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Comms 485: Primary Research

PATIENTS
Influence
1. Do you believe your doctor listens to what you have to say? Why?
Awna Striebel (Allergy patient with multiple intolerances): Partially. Doctors rarely listen to the
whole picture of my medical issues, so they dont always put all the pieces together, but rather
focus on isolated problems. The more specialized doctors (ex: endocrinologist) usually take the
time to write everything down to get the whole picture. I think part of the issue is that general
doctors fit in so many patients that they are always in a rush because they see so many patients
in one day.
Meghan Bean (college student who goes to an allergy specialist. She also sees many other
specialists as well): It depends. A lot of doctors do, especially at the BYU student health center. I
have had a few doctors that are very dismissive of the research I bring in though.
Dillon Ramey (college student who has seen doctors on a case-by-case basis): Usually, but
sometimes it seems like they think I might be exaggerating symptoms. Probably because
theyve had other patients do it.
Bryan Tieken (Male adult in mid 30s with severe allergies and asthma. Sees several doctors
regularly): I do believe my doctor listens to me because he listens without interrupting. The other
reason I believe he listens is because he reiterates what I told him and then asks clarifying
questions along with other questions to before he makes any recommendations.
Christy (Female in her mid 50s with allergies, asthma and MANY other medical problems.
Sees doctors frequently for different things. Expressed her concern on not being able to find a
doctor who listens to her and actually wants to help her. She is a registered nurse and has
worked closely with a lot of different doctors and various fields):Some doctors I have seen do
listen, many do not. Many doctors I have had contact with do the minimum with exams. I feel
they are busy and dont want to take the time to find out about me or what my real or complete
concerns are. They treat the most obvious problem and send you out the door.
Erin Hafen (young mother - mid 20s - who sees her doctor regularly): Yes. He limits his number
of patients. That makes me feel like he has time to listen to me and wants to listen to me.
Chad Henkel (Male adult in mid 30s with allergies and asthma, sees multiple doctors since a
recent move): Yes. Every time I bring up an issue, he would always take the time to listen and
he would restate to clarify for himself what I believed and then he would ask questions based on
what I said. He really listened.

Jenn Moxon (female in mid 40's with severe allergies to foods, medications and insect stings;
also, her lifelong doctor recently retired and she has switched to another): I felt like my old
doctor listened to me and knew me well. I am not so sure about the new doctor in the practice.

2. When was a time your doctor has or has not taken your concerns into
account in his/her treatment?

Awna: When general blood tests werent showing any obvious issues, my doctor assumed
everything was fine, even though my symptoms told him about obviously werent fine. I then
had to pay beyond what my insurance covered to see a specialist who would look into it deeper
and do more extensive testing.
Meghan Bean: I went to a doctor for a thyroid disease, and I feel like he was very dismissive of
my symptoms. There are times when people read way too much into Web MD, but I also feel
like you know your body. I had to basically beg this doctor to scan me for my thyroid.
Dillon Ramey: I went into the doctor's office with severe stomach pain. The doctor immediately
put me on morphine which I was grateful for and then went about finding the cause.
Bryan Tieken: Last time I visited earlier this year it was about not sleeping well. I advised that I
haven't known what a good night sleep was until I had to be treated for a neck injury and was
put on pain killers, muscle relaxers and prescription anti-inflammatories. I told him I wanted to
keep getting good sleep but without the pain killers. He clarified I did not want something that
was habit forming and then made the prescription for 1-2 tablets of Trazodone per night. It has
not been habit forming and I can take 2 if really needed.
Christy: One time I saw a doctor for a bad cough. I tried to tell the doctor that when I get a
cough like that I usually ended up on steroids for several weeks due to asthma. He didnt listen.
I had to go back to another doctor later to get the treatment I needed after I had become much
worse because the first doctor would not listen.
Erin : I cant think of a time when that he hasnt taken my concerns into account, so he must
usually.
Chad: There was a time where I wanted to take part in a rehabilitation (not drugs, body
rehabilitation) program but he wouldnt help me do it. He just wanted to go in a really slow
process and wouldnt go with me through the steps to see what that would even be about.
(Different doctor).
Jenn: My old doctor took my thought and feelings into consideration every time.

