Where Do Those Patients Go Once We Lose Them To Follow-Up?

Kathleen Satterfield DPM FACFAOM

At a recent teaching conference I attended, after all of the formal lecturing was over, my colleagues and I made a real discovery about where patients go when they disappear from your practice and why. Haven’t you always wondered?

That day, we were discussing the topic of Morton’s neuroma and the best treatment protocols.

Do you perform alcohol sclerosing of the nerve, thereby killing the nerve?

Do you decompress the nerve, thereby freeing it to recover (hopefully)?

Do you inject cortisone in the hopes of calming the nerve, allowing it to become less inflamed temporarily?

Do you remove the nerve completely? Does this, hopefully, eliminate the pain albeit with a stump neuroma in place of the excised nerve?

Over a few weeks, we had several leading authorities on the subject speak to us via teleconference and each defended his method. In the process, each physician usually either implied or outright said that the other person’s method was inferior and that he had seen many of the other person’s patients who had failed and had been referred to him for correction.

This was food for thought. How many times have you seen someone else’s patients and have taken pride in having to “fix up” his or her mistakes? It is a heady thought. I have seen some of the most well trained podiatrists’ patients, even though I had only a PSR-24 and was able to give them comfort with my care.

But who was I kidding? That podiatrist, who trained 20 years before me and had only a one-year residency, had to fix up my patients as well. We should never kid ourselves that it does not go both ways. Those doctors who brag that they are seeing someone else’s mistakes and fixing them are forgetting that it is a two-way street.

After a lively discussion one morning about one doctor’s competitor’s supposed failures that kept ending up in the other man’s office, Lawrence Harkless, DPM, reminded us that if we notice that our patients are not coming back, we should pick up the phone and call them to ask why.

Frankly, the idea scared me. I was afraid of what I might find out. Had I offended them? Had my treatment style turned them off? Well, if I had, I should want to find out, right? If my treatment had not been successful, I should want to find out and amend my ways.

The late Louis T. Bogy, DPM, had been the longtime mentor of Dr. Harkless in San Antonio and he had told Dr. Harkless that the number one reason patients wouldn’t come back is because they were having trouble paying the bill. The podiatric physician and surgeon who is more sure of himself or herself will know why the patient did not return for a second visit: The doctor solved the problem in one visit. Oh, I wish I was so assured.

Dr. Harkless says that either they may not have been able to pay the bill, as Dr. Bogy said, or they may have gone to see someone else. The worst thing that will happen if you call those patients is you will gain some information. You will help them to work out a payment plan. Patients will see that you are sincere about their care or you may be able to find out from their new podiatrist what was going on if you missed the diagnosis.

Sometimes, we are too arrogant and we may need to let down our guard a bit. But I do not really see it happening. Heaven forbid, we might learn something but at the risk of the guy down the road getting bragging rights for a week or two.

Comments

This is a topic that is something I have always wanted to speak about but found most of my podiatric colleagues really don't want to listen too. There is the concept that 90 percent of all plantar fasciitis is cured with conservative treatment. My initial comment is how long have they been followed up in your office after the initial pain is gone or vastly reduced. Did you know that podiatry only treats 9 percent of all the plantar fasciits seen by the medical community? Yes, we don't even treat most of the plantar fasciitis in the medical community.

We need to do studies follow up in our own practices. I did this with 800 cases of ESWT cases in our ESWT group. The results were very interesting and amazing. It is time we took that honest look with calls and follow up from our own practices.
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As podiatrists, we are way too sensitive. We lose patients for all sorts of reasons that have nothing to do with US! They get better and that's all they wanted. They get worse or do not get better and go somewhere else. They lose their job and therefore their insurance. The office is too far to travel. They develop more acute health problems. They have family emergencies. They die. They move. They lose interest in the process. Sometimes, they go to their lawyer.

I always asserted that my patient was my patient only when he or she was in front of me. Once they left, they were anyone's patient. Ergo, you can't steal patients because patients have free will.

So in the end, we control very little. We need to stop agonizing over things over which we have no control. Do the best you can for every patient with the skills you have. At the end of the day, the rest is out of your control.

It's not all about you nor is it about me.

I agree with Dr. Lang. Sometimes we get so caught up in the why, we lose sight of the now. I've heard of some completely changing their office protocol try to retain more patients and find out they end up losing more!

Certainly, if a patient leaves for a reason we know about, it makes it easier to swallow. Ultimately, though, it's the patient's decision and may have little to do with us. Take care of the patients you see currently and hopefully they will have the loyalty to return when the next problem crops up.

Great thoughts and I agree up to a point. If a patient left my clinics in the past though because I "got it wrong," I would like to know somehow so that I could learn and improve. I might think I have the best idea for treatment of tinea pedis or hammertoes but if I don't have evidence of it, then all I have is anecdote.

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