Podiatry Management Online


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09/18/2017    James E. Koon, DPM

Millennial Expectations

For some time now, patients have been researching
their doctors on the Internet. I am consistently
told by new patients that they chose me based on
my Internet reviews. Word of mouth referrals are
still a mainstay of my practice. I have never

My experience has been that all patients’
expectations are rising. Everyone wants
everything giving to them and they all want their
insurance to pay for it. Many come in with pre-
conceived ideas of what they have because “Dr.
Internet” has seeded their minds. Many come in
wanting Jublia or Lyrica because of advertising.
Very, very few patients have no idea or concern
of declining reimbursements to us or the burden
of running a practice/complying with CMS/dealing
with insurance companies. Some patients do
recognize that we don’t make the money we used to
but most still think we are all rich.

Patient respect for doctors has declined
significantly in the past decade and we doctors
are responsible for some of that. I know many of
you will argue the point, but showing up on the
hospital floor wearing jeans and a Polo and no
smock is unprofessional. Keeping a cluttered
office is unimpressive. Papers taped all over
your cabinets and reception windows makes your
office look cheap. Dirty carpets, torn upholstery
on your chairs, dirty AC vent registers, dusty
exam lights, dirty windows, etc. give off a poor

Being a money grubbing whore is the worst
impression maker there is. I have countless
patients that have come to me who have been in
other offices where they felt they were being
raped every visit. This impression is the worst
for Podiatry and for Medicine in general. Those
who engage this activity cannot be reconciled.
They are who they are and we all have them in our
towns and we all know who they are. There is
nothing you can do about that. It has been that
way forever and it will be that way forever.
Those practitioners could not care less about
anyone else. They are in it for the money.

My dad, a former GP, told me early on that if you
make patient care decisions based on money you
are making the wrong decisions for your patients.
I recognize the need to make money but there is a
great and vast difference between conducting
yourself as a business vs being a professional.
Patients can see BS when it is presented to them.
They know when they are being taken advantage of.
It tarnishes their perception of physicians.

What patients want is to get better. They want to
be rid of pain. They want a doctor who is
compassionate and caring. It isn’t hard. Be
honest, be caring, be professional. Not everyone
is going to get better and that’s a fact. But you
must try to help them with sympathy and empathy.
I have been told by other doctors that have seen
my treatment failed patients that the patient
still loves me despite my not getting them
better. No one sues a doctor they love.

Unfortunately in these days of internet reviews
it is more important than ever to conduct
yourself professionally. A bad review on the
internet can be a very, very hurtful thing as
many sites share reviews making one bad review
one that shows up on multiple review sites.
Patients MUST be made aware from the outset that
they will be held responsible for libelous
remarks on the internet. We have it in our new
patient form (that they must sign) that we will
defend ourselves vigorously for any libel
submitted on the internet and that we will pursue
damages as a result of any made.

I don’t get along with every patient. No one
does. When I recognize I am not in a productive
doctor-patient relationship I inform the patient
of my feelings and recommend they seek ongoing
care from another practitioner. In my opinion,
that is the defensive position to exercise. I
rarely send out dismissal letters because I don’t
need to. I tell them nicely to their face and
they get it.

Everyone expects great care in America and
fortunately most give it. It’s why we went into
Medicine. It is a most rewarding field to be in
for me and one that gets better every year. Over
time, we all learn to work smarter, not harder.
Do the right thing always and you will have very
little to be concerned about.

James E. Koon, DPM, Winter Haven, FL

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