Successful DPMs know the right formulas for keeping patients. One should manage medical information professionally, run an efficient office, listen to patient concerns and always keep the patient foremost in mind. On the flip side, if a podiatric practice engages in certain other behaviors, the podiatrist will likely see more than a few patients walk out the door without returning any time soon. That said, here are pearls on what not to do to keep a thriving practice. Unlike articles that suggest ideas to help you keep patients, I absolutely guarantee that the ideas presented in this article will work to drive patients away from your practice. • Ignore patient privacy. We all know that HIPAA has made ignoring privacy more difficult but for those who are determined to do so, here are a couple of easy habits to adopt into your daily routines at the office. Keep the exam doors open without asking the patient. Although this works better in the MD’s office with the patient half undressed and/or in a gown, it can be nearly as effective with the podiatric patient. Be sure to question the patient loudly enough so you are heard in the hallway. If the patient is soft spoken, just repeat what he or she says in a loud tone of voice that can be heard everywhere in the office. Don’t forget to talk about one patient in front of another. For instance, if you get a phone call from a patient or insurance company, quickly pick up the phone in the treatment room and then discuss all the details of the first patient’s care in front of the second patient or an insurance rep. Do not forget to mention the first patient by name at least twice. Not only does it embarrass the second patient to learn about the first, it puts doubts in the second patient’s mind as to who is hearing about his or her case. • Keep staff in the dark. Do not tell your staff anything about your treatment plans. This ensures that the staff has no idea what to say whenever your patient calls with any question pertaining to his or her treatment. Accordingly, they will say they do not know and will have to check with the doctor and get back to the patient. It is good for the staff to throw in a little sarcasm about the doctor never telling them anything. When a patient asks, “When would the doctor want to see me again?” the answer is always, “You know Dr. Smith. He never tells us anything. I will have to check with the doctor and call you back later.” How Not To Manage Time • Make patients wait. Overbook appointments and then be sure the staff always misleads the patient about the length of the wait. Once you get the patient in the waiting room, he or she has no place to go so the patient is yours. The staff can also assist here by seeming annoyed any time a patient asks, “How much longer?” Never apologize for the delay. • Be in a hurry. Even if you are not in a hurry, there are little tricks to appear that way. If you see the patient sitting down, keep getting up while the patient is talking and head for the door. If you talk to him or her while you are standing, stand near the door and always keep putting your hand on the doorknob. • Return phone calls slowly. Emphasize to patients that they should call so you know how they are doing. Have patients tell the staff that you will want to talk to the patients. Then do not take the call and do not call back for a couple days. A slight variation of this is to tell patients that if they do not improve, you want them to call the office on Monday. Emphasize how important it is for them to call Monday morning so you can see them Monday or Tuesday if necessary. Actually make them promise to call. Then when they do call, have the staff casually make the appointment for the end of the week. How Not To Treat Patients • Emphasize the money. Have financial information signs on every table in the reception area and on the window of the receptionist’s area. Feature financial signs prominently in the practice brochure. When setting up an appointment, the receptionist should ask about insurance even before getting the patient’s name. Then have the staff collect the co-pay before the patient checks in and before the staff even asks how the patient is doing. • Feed your ego at the expense of the patient. This has been used for decades if not centuries. Show the patient who is top dog. Call patients by their first names but insist they call you doctor. It is amazing how quickly this works, especially if you ignore the patient who might use your first name. • Keep secrets from patients. Do you want another great little trick to show the patient how unimportant he or she is to you? Do a test and emphasize you are anxious about the results. Dutifully explain to the patient the reason for the test. Perhaps you are concerned about the need to change the antibiotics for an infection. First, do not indicate whether the patient should call you for the results or wait for your office to call. Second, if you do promise to call back with test results, do not follow through on it. • Brush off a patient’s own initiative. Whenever a patient questions you about something he or she found on the Internet, do your best to sound hurt and that it is a personal affront to your knowledge. Be sure to tell him or her that those who write for the Internet usually have the knowledge that you have and if the patient does not trust your opinion alone, maybe it is time for a referral. This also prevents patients from taking any responsibility for their own health care. • Treat the patient like a number. Any time a patient calls for an appointment, be sure your staff asks, “Have you seen the doctor before?” If the patient is offended, teach the staff to retort, “It is just that we have so many patients, it is impossible to keep up with them all.” The receptionist should then ask why the patient needs to see the doctor. This works especially great with post-op patients who are having a complication. With a little luck, you can drive them away and start a malpractice suit all at the same time. • Rudeness rules. Besides driving away patients, being rude has the added advantage that members of a disrespectful and uncaring staff should be easier to hire and require lower salaries to keep. An abrupt receptionist who never takes her eyes off the computer or ears off the phone is a great start. Instruct her or him to retort rudely whenever patients interrupt anything she is doing. Do not ever encourage her or him to smile. An attitude of “whatever I am doing is more important that what you may need” is the foundation. In Conclusion I am confident that with a little thought you can develop your own list of how not to keep patients. Please consider this article only a start. For those of you not interested in losing patients, look around your daily practice operations to see how many of these unrecommended practices you or your staff are actually doing right now. Dr. Metzger is the founder and principal of Innovative Healthcare Resources, which provides practice management information, consultation and locum tenens to the podiatric community. For more info, contact Dr. Metzger at (800) 495-8959 or via e-mail at firstname.lastname@example.org . Also check out www.innovativehealthcareresources.com . Editor’s Note: For a related article, see “Secrets To Bolstering Patient Satisfaction” on page 20 in the February 2005 issue.