3. Do you feel like you have any influence over the treatment your doctor
recommends? How?
Awna: Sometimes. When Ive done research on my symptoms beforehand and request to be
tested for specific things, my doctors often consider it. One of my specialists actually consults
with me on which option of treatment I feel best about (after explaining the implications of each
option), which I really appreciate.
Meghan: Yes, I feel like I usually do research before about medications, and theyre usually
pretty responsive to my ideas and what I feel comfortable with.
Dillon Ramey: Yes, typically he gives me a range of options and I choose what I want to do.
Bryan Tieken: I do feel like I have influence over my treatment. When we discussed my asthma
medication, we talked about the various inhalers available. I gave the options but let me make
the final decision. Also the more I know about a medication, the more he is likely to prescribe it.
Christy: Recently I saw a gynecologist for a physical exam. When she renewed my
prescriptions, she also ordered a new inhaler & gave me a prescription for Singular for my
asthma . I already knew what I needed.
Erin: Yes, he usually gives alternatives to me and lets me pick. I really like that. He usually gives
options for a more natural remedy and a more medical remedy.
Chad: Yes. Because when I ask a lot of questions to understand where theyre coming from with
what the treatment will do I can really tell them if I want to be apart of the program or vision that
theyre seeing or bring up more of my concerns or decide what I really want more of. I feel like I
say because I ultimately tell them what I want in something thats important to me and the weigh
that every time.
Jenn: Not any more my old doctor retired and i don't have the confidence in my new doctor that
I had in the last one to listen to me.
Trust
1. Are you confident in your doctors competence and expertise? Why?
Awna: Yes. He explains the gist of my issues with confidence (instead of just prescribing
something and giving no explanation), and hes part of a well-respected association for doctors.
Hes also had many years of experience.
Meghan: Yes, I think so. Im confident in them because theyve gone to medical school for so
many years. I guess there are some instances when they say something that that makes me as
a patient feel less as a person, and more as a subject. Like Dr. House.

Dillon Ramey: Not especially, Ive heard of too many peoples diagnoses changing after getting
a second opinion.
Bryan Tieken: Yes, I am confident. He appears to know what he knows he is doing and isn't
afraid to let me know he needs to investigate something further before drawing any conclusions.
Christy: They are all so specialized that you cant find a doctor to treat all of you, just bits and
pieces of you. They might be competent in one very specific area, but I do not feel they are
competent in taking care of all of my medical needs. I cant afford to see enough different kinds
of doctors to take care of all of my needs competently. One day I hope to find a doctor who is
competent and capable of knowing and taking care of all of my needs.
Erin: Yes. I feel confident because he seems really confident. I gain more confidence in him as I
continue to see him and like what he does for me. I felt confident in him at first because of good
recommendations I had received about him.
Chad: Yes because he has gone into detail about everything he has talked about, and its never
been a guessing moment.
Jenn: My old doctor 100% my new doctor is not as good as listening to the symptoms he needs
a test and a lab report to tell everything, and he does not take into consideration anything other
than what the test says-- no personal insight-- no environmental concerns ect.
2. a.) Can you rely on your doctor to have open lines of communication?
Why?
Awna: Yes. He always shows me my all of my test results with transparency, and he doesnt
dismiss anything that I say, even if it turns out to be something unimportant.
Meghan: Ive had to deal with more sensitive issues. Ive needed medicines that are controlled
substances. I needed some Vicodin for kidney stones. I always feel awkward, because I dont
want them to misunderstand me. But theyve always been surprisingly cooperative and open. I
did have one doctor who had Aspergers and he was very blunt. He would just dismiss lots of
my ideas, and that was hard for me to be open with him because I didnt want to be judged.
Dillon Ramey: Yes, I feel my doctor has no incentives to hide anything.
Bryan Tieken: Yes because he has always followed up in the past.
Christy: One doctor I went to took about five tries of contacting their office to get my
prescriptions ordered at the pharmacy correctly. I felt it should have only taken once.
Erin: Yes. He gave me his phone number and he tells me to text him if I have random questions.

Chad: Yeah because our first few meetings I set expectations.


Jenn: Not anymore, he comes off as extreme and doesn't listen when I explain my history.
b.) Can you rely on your doctor to respond in a timely manner? Why?
Awna: Yes. It never takes too long to get an appointment, and I can usually get in the day of if
its something more urgent.
Meghan: Yes I would say so. I always go through the receptionist and they helped me right
away. I did have a doctor that I always had to wait in their waiting room for a long time. But I
understand that doctors need to take time for other patients.
Dillon Ramey: Yes, I feel he has been responsive in the past.
Bryan Tieken: Yes, he has previously given timelines for follow-up and has kept to those
timelines.
Christy: Once I had a gynecologist change my prescription and cut the dose of my hormone
prescription in half and told me to try it for a while before she renewed the prescription, she
never once called and asked how I was doing. Three months later the medication was finally
renewed after I called the office. I think I had been forgotten or ignored.
Erin: Just how he has dealt with me in the past with communication makes me feel like he will
get back to me as soon as he can.
Chad: Yes because he cares about results and news being conveyed to me, so he will always
make sure Im contacted.
Jenn: No. I've had to reach out several times to get responses to questions.
3. What makes you feel like you can or cant rely on your doctor to keep his or
her promises?
Awna: I dont know if I can answer this question because the doctor usually addresses my
needs in the moment, so theres never a promise for something in the future that needs to be
made.
Meghan: I cant think of any experiences at the moment!
Dillon Ramey: I feel like I can rely on him because he has been trustworthy in the past.
Bryan Tieken: He has always called or followed-up when he said he would.

