown by provider/nurse for patient questions and worries (.67/.56), care provider efforts to include patient in decision-making (.66), and instructions about follow-up care (.65) – were all closely correlated with the likelihood of patients recommending the physician or hospital.^9,11

Patients want doctors who can skillfully diagnose and treat their sicknesses and communicate with them effectively… ¹² And for good reason! Patients that enjoy good communication with their doctor are overall more likely to be satisfied with their care, not to mention more likely to share pertinent information for accurate diagnosis of their problems, follow advice, and adhere to the prescribed treatments. Clinical research supports this idea too – doctors with great communication and interpersonal skills may detect medical concerns more quickly (thus preventing medical crises and interventions) and result in better patient outcomes and satisfaction, reduced healthcare costs, improved patient understanding, and better treatment adherence.^12,13

 So… what can you do to better engage with your informed and technologically savvy patients? To build loyalty and trust? To ensure patients feel supported as equal health partners? The answer boils down to communication and across all fronts –

Build Your Customer Base (a.k.a. Be An Option)

To be considered, you need to be known! Given the large number of patients that are searching for health information online, your presence and your ability to differentiate your practice will help attract new patients (and keep existing ones).

Differentiate yourself from your competitors

At the end of the day, patients stay because of value. In HealthPocket’s research, they found both that a large share of patients don’t have a regular doctor (23.7%) and that a large share would not change doctors despite savings (42.2%).⁴ What does that mean? You want your patients to be in the loyal category, and capture the ‘share of the pie’ (literally) that is open to switching. Price is, of course, only one factor patients consider. The JAMA survey found that patients still overwhelmingly pick their primary care physicians based off of whether they accept their health insurance (89%), location (59%), physician experience (46%), practice reputation (44%), word of mouth (38%), and physician referral (34%).⁶ Some of these factors are harder to change (your location or years in practice), but others can be more easy to address. Build a strong patient following by focusing on value.

Build your online presence to let patients know

While other factors remain crucial when patients pick a physician, a large (and increasing) are of patients are looking at online presence – Nearly 20% of patients say that physicians’ ratings on websites are very important, and 40% said websites are somewhat important, when looking for a primary care physician. Of those who used the web to search for physicians, 35% say they picked a doctor based on good ratings, while 27% reported avoiding those with bad ratings. Medical excellence is now more of a qualifier than a differentiator.⁹ Make sure your online presence highlights the value of your practice and services, so:

• Track how you’re doing – Googling your (or another physician’s) name, a handful of popular websites show up, including HealthGrades.com, RateMDs.com, or Vitals.com, where practitioners are rated (through stars or percentages, based off of patient satisfaction reviews or algorithms that weigh certain patient experiences over others).
  • Check that you are on the list, and garnering positive reviews, to get patient exposure.⁶
  • If you’re interested in tracking what patients say – set up a google alert that emails you every time you or your practice are mentioned online. And if you’re not doing it, you’re behind: According to a ZocDoc survey, 85% of physicians read their online reviews (and are hopefully learning from them!).¹⁴
• Ensure the information available about you is accurate – the easiest way to do this is to have a professional website that appears first when patients search for you or your practice (rather than third party reviews with potentially negative reviews or inaccurate information).
  • You can even use your website to share your appointments calendar so patients can sign up for consultations directly.
• Get your name out there – Social media can be an easy and fun way to engage potential patients and connect with existing ones.
  • Use Facebook, Twitter, Google+ or Pinterest and craft your online image by strategically deciding what types of information you disseminate.
  • To foster your following, reward social media connections with coupons or valuable content, thank patients for contributing to your success, own up to your mistakes, provide personalized messages, and encourage patient participation.¹⁵
  • “[Patients] are going to pick you over the best hospital in the country because of the way you humanize your existence and your presence using tools like YouTube or Vimeo or a simple Web cam.”¹⁶

Foster Your Patient Relationships

The vast majority (74.6%) of potential defectors (the substantial share of patients at risk of leaving their doctors discussed above) were patients who did not have strong confidence in their current doctors. ^{4 [1]} Building confidence through processes and people is a crucial component of ensuring a strong and loyal patient base, so thoughtfully structure your practice and consultations.¹⁷

Strengthen non-consult patient interactions

Pay attention to your practice surroundings – every interaction you have with patients (whether on the phone or in-person) impacts their impression of you.

