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Late one afternoon, Madison, WI, pediatrician Susan Ehrlich, MD, FAAP, sent her staff home but ushered a patient’s parents into her office. Their toddler wasn’t sleeping well at night. The parents were quarreling over how to handle the problem.
Ehrlich spent an hour helping them work it out. Since this was not strictly a medical appointment, Ehrlich received no compensation. "That’s part of my job not just to look in the kids’ ears, but to help the parents deal with all these other issues, too," says Ehrlich.
That dedication helps explain how Ehrlich has earned the overwhelming respect and commendation of her patients. In a 1996 patient satisfaction survey, Ehrlich received a rating of 97.5% excellent the highest in the national database of the Alexandria, VA-based American Medical Group Association, which included 26 multispecialty group practices, 2,500 physicians, and 113,000 patient surveys.
The score represents an average of responses to six questions that dealt with physician interaction, such as the patient’s perception of time spent with the provider, technical skills, and personal manner. "She definitely stood out in the database," says Julie Sanderson-Austin, vice president for quality management and research. "A good deal of her patients rated her 100% excellent."
The bottom line for Ehrlich: Make every patient feel important, she says. "As a pediatrician, I feel that every child that I see should have the same quality of care I want my [own] child to have," says Ehrlich, whose children are 15 and 11.
Teamwork with a skilled and experienced nurse at Physicians Plus Medical Group helps her fulfill that goal. But so does a caring attitude and body language that says she’s listening.
At the end of the day, Ehrlich often calls patients to check on the sick children she saw just hours before. "She’s very caring, and she follows up tremendously," says her nurse, Kathy Walsh, RN. "She goes the extra step."
Ehrlich faces the same conflicts as most physicians in this managed care era. The push toward greater "efficiency" makes both doctors and patients feel rushed. Emergencies or urgent care visits wreak havoc with schedules. Good preventive care takes even more time.
Ehrlich sees about 30 patients a day, but she vigorously resists the trend toward seeing more in the guise of better "productivity."
"There is absolutely no substitute for time spent with patients," she says. "So much of what we do in pediatrics has to do with preventive medicine. You can’t do that without spending time.
"Ultimately, you save money for the HMOs by talking about nutrition and accident prevention and keeping children safe and getting parents into a smoking cessation program," she says.
Ehrlich schedules 30 minutes for each physical 45 minutes if there’s a sensitive issue, such as a teenager having her first pelvic exam. Walsh brings the patients into the exam room and takes an initial history. "We’ll touch base before I go in, and she’ll tell me what she thinks are concerns I need to deal with more," says Ehrlich.
Walsh also conducts patient education during those visits and answers phone calls for Ehrlich, freeing the doctor to take short, acute care visits in the midst of a physical.
Even so, Ehrlich often finds herself with patients waiting in the reception area. How does she keep them from getting frustrated?
"I hate making people wait," she says. "If there’s anything on that [patient satisfaction] survey I got graded down on, it’s the length of waiting time."
Ehrlich says she acknowledges the wait and tries to make patients feel their time is as important as hers.
"I always say, I’m sorry I kept you waiting.’ And I always tell them why I kept them waiting [such as if an emergency came up]," she says. "I say if their child ever needs extra time, I hope the next person will be as gracious as they were. That defuses [any frustration] right there."
When her schedule is overflowing, Ehrlich tries to keep from seeming rushed or harried with her patients. And she pays attention to any possible subtext of their visit, such as problems they may not immediately mention.
Before becoming a doctor, Ehrlich received a master’s degree in theater. She learned to look beyond someone’s words for body language as expression. That proved to be good training for medicine, she says.
"You learn to go beyond the written or spoken word to what’s truly happening," she says. "I find I use that in every patient encounter I have."
Ehrlich does most of her chart writing at the end of a patient visit. "I’ll take a few notes, but I think it’s rude [to write while they’re talking]," she says. "I want to sit and listen to what they’re saying."
Ehrlich believes there was another key to the gratifying response of her patients her nurse and support staff.
She breaks down barriers between traditional physician and nurse or staff roles. For example, if the coffee pot is empty, she brews up a new one rather than looking for an "underling" to do it.
She asks Walsh for her opinion about cases. Because they must take vacation time at the same time, she takes Walsh’s needs into consideration. When she received the "top performer" accolade, Ehrlich bought Walsh a gift in appreciation and gave her partial credit.
"If you respect what they do and the expertise they bring, then you get paid back in kind [by your staff]," Ehrlich says. "Then your patients feel it."
Most of all, Ehrlich succeeds because it’s clear that she enjoys her job. "I remember when I was in medical school and someone said, Don’t go into pediatrics. It’s all ear infections and you’ll get bored,’" she recalls.
"What that person failed to see is that every ear is attached to a child, every child is attached to a family, every family is attached to a community," she says. "That’s what makes pediatrics interesting."