Christy: Act like they care about me more than their paycheck. They need to follow through.
I appreciate privacy and not hearing about another patient and wondering if another patient
is hearing about me.
Erin: I had a small emergency late at night and texted him and he responded really quickly and
was helpful.
Chad: Nothing really. I dont feel that way because we always leave with an objective its not a
checkup or a mystery, we always try to find something tangible to go off of for further visits.
Jenn: i feel he lacks professional ethics.
Transparency
1. When selecting medical care, how does a doctors background influence
your decision?
Awna: It influences my decision pretty significantly, because I dont think that schooling alone
can prepare a doctor for any patients issues when the body can be unpredictable. So, the more
experience the doctor has, the wider his/her scope of thinking when it comes to medical issues
and solutions.
Meghan: Usually my mom and I would pick out the doctor when I was younger, and it was
usually someone who a lot of people had gone to. Its very referral-based.
Dillon Ramey: I usually go off of word of mouth or online reviews so brackgroud doesn't play a
big role beyond that.
Bryan Tieken: Not too much as long as there are not bad reviews. If there are bad reviews I tend
to steer clear.
Christy: : I want to know if they are board certified and what their reviews are. I check them out
online and choose the one I feel best about from there as well as talking to others who have
been treated by them or who have worked with them.
Erin: With this doctor I liked knowing that he was very healthy and active. He does triathlons and
stuff. His treatments are focused on helping his patients be able to be healthy and active too.
Chad: It does not matter to me. But my curiosity of their background leads me to ask certain
questions about their upbringing and growth in their industry.
Jenn: it hasn't, but needs to influence it more now.
2. How transparent do you feel your doctor is in his or her practice?

Awna: In Canada, totally transparent. In the U.S., I have trouble trusting the medical system and
its doctors completely becausej it feels more like Im the customer of business than the patient
of a healer/doctor. Part of that comes from being charged for every little thing they can get an
excuse to charge for, because they know that there are some things that patients wont be likely
to refuse for the sake of protecting their health.
Meghan: I feel like theyre pretty transparent, and havent done anything wrong. Nothing under
the table. They dont always explain things when they dont have to, but I dont always ask.
Dillon Ramey: I have no reason to believe he hides anything.
Bryan Tieken: Not real sure about the office transparency however so far the doctor has been
very willing to answer any questions I have asked.
Christy: I couldnt say. I dont know, but I feel they should be.
Erin: Very transparent.
Chad: Very transparent.
Jenn: I need to look into it more.
3. Is there anything about your doctor that leads you to believe he or she is
honest or dishonest?
Awna: No
Meghan: My main doctor (shes a very devout Hindu), and she talks about it sometimes. She
seems very honest, and like shes on my side.
Dillon Ramey: I think he is honest because I don't see a reason for him to lie.
Bryan Tieken: So far he hasn't done anything to lead me to believe he is dishonest.
Christy: There are some doctors and surgeons I have trusted because they have given me their
professional opinions and allowed me to make my own choice without pushing for the most
costly approach. I dont appreciate it when doctors charge an exorbitant amount for services
knowing they will adjust them later just so they can get more money from patients or insurance
companies. I feel this is dishonest. I feel a fair amount should be charged from the beginning.
Erin: No, I dont think so
Chad: No, no real indicators for me..

Jenn: Nothing either way.


