Why Some Medical Practices Fail

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On the surface, this seems like ano-brainer, but the outcome is in the details. It is often easy tosee why some practices fail and many patients are often the cause ofa medical practice on the margin not staying in existence. Word ofmouth is very strong among patients that are not happy with the carethey receive and can be the cause of a practice not succeeding.
Many years ago, I was a patient in apractice that was not doing well and I had to evaluate if I was goingto stay or try to find another doctor. More than once, I was toldthat a test result was in the mail and never would receive it. Thenone day I happened to be in the waiting room and heard the officemanager tell a patient that something was in the mail. As soon asshe hung up the phone, she and the receptionist were joking about itand went back to exchanging the latest gossip about a patient. Idon't know whether they knew I could hear or even cared that otherpatients in the waiting room could hear, among them the patient theywere talking about.
I could see the patient getting veryred faced and it was not long before she got up and walked out thedoor. Then another patient got up and left and only two of us wereleft to listen to the two of them continuing to run differentpatients down. As the two of us got up to leave, the nurse was atthe door calling my name. The other fellow continued to walk out thedoor. The nurse wisely waited until she had me in the room and askedwhy patients were walking out. I told her none too politely that itwas the office manager and the receptionist causing patients toleave. She stated that the office manager was the doctor's niece andnothing could be done about this. Then she stated that this was herlast day at the practice, as she could not get along with the officemanager.
Shortly, the doctor walked in and Iadmit I was not it the best of moods. When the doctor asked what waswrong with me today, I opened up with both barrels and probably saidmore that I should have, but I wanted him to know that I was leavingand why I was not coming back. This was long before HIPAA (HealthInsurance Portability and Accountability Act of 1996), so there wereno regulations in place to protect patient rights or privacy, onlywhat the doctor determined was right and wrong. As I was walking outthe door, the doctor said he would not fire his niece. I quippedthat because of her he had lost four patients in less than an hourand he should reconsider.
Two months later the office closed andI heard the doctor was in a large city in another state. He did needto return for the trial against him, his niece, and the receptionistfor defamation of character, which they lost. Shortly after all weregone out of town and I have heard nothing more about them. Beforebecoming a patient of my current doctor, I left two other practicesas a patient because of overly chatty office personnel. My currentprimary care doctor is a hospitalist and seems to have new stafftwice a year. On one visit that was my first question. He answeredthat seems to be the only way they could prevent overly chattyreceptionists and others for violating HIPAA. The office manager isvery strict about HIPAA and terminates any employee caught violatingpatient privacy rules with no second chances.
I did get an opportunity to visit withher and I can appreciate why the doctors like her so well. Sherequires every new employee to read the pertinent rules and sign thatthey understand them and what will happen if they are caughtviolating them. Her only comment that I agree and support is howoften people think they can get away with looking at a patientsrecord and then chat about it with other people. I could only saythat three employees were people that I have seen for more than oneyear. That does not mean that there couldn't have been more tendingto patients or on a day off. I do know that a few are rotated toother departments on a regular basis. I know of one that I see indifferent departments and she did say she likes the rotation for thevariety of duties she can do.
The above is just one reason thatphysician practices fail. There are others – financialmismanagement, not making the patients feel welcome, doctorindifference, and communication failures. Yes, some practices hangaround because the patients are totally passive and as long as theyget the pill they need to resolve a health problem, the patients arenone the wiser and care less about how they or the office is handlingtheir records and problems within the office.
As patients learn more about HIPAA andbecome more empowered, this is slowly changing for the best. Patients are demanding better health care, respect as patients,patient privacy, and access to their health records. In many cases,patients are active in opposition of some budget cuts by Medicarethat is damaging good doctors financially. One doctor that is in aclinic knows me and that I can advocate, asked if I would support himand others by writing our federal elected officials. He lookedrather hurt when I said no. He did have the courage to ask why. Ipointed out several personnel deficiencies I could see just standingin the hallway. We had an unobstructed view to the receptionist andbilling department. Three employees could see us, but they continuedchatting and one pulled out a patient file and they started talkingabout that patient.