• The convenience of office hours (.50), practice promptness in returning calls (.49) and helpfulness on the phone (.51), the cheerfulness of your practice (.52), and waiting times both before seeing a care provider (.50) and before going into an exam room (.46) are all closely associated with a patient likeliness to recommend your practice.⁹
• Hiring the right people and creating the right practice atmosphere may seem like a lower priority, but is important!
• Keep an eye out for what is happening outside your exam rooms – for example: When the wait time gets excessive, come out and personally apologize to those waiting and explain the delay. People appreciate transparency and that they (and their time) are respected.

If you want to test how you’re doing, ask your patients to describe your office’s ‘branding’ – you’ll know right away whether that aligns with the atmosphere you’re trying to convey. ⁹ And, remember, investing in early relationship building may help smooth over minor issues later down the road.

Foster the patient relationship before, during and after your consultations

Many providers (like most people) over-estimate their communication skills. Studies on doctor-patient interactions demonstrate patients are often dissatisfied with their providers’ communication, even though those providers consider their skills adequate or even excellent.¹² In one study, for example, 75% of surgeons believed that they communicated satisfactorily with their patients, but only 21% of the patients reported satisfactory communication with their doctors.¹⁸

In an overview of patient-doctor communications, Ha et al. identify the major issues that cause communication breaks down: i) nondisclosure of information as a result of miscommunications regarding treatment, ii) physician avoidance (because it distresses them) of the emotional and social impact of patients’ problems, iii) discouragement of collaboration when patients are not encouraged to voice their questions, concerns, and expectations, iv) patient resistance and implicit/explicit push back on the information sharing (because they are asserting their own views). The authors explain that communication skills are a result of both style and content – crucial stylistic elements include attentive listening skills, empathy, and the use of open-ended questions to engage patients (particularly when delivering bad news). The authors suggest the following sources for improving communication: ¹²

• Training – Studies have shown that training for communication improves doctor-patient communication, although the effects can decline over time. Continuous attention to effective communication, coupled with regular feedback, are crucial to preserving learned techniques.
• Collaboration – Doctors can build moments of collaboration into their consultations by ensuring discussion of treatment choices with patients; practitioners effectively facilitate a dialogue around patient expectations, preferences, risk acceptance, and associated costs to maximize their patients’ adherence and outcomes. As conflicts can be unspoken, physicians should encourage exploratory conversations and strive to identify problematic patient responses and surface avoidance on their parts.

Overall, most of the communication research focuses on the basics – spend time with your patients, engage them in communication, and allow them to ask you questions. Remember that patients regard their doctors as a primary source of psychological support!

When you’re not face-to-face, Electronic Health Record (EHR) ANDa number of powerful technological innovations can support your communication efforts.

• Patient Portal – The use of electronic patient portals is a great way to connect with patients in a secure and HIPPA-compliant way. By asking patients to fill out demographic information and pre-consult questionnaires ahead of time, you can facilitate their experience with your practice and ensure you make the best use of the time you have together in the consultation.
• Reminders (Text/Email) – The use of automated reminders, whether through text messages or emails, can be a powerful way of touching base with your patients. Reminders can serve to encourage appointment scheduling, attendance, and follow-up, improving the following of communication between doctors and patients in a free, easy and nonintrusive way.
• Social media – Many doctors turn to social media to communicate with patients and share health resources, nonclinical suggestions, or even practice promotions. These personal interactions can help build strong relationships (see above for tips and tricks).

As you build your rapport with patients, you may benefit not just from their increased loyalty, but also improved access to information –  ask your patients more about their experiences with your practice, or see if they’d be open to referring friends!