Satisfaction
1. How satisfied are you with the relationship that your doctor has with you?
Please explain why you are satisfied or not satisfied.
Awna: Quite satisfied, because he always remembers me right away and usually remembers
issues I came for in the past and asks how they are going.
Meghan: Im satisfied because I feel like shes known me for so long that she understands my
body and my needs. Because shes religious, I appreciate that she understands sensitive
issues.
Dillon Ramey: Not satisfied because I dont feel he knows me so I get asked the same
questions repeatedly.
Bryan Tieken: So far really satisfied. My initial health examination he actually took the time to
complete a more thorough examination than any of my previous doctors ever did. He acts like
he really wants to get to things that can really benefit my health.
Christy: I was very satisfied with my OB/GYN doctor & surgeon that delivered my seven
children and also a local family doctor, but they both died many years ago. They took care of my
physical needs and really cared about me personally. I had a physicians assistant I really
liked because she listened, was competent and took care of all of my medical needs; but she
was snatched away by a sleep center. I have also appreciated one of the orthopedic surgeons
I have had, because I never felt like he was taking advantage. He just gave me his professional
opinions and allowed me to make my choices. I have been very pleased with the surgeries he
has done on myself, my husband, and one of my sons. I am currently not satisfied with any
doctors I have seen. Thats why I keep looking for the right doctor for me. I have tried many. I
must be looking in the wrong place or for the wrong kind of doctor. I cant seem to find a current
doctor who feels as thorough or caring.
Erin: Really satisfied. I feel like we have a friendship outside the doctors office. We are
Facebook friends!
Chad: Im very satisfied because any time I visit him, we get right to business with whats going
on and its always a very productive meeting with him. Sometimes after nine months, sometimes
after a week. We literally pick up where we left off.
Jenn: I'm not satisfied: he doesn't know me and I don't know him.

2. Are you satisfied with the medical care suggestions you receive from your
doctor? Why?
Awna: For the most part yes, because theyre accurate. Sometimes, though, when there are
symptoms that he doesnt know the cause of, he just doesnt have any suggestions at all for
them, which can be frustrating.
Meghan: I would say so. There have been some situations where she gives me options, and
asks what I prefer. There have been times when she was a proponent for one option, and if I felt
like the other one would be better, she trusted me. I appreciated that she trusted me, while also
using her medical expertise to advise me.
Dillon Ramey: Yes, they have worked well in the past.
Bryan Tieken: I am satisfied. He has changed how I was taking one of the medications I have
taken for years. He asked how I was using the inhaler and then educated me on how to really
use it. Come to find out I was using it completely wrong.
Christy: There are not many suggestions. I havent felt they were very thorough. They mostly
just do the physicals and send you on your way. At least they renew my medications.
Erin: Yes. He always gives options.
Chad: For the most part. Because he gives me really constructive well thought out suggestions
for what I go through, what Ive gone through, and its for me to piece them out and report to
him. The only reason Im not completely liking all of his suggestions is because he does not
know everything and thats ok. Hes done his best.
Jenn: Not with my new doctor.
3. Where do you feel your communication with your doctor is lacking?
Awna: When hes too rushed during the appointment, or when he jumps to conclusions about
my diagnosis too quickly and consequently doesnt consider what I say after hes decided that.
Meghan: My doctor with Aspergerswe have completely different personalities.
Dillon Ramey: He doesnt know me so we inefficiently repeat conversations sometimes.
Bryan Tieken: I'm not sure. I haven't had anything show up yet to show that it is lacking.
Christy: I have no relationship with any of them currently. Part of it is my fault, because I havent
consistently been going to the same doctor lately. That is because they dont really seem to
care. It just feels like it is their job with a paycheck.

Erin: Nowhere really. Sometimes I could probably speak up more.


Chad: Just not seeing him a lot? Wait, no where.
Jenn: He does not listen.
Commitment
1. Compared to other doctors, can you see that your doctor wants to maintain
a relationship with you?
Awna: Yes.
Meghan: She does a good job about that. I do have another doctor in mind that does a better
job (kidney doctor). He always asks for updates and he asks about other things besides just my
health. On top of that, hell go above because he wants to show he cares. Hell tell me about
recent things hes read that can help me with my kidneys, etc.
Dillon Ramey: No, he just wants to treat me and get paid.
Bryan Tieken: I believe so. His actions say it louder than words from previous doctors.
Christy: : I did in the four physicians I spoke of in Satisfaction question #1. I do not see that any
of the doctors I have been to since care at all about maintaining a relationship with me.
Erin: Yes. Besides medical stuff I feel like he cares about my life. He likes pictures on my
Facebook of my family and my kids. He helped with the deliveries of both my kids and I think he
likes seeing them grow up.
Chad: Compared to other doctors, no.
Jenn: No.
2. If your doctor isnt available for an appointment, do you wait to see him/her,
or do you schedule with another doctor?
Awna: This usually isnt an issue, but I go to a walk-in clinic whenever it is.
Meghan: I usually wait to see them, unless I have to. Especially with sensitive things, its hard to
re-explain things.
Dillon Ramey: I schedule with another doctor.