The doctor was getting the idea and wemoved to the other side of the hallway and closer to the talk. No,they were not talking about a coding problem in billing and it wasrather clear they were talking about a patient and what the medicalproblems were. The doctor admitted he had heard enough and asked meto go to the waiting room and return with the two patients closest towhere the employees were talking. I was surprised that no questionswere raised when the three of us headed down the hall to the doctor'soffice. When we got to his office, he directed them into his officeand got them seated. He then carefully asked them if they hadoverheard what the employees were talking about. One of the patientssaid she knew who they were talking about and was clearly upset aboutthis. The other patient said she knew that they were talking about apatient, but did not know the person. At that point the nurse whohad been with the doctor's next patient knocked and entered theoffice. When she saw the three of us, she apologized and started toleave, but the doctor asked her to stay.
He asked if these were his last twopatients for the day and the nurse checked the schedule and saidthere was one more already waiting to see him. He asked if theycould wait an hour while he corrected a problem and the two said theycould come back another day, and they understood and appreciated hisneed to correct the problem. The doctor asked the nurse to taketheir names and phone numbers to call them later or the next day andreschedule them. He thanked the three of us for our information,said it would be taken care of immediately, and asked the nurse toescort the two patients back to the waiting room to leave. I startedto leave and he asked me to stay and got the nurse to check if thepatient was the one that was going to be leaving for vacation and hewould see her if that was the case. She was not and agreed that shecould come back another day.
The doctor accompanied the last patientout and asked the three employees to come to his office while thenurse and I answered the phone and took care of anyone coming in. The nurse was still in the dark and once the door to his office wasclosed, she asked if there was anything I could say. I said “HIPAAviolation.” She said “good” and that was the end of theconversation. The nurse went to a filing cabinet, pulled out a stackof papers, sat down, and started looking through them. She stoppedand asked what my position was and I stated just a friend of thedoctors. I asked if she knew where the HIPAA file was. She said inthe doctor's office, and I asked if any of the computers were hookedto the Internet and she stated only in the doctors office. Thensomeone came in and the nurse sent her directly to the doctor’soffice and then said to me, “the payroll clerk.”
The doctor called the nurse and askedher to find three boxes for personal belongings and to stand by toenter his office when he brought each employee out. The doctorbrought one employee at a time to remove her personal belongings andthen escorted them to the door. When he was finished, he asked thenurse to get him the applications file. She handed him the file andshe said the three positions for each were clipped together in theorder she thought would help him. She said your friend has somethingto discuss about HIPAA. The doctor instead said he wanted toapologize to his nurse for not taking her serious and having a friendmake him realize that things were not right.
Then he asked what was on my mind. Iasked him if he had the HIPAA rules and he said he did. I told himit would be a good idea to have a copy together with a paper statingthat the employee had read and understood them and a place for themto sign to that effect. Then a second page stating that if theychose to violate the HIPAA rules that they could be dismissedimmediately and a place for their signature stating that theyunderstood this. This would become part of their employee file. Inaddition another copy would be placed where they would see it eachday.
He thanked me for the advice and askedif in the next three days I would come in and get this accomplished. I agreed and he asked if I would also be the receptionist for thenext two days and that I would be compensated. Then he asked thenurse to clear and reschedule the next day's patients and if I couldstay while he looked over the applications and assist with somecalls. We changed desks and he started looking at the applications. We were fortunate to find seven applicants still looking for work andscheduled four for interviews the next morning and three in theafternoon. We reviewed what had been done and only one patient hadnot been actually contacted, but a message had been left. Otherpartners in the clinic were stopping by and they were sent to thedoctor's office. Sheryl, the nurse, and I finished up and she askedif I could be there by 7:30 the next morning and when I said yes, shetold the doctor we were leaving. He asked if I needed a key andSheryl said she would be in by then. The doctor stated he would havea laptop hooked up in case I needed the Internet and have it alsoconnected to a printer
The office returned to normal thefollowing week and the doctor and I do not talk about it. Sherylsays things are better than before and they have lost a position whenone employee decided she did not like the work, but that the othertwo are doing what three were before. She said that one of thebilling employees from another office does help occasionally.