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[1]  Of patients  with confidence in their providers, only a tiny 1.9% share were at risk of looking for another physician.⁴

 

References and Additional Resources

1. Health Fact Sheet. Pew Research Center website. http://www.pewinternet.org/fact-sheets/health-fact-sheet/. Updated 2015. Accessed November 19, 2015.
2. Diaz JA, Griffith RA, Ng JJ, Reinert SE, Friedmann PD, Moulton AW. Patients’ Use of the Internet for Medical Information. Journal of General Internal Medicine. 2002; 17(3):180-185. doi:10.1046/j.1525-1497.2002.10603.
3. Kruzel MD. The Age of the ePatient. Cancer Communication Research website. https://medium.com/cancer-communication-research/the-age-of-the-epatient-b9a14b27aecb#.aods6cqmd. Updated November 20, 2015. Accessed November 18, 2015.
4. More than half the population not wed to a doctor. HealthPocket website. http://www.healthpocket.com/healthcare-research/surveys/more-than-half-not-wed-to-doctor#.U7B5PWdOXct Updated April 25, 2013. Accessed November 20, 2015.
5. Looking for health on the internet. Newsweek website. Updated July 16, 2003. Accessed November 18, 2015.
6. Hanauer DA, Zheng K, Singer DC, Gebremariam A, Davis MM. Public Awareness, Perception, and Use of Online Physician Rating Sites. JAMA. 2014;311(7):734-735. doi:10.1001/jama.2013.283194.
7. Courneya PT, Palattao KJ, Gallagher JM. HealthPartners’ Online Clinic For Simple Conditions Delivers Savings of $88 Per Episode And High Patient Approval. Health Affairs. 2013; 32:2385-392; doi:10.1377/hlthaff.2012.1157.
8. Column: The doctor will see you now — on the Internet. USA Today website. http://www.usatoday.com/story/opinion/2013/01/13/doctor-medicine-internet-visit/1830743/. Updated January 13, 2013. Accessed November 18, 2015.
9. Dolan PL. What makes patients loyal? It may take more than you think. American Medical News website. http://www.amednews.com/article/20061204/business/312049995/4/. Updated December 4, 2006. Accessed November 19, 2015.
10. Kruzel MD. How to Be An Empowered Patient. Cancer Communication Research website. https://medium.com/cancer-communication-research/how-to-be-an-empowered-patient-411cf2cc9ac7#.50m5ph1jh. Updated November 6, 2015. Accessed November 18, 2015.
11. Press Ganey Performance Insights. Protecting market share in the era of reform: Understanding patient loyalty in the medical practice segment 2013. http://img.en25.com/Web/PressGaneyAssociatesInc/PerfInsights_PatientLoyalty_Nov2013.pdf?elq=3bb05efe8c5d489aaec22cd9dc054052. Accessed November19, 2015.
12. Ha JF, Longnecker N. Doctor-Patient Communication: A Review. The Ochsner Journal. 2010; 10(1):38-43.
13. Clack G. B., Allen J., Cooper D., Head J. O. Personality differences between doctors and their patients: implications for the teaching of communication skills. Medical Education. 2004; 38(2):177–186.
14. Mazzolini C. Most physicians read their online reviews, survey finds. Medical Economics website. http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/digital-doctor-survey/most-physicians-read-their-online-reviews-surve. Updated October 14, 2013. Accessed November 19, 2015.
15. Newton M. Five Ways to Use Social Media to Build Patient Loyalty. Physicians Practice website. http://www.physicianspractice.com/blog/five-ways-use-social-media-build-patient-loyalty. Updated September 23, 2014. Accessed November 19, 2015.
16. Dolan PL. Patients online drill deep for information on doctors, procedures. American Medical News website. http://www.amednews.com/article/20121105/business/311059969/6/. Updated November 5, 2012. Accessed November 19, 2015.
17. Blizzard R. Dissecting Patient Loyalty. Gallup website. http://www.gallup.com/poll/15445/dissecting-patient-loyalty.aspx. Updated March 29, 2005. Accessed November 19, 2015.
18. Tongue JR, Epps HR, Forese LL. Communication skills for patient-centered care: research-based, easily learned techniques for medical interviews that benefit orthopaedic surgeons and their patients.Journal of Bone Joint Surgery American. 2005; 87:652–658.