Bryan Tieken: I wait to see my doctor unless it is an emergency.


Christy: It depends on what I am seeing the doctor for. When I find another good doctor, I will
always want to use see the same doctor if possible.
Erin: Never had to schedule with another doctor, but this doctor always lets me know if he is
going out of town and recommends another doctor to call if there is an emergency before he
gets back.
Chad: I wait to see him. I do not have to go over the multiple things all over again, because a lot
of it isnt on a record or a log because they havent been serious for the visit, but very important
to me in general. And weve had time to go over those things while I was there for the purpose
of my visit.
Jenn: I just need to change doctors to someone I already know and trust.
3. Have you ever received communications such as Christmas cards, Get Well
cards, etc. from your doctors?If so, do you feel that those cards were sincere or
not?
Awna: No I havent, but I if I did I would be pretty neutral about it (like, not feeling that it was
insincere, but not necessarily excited either).
Meghan: Ive only gotten things like those from my dentist and I dont really care about them
because they feel so clich. But its still a nice touch. Because its such a clich, Id be almost
offended if I didnt get them.
Dillon Ramey: No but I wish I did.
Bryan Tieken: I have not received any card, etc from my doctor.
Christy: I have not received many, but the ones I have received I felt were just sent to
encourage me to keep going to them. I did not feel they were sincere.
Erin: I havent received anything like that from my doctor.
Chad: Ive not received anything.
Jenn: In the past, yes. But not since starting with my new one.

DOCTORS

Influence
1. To what extent do you believe your patients listen to what you have to say?
Why?
Karin Chen, Allergist, Primary Childrens Medical Center: Most of the time, yes. Occasionally I
will see a patient who already has a very strong belief system and feeling about what is causing
their
condition, and it can be difficult to change that belief.
Terry Baker, MD (ENT doctor with an allergy clinic in his office): Patients seem to listen best
when there is a relationship of trust. If, for example, the patient has preconceived notions about
their condition that they have obtained from a different source, such as the internet, then they
tend not to listen. Also, if you, as a doctor, use good communication skills such as eye contact,
body language etc so that you are engaging and connecting with the patient, they are much
more likely to listen. Patients are more likely to listen if you show concern and compassion.
Arrogance and speaking in technical jargon, especially when done to show how smart you are
rarely resonate with the patient and will shut down listening. Explaining in lay terminology that is
not condescending is essential. Analogies and pictures are key. Also, try to be succinct.
Attention spans have limitations. Especially if the disease is a chronic one. There will be
other appointments to reinforce concepts and repetition is king.
Dr. Allen Bitner, MD (Allergy specialist at Bountiful Clinic for Intermountain Healthcare):
It is variable among patients. Those who take more interest in their health generally listen better
to what I have to say. Some only come because they are expected to, and dont care as much.
Those patients arent motivated to listen as well.
David Pinkston, Chiropractic Physician (Trained in the NAET method of treating allergies) : I
explain exactly what I do and why it works. This seems to work best.
Elizabeth Diaz, Registered Nurse (different areas, now works with Postpartum Labor/Delivery,
though): Since I work on Mom/Baby (postpartum) I would say many new moms are eating up
every last word I say and begging for more information because it is all new to them and they
want to get it all right. The moms who have a few other kids many times will just kind of brush off
what I have to say because they already know it all, or at least think they do.
Jeff Ogden, MD (internist): They are generally attentive and receptive because I see positive
results. Generally I see the opposite when they haven't complied.

2. How do you influence your patients to listen to your concerns or


suggestions?

Karin Chen: I discuss verbally, show pictures and/or lab results on the computer, and provide
written instructions and handouts to reinforce the concerns/suggestions. I try to adjust my
explanations based on the education level and medical understanding depending on the family.
Terry Baker, MD: By utilizing the above concepts. Good communication skills, compassion,
avoidance of arrogance, analogies and pictures. And repetition.
Dr Allen Bitner, MD: I try to make a point to explain my reasoning for suggestions and
diagnoses in terms they can understand. It is often intimidating to a patient to hear a bunch of
large medical terms that mean nothing to them. When I make it so they understand, they retain
the information much better. If they are already well-informed then they follow along with what I
am saying much better. I try to have one-on-one conversation with each patient often and
answer any questions they have.
Elizabeth Diaz, RN: Most moms want their babies to thrive and will do whatever it takes. So for
example if a baby has a feeding gap and is only breastfeeding I let them know we need to do
something about it, and that it is becoming urgent because babies blood sugar drops after such
long gaps and if it drops too low they may need to spend time in our Level 2 nicu. Or if a mom
had a Csection and feels good and says she wants to skip a pain medication I just sort of inform
her that skipping now will likely lead to uncontrollable pain which is why the doctors schedule
the medication the way they do. So I guess providing information.
Jeff Ogden, MD: I try to get them to understand what the benefit is of intervention.

3. In what ways do you feel your patients understand your diagnoses?


Karin Chen: I give them an opportunity to ask questions and try to spend an ample amount of
time with each patient.
Terry Baker, MD: By asking probing question. In other words, avoiding yes or no questions. For
example, at the end of a conversation instead of saying do you have any questions?, say:
Based on what we have discussed, what is your understanding of your condition? When the
patient describes back to you what is going on with her, then you know information is flowing.
Dr. Allen Bitner, MD: Again, it is variable among patients. Informed listeners understand. Some
patients arent as detail oriented or dont care to understand because they arent as concerned
for their health.
Elizabeth Diaz, RN: They felt the labor or Csection pain and understand
Jeff Ogden, MD: They voice back to me appropriate questions and express their agreement to
intervention.

Trust
1. How do you earn your patients trust to ensure they return to your
practice?
Karin Chen: I give them an information sheet which states the suggested return visit timeframe.
I discuss the plan/prescription and reason for followup (to see if the medication or
recommendations are working). I discuss if that they are not better, that is even more reason to
come back. Our scheduling staff will also call family to schedule the next appointment.
Terry Baker, MD: Begin with basic communication skills: eye contact, body language, building
rapport are the foundations of trust. Listening to patient concerns and showing compassion also
builds trust. Avoid being dismissive of concerns that are not well founded or lack evidence.
Avoid interrupting or cutting the patient short. Get to know your patient.
Allen Bitner, MD: It starts from the moment a patient enters the office for their appointments; the
secretaries at the front desk during check-in must be personable and friendly in order for a visit
to begin pleasantly. We actually call those people patient service representatives. The patient
then meets with a nurse or physicians assistant who must also have great people skills and be
understanding. Then they meet with me and I try to be as personal as can be.
Elizabeth Diaz, RN: We try and give them the best care possible. They appreciate when we are
patient, answer questions, answer their call lights in a timely manner, and our boss has us tell
them "what's important to you, is important to me." So if pain management is their priority we try
to be especially attentive to that need.
Jeff Ogden, MD: I listen to them, teach them in great detail how to improve and treat their health
issues and then they see the positive results.
2. How do your patients communicate to you that they trust you?
Karin Chen: They call to ask questions, discuss their concerns (even those outside of their
immediate medical issue). They return for followup.
Terry Baker, MD: Again, a good knowledge of basic communication skills and body language
can tell you whether there is trust in the relationship.
Allen Bitner, MD: Their attitudes and responses.
Dr Pinkston: I can see they trust me when they listen and follow the instructions I give them.
Elizabeth Diaz, RN: Just the fact that they are letting me handle their new child is huge, they
have to trust that I know what I'm doing and that I will provide their baby with great care.

Jeff Ogden, MD: Verbal expression and compliance to the recommendations.


3. Would you describe things your patients have done that indicate they can
be relied on to keep their promises or that they do not keep their promises?
Karin Chen: I consider them trustworthy when medications are refilled regularly. They come for
follow up visits regularly. They call if they have questions.
Terry Baker, MD:
Allen Bitner, MD: I can generally tell just by listening to my patients. Over the years in my
practice it has become easy to tell when a patient is or is not taking the precautions and
medications that I suggest. I try to be personal and understanding with them because there is
usually a good reason why they are not. It all comes down to having a good discussion to work
things out.
Elizabeth Diaz, RN: I can't think of anything, I'll think about it and get back.
Jeff Ogden, MD: Compliance that is measured over time and have brought positive results.
Transparency
1. Do you believe your patients are honest or dishonest with you? Why or
why not?
Karin Chen: Sometimes yes, sometimes no. As an example, some patients will let me know if
they have had trouble with taking their asthma medications regularly. Others may not tell me but
I will know if they don't refill medications on time.
Terry Baker, MD: Patients are, for the most part, honest. After all, most people understand that
they are paying the doctor for a service to help them and being dishonest clouds the diagnosis.
Allen Bitner, MD: It varies among my patients. I try to ask detailed questions that get down to the
specifics of what is going on with their medical patterns. People sometimes might think they are
taking something correctly when they are not and it could all just be a misunderstanding. I like to
assume they are being honest with me and we may have misunderstandings.
Dr. Pinkston: I think most are pretty honest. Sometimes I have to ask a lot of questions before
they tell the whole story.
Elizabeth Diaz, RN: I would say I believe the majority of my patients are honest with me. There
are some who I sometimes wonder about, they will say they are in extreme pain belt are sitting
there laughing and smiling with family and friends, it definitely makes me wonder if they actually
need the narcotics they are requesting or not. Or sometimes to avoid a bottle feed after a

feeding gap a mom will say that she suddenly can breastfeed like a pro, but got no help and
won't let you watch.
Jeff Ogden, MD: Vast majority are honest. They express desire to be healthy and I see the
results of their actions.
2. How do you hold yourself responsible for the treatments and medications
you give your patients?
Karin Chen: I ask questions about what happened. This would include anyone involved, such as
the nurse, parents, patient, etc. Then I suggest a new treatment option and see if the family is
comfortable with the new option. I will apologize for treatment problem if it was something that
could have been prevented. I also try to discuss the risks and benefits of the treatment in
advance so the family can anticipate potential problems.
Terry Baker, MD: Patients must be told the rationale behind the treatment. Patients must be
educated as to the potential complications. If a treatment takes a while before it becomes
effective, the patient must be told and educated. The doctor should make herself available for
potential questions and complications to treatment.
Allen Bitner, MD: It is a general principle of being a physician; it comes with the job. I do regular
follow-up checks with my patients to see how they are responding to the medical care.
Elizabeth Diaz, RN: Absolutely. If there is something I don't feel comfortable doing or giving I call
the doctor and express my concern. If they continue to want whatever it is to be done or given, I
carry out the doctors order and document everything thoroughly from my concern, to the phone
call, to carrying it out.
Jeff Ogden, MD: I am always keeping up to date on treatments and new information.
3. How do you keep yourself up to date on the latest research or practices in
your field?
Karin Chen: I read journal articles, discuss cases with colleagues and subscribe to a specialist
listserve that is curated for my field of practice (I can send in questions about difficult cases), as
well as attend medical conferences 1-2 times a year.
Terry Baker, MD: I subscribe to all the medical journals that are relevant to my field of expertise
and I read the important articles. I also attend continuing medical education conferences in my
field of expertise.
Allen Bitner, MD: I am a member of two national organizations in my field. One is the American
Academy of Allergy, Asthma and Immunology, the other is the American College of Allergy,
Asthma and Immunology. Both organizations hold conferences and blast emails that give me all

of the updates and information I would ever need. I also subscribe to the journals that are
produced by each and continually work on my medical education.
Elizabeth Diaz, RN: There are education modules assigned each quarter, and we have to read
CPG (something practice guidelines) which have been modified when new research or
something changes how we do things.
Jeff Ogden, MD: I read medical journals and do personal research.
4. What do you wish potential patients would know about you and your
services?
Karin Chen: My practice is described on our website and a lot of referring physicians know
about my services. I specialize in Pediatric Allergy & Immunology, and really enjoy tailoring care
for kids. It is quite different from seeing adults.
Terry Baker, MD: Mainly, that I am here to help. My main motivation is to help you get well. In
todays world the doctor patient relationship is being redefined by a demanding public. Patients
can be quick to make assumptions about physicians that are cynical in nature
Allen Bitner, MD: I would like them to know that informed patients are more likely to be cured
and thats where I am here to help.
Dr. Pinkston: That I am genuinely interested in helping them get better.
Elizabeth Diaz, RN: I wish patientss knew that it wasn't a hotel and that I am not here to do
absolutely everything for them. I am happy to help when needed, or teach them how to care for
themselves or baby, but sometimes at night, the dad (who is supposed to be there to help the
mom) will ask me to bring them a drink or change the baby's diaper. Stuff like that is incredibly
frustrating, it's like having an additional patient to take care of sometimes.
Jeff Ogden, MD: Their health depends upon their actions. I like to teach them and advise them
on how to improve and resolve their health issues. I focus on prevention. Their is hope!

Satisfaction
1. How satisfied are you with the relationships youve established with your
patients? Please explain why you are satisfied or not satisfied.
Karin Chen: Overall, I am satisfied with the relationships that I've established. I see patients
chronic conditions and it is very gratifying to see them year after year and be able to help them.
Terry Baker, MD: I am satisfied with the vast majority of the relationships that I have with my
patients. There are a few relationships that have not been productive. Workload strain and

doctor burn out can undermine communication skills, which in turn leads to dissatisfaction. Bad
outcomes are also a source of dissatisfaction, so staying current and knowing your specialty
well to avoid bad outcome is key.
Allen Bitner, MD: I am very satisfied. I look forward to work each day. At every practice there are
going to be a few more difficult patients than all the others, so its not all 100% joyful, but I
mostly enjoy my time with each patient. It helps to be personal with each person.
Elizabeth Diaz, RN: Generally I'm satisfied with relationships, many parents will ask to take
pictures or write thank you notes. However, I see my patients for a short time, and haven't
worked there long enough to see people multiple times.
Jeff Ogden, MD: I am mostly satisfied because I see long time improvement and I see the
positive effects on their lives.
2. How have you successfully developed patient satisfaction to the extent that
they return to you for preventive care?
Karin Chen: I have a very specialized practice (primarily patients with immune deficiencies) and
are usually very motivated to continue staying well by seeing
me at regular intervals. Some patients who have allergic issues are seen by me as an initial
consultation, and can later be be managed by their general practitioner/primary care provider
thereafter. They may not need to return to my clinic for preventive care.
Terry Baker, MD: Start with good communication to establish rapport. Listen to patient concerns.
Educate patients effectively. Stay up with your specialty to achieve good outcomes.
Allen Bitner, MD: I listen and try to spend a good amount of time with them when they come for
an appointment. There is a stigma that doctors are always rushed and I like to break that mold. I
like to not seem rushed. But overall, I improve their health so they come back.
Elizabeth Diaz, RN: Don't do preventative care really.
Jeff Ogden, MD: Definitely! They see good results so they continue to visit.
Commitment
1. Can you provide any examples that suggest your patients do or do not
want to maintain a long-term commitment to a relationship with you?
Karin Chen: I have been in practice for over 5 years since completion of my fellowship training.
The longest time I've followed a patient is 5 years. They are committed to me either because
they find that my "doctoring personality" works for them and also per my answer to the previous
question.

Terry Baker, MD: poor outcome, poor communication that may or may not be realated to work
overload and physician burn out.
Allen Bitner, MD: Many first-timers to my office are only there because they have one small
question or have a single-instance of an illness and they dont generally come back, so I dont
have the chance to create a long-lasting relationship with them. Hopefully I make a good impact
in all cases though.
Elizabeth Diaz, RN: We don't really do long term care, however we do hear often that it's been
the best birth experience pts have had, so one would assume they would return if they have
another child.
Jeff Ogden, MD: They do not want to commit to making the lifestyle changes or except the
needed treatment to resolve their health problems. Then they may not return to the practice.
The opposite true as well.
2. How are you successful in retaining your patients?
Karin Chen: I work in an academic setting. In these types of settings, our clinics tend to see
challenging cases and more complicated cases. There often is an understanding in the
community that the physicians at our facility are highly qualified for seeing these types of cases
that may otherwise be too difficult for a primary care provider (and it is very normal to be
referred to our clinic for specialized care, not because the primary care provider is not doing
his/her job). Because of this, patients often understand that their condition requires this higher
level of care and my not have a lot of other choices outside of our facility. Irrespective of that, I
still try to be very kind, answer all questions, and work with families one-on-one as I usually see
pediatric patients. I try to do things that help keep the kids from crying and make their
experience as positive as possible. We are also constantly working on improving the wait times
for phone calls, checking in, etc.
Terry Baker, MD: Fairly successful but certainly, less than perfect.
Allen Bitner, MD: I follow up regularly, I have the nurse check-in and create new appointments
for them, and they are always coming back if they have a chronic illness.
Elizabeth Diaz, RN: We've only been open 5 years and a few people have delivered multiple
babies at our hospital.
Jeff Ogden, MD: Mostly because I will take the time and interest to teach them how to improve
their health. They feel hopeful. They also see the great results and want to return.
3. What has been the most successful tactic you have used to garner new
patients?

Karin Chen: By referral from other physicians because I am in such a specialized practice.
Terry Baker, MD: Word of mouth from patients that have had a positive experience with me.
Allen Bitner, MD: 1. Patient satisfaction goes a long way by word of mouth, 2. Other physicians
in differing practices refer patients to be and in those cases I see the patients as soon as I can,
even if that means staying late, because it builds trust with the patient and other physician.
Dr. Pinkston: Listen to their concerns, reassure them and be a real help to them.
Elizabeth Diaz, RN: I suppose moms saying they like the hospital to friends.
Jeff Ogden, MD: Word of mouth from current patients.