A brief review of the site analytics seemed to tell a different tale, so we ran a detailed user-interface analysis.  Turns out our clients were underestimating their patients web-savvy.  By a long shot.  Here’s what we learned:

The most accessed page is the home page (which makes sense), followed by “Our Physicians,” then “Our Services,” and finally the forms page.  About 50% of people who go to the site at all click through to the “Our Physicians” page despite the fact that all of the the names are listed on the home page.

Nearly 30% of visitors came from search engines, which would suggest that patients are looking for them.  The most popular searches were various combinations of a physician’s name and the location of the practice,  then the practice’s phone number and finally, way down the list, the name of the practice.

Viewers who go directly to the site (i.e. who knew the website’s address and didn’t find it through a search engine) are looking at 3-4 pages per visit and are spending about 4 minutes on the site, which is actually a pretty long time.  We assumed that these viewers are mostly existing patients who are looking for more information about the practice.

Last but not least, 42% of viewers are hitting the RSS button to subscribe to the site’s blog feed.  This was most interesting to us since the client hadn’t decided if they wanted to commit to a blog yet, so we had just put a couple of starter posts on their blog feed and hadn’t updated it in MONTHS.  Despite that, nearly half of viewers attempted to subscribe!

Take home points for your practice:

• You need a website and it has to be indexed with the major search engines
• You need detailed physician (and staff) bios on your site – patients want to know who you are as a person before they decide to see you as a physician
• To maximize your search engine optimization (i.e. to move your site up in the rankings on Google searches), your names and phone numbers are the most important meta data to include.  In real life, patients usually don’t know (or care about) the exact name of your practice, but they know your name.
• Patients will wade through all those crappy physician ratings sites that always show up at the top of Google searches to find your site.  Make sure you give them what they want: information about you, your services and how to find you
• Forms are important and useful, but spending a little time on a blog (once a week, once every two weeks) will go a lot farther in terms of attracting new patients and engaging current ones

If you would like us to run a detailed user-interface analysis on your website and show you how to maximize its impact on your practice, we’ll be happy to do so.  And if you haven’t built a practice website yet, we can build you one with an infrastructure that will maximize your return on investment.

Facebook is — Literally — A Lifesaver

Bad use of the word “literally”.  A lot of caring hospital employees and a doctor saved this woman’s life. Facebook did not literally lay hands on her. Editor, edit.

I almost literally choked when I read one of the authors was Newt Gingrich, not generally known as a medical specialist. My mood began a free fall.

The story is that a woman shows up in  the ED, reports to doctors that she’d been treated at a number of hospitals over the preceeding months for a bewildering array of symptoms, rapidly decompensates, then is saved by a social-media savvy physician who checked out her Facebook profile where she had documented in excruciating detail exactly what had befallen her in months prior. This doctor figured out she has “hole in her heart” causing shower emboli to her cerebral vasculature, swoops in, operates and saves her. Literally.

The story smell fishy. Hard for me to believe that co-author Kamal Thapar, MD had much of a hand in writing the article. It doesn’t roll the way CVAs do in the ED. I know well how fragmented care leads to real-life complications with patients, but rarely does a “hole in the heart” causing embolic rain showers get overlooked by several hospitals. I smell tuna on the hands of Newt Gingrich (or a staffer) manipulating facts for effect.

I might believe that she had a typical CVA work-up which included an echo which picked up the clot. During rehab perhaps some social work intern Facebook’d her trying to find somebody who could be held responsible for her care. Interestingly, I searched “Google” and Lexis/Nexis on “Eau Claire woman stroke Facebook” and came up with nothing. You’d think a story like this would have generated at least one hit.

This poor woman! If the story is true, she has screwed herself right out of disability, health, and life insurance forever, maybe a moot point given her catastrophic brain injury. If you haven’t (yet) had a catastrophic brain injury, the place to publish intimate details about your health history (or any other history) is absolutely, positively, 100% NOT Facebook (or any other social media outlet), where internet archiving renders your information permanently public. Employers and insurers can and do use this information against applicants. 

This line was literally the last straw:

“As people document their health on the Web, it is easy for anyone — including doctors — to discover what is really going on.”

This is laughable. People are 100% honest online? You can believe literally everything you read? Might people exaggerate a little? Is Thamal Thapar MD really suggesting that it’s possible to do a search on every patient you see? It’s the modern-day equivalent of a house call?

Argh. Not the way for a physician to use Facebook.

He had an brief, potent post this week which prompted an interesting comment. Here’s the link:

ROI of engaging patients in social media

He bottom-lined the social media return on investment for him this past month: 14 patients. He got 14 new patients from the big wide world of the world wide web, using a variety of now well-established platforms (Twitter, Facebook, website). I’m not sure what his average reimbursement for new patient consult is, but for those of us here in the midwest, let’s say the average reimbursement for a new patient encounter is oh, $80 (I’m low-balling a bit). That’s $1120 from the internet in a month. That isn’t bad.

A reader commented on how he went about finding a new dentist. He sensibly narrowed down his choices geographically, then checked the dentists out online. That’s exactly what I do, with the addition of finding dentists on my insurance panel. You have potential patients out there doing the same thing. Can they find you online? If they do, what do you look like?

There is a stranger in the clinic room, and it is not your patient. This stranger is a multifaceted, opinionated entity with likely conflict-of-interest. This new acquaintance has already spoken to your patient and influenced the direction of this visit in the form of health statistics, symptom explanations, and feared complications. Now your patient wants to know what you think.

The stranger in question, of course, is the all-seeing Dr. Google.

Patients have always been influenced by the anecdotal – Great Aunt Tilly had a runny nose once and it turned out to be a brain tumor! – but thanks to Dr. Google, patients now meet thousands of Aunt Tillies every day and bring you enormous, inkjet-stained stacks of medical research to prove it.

Even though a lot of the information Dr. Google doles out is inaccurate (check out the post for a cool study that analyzed how bad online search engines were at answering 5 common pediatric problems), patients loooove him. Multiple studies have shown that a majority of Americans seek health information online and believe that the information they find there is the same as or better than yours. Ouch!

So how do you compete with this virtual snake-oil salesman when you’re lucky to get 10 minutes of face time with your patients and he’s wooing them 24 hours a day?

• First off, acknowledge your patients’ online efforts even if you disagree with their conclusions. By taking 30 seconds to validate their concerns, you will make the rest of the visit go more smoothly (and quickly). Happy patients are engaged patients. Happy patients stay with you and happy patients refer their happy  friends.
• Make your website an online home base. Put links to sources of information you trust. Talk to your patients through a blog that is easy to read and navigate. Bolster your authority in the office by meeting your patients online.
• Get paid for your time. If a patient shows up with more than a page or two of print-outs, I accept it graciously and tell them I will be happy to review it with them at a follow-up visit.
• Go old school. I keep a list of online resources… on paper. I hand it to patients like a prescription. It isn’t long or overwhelming, and it enhances patient education very effectively with minimal effort on my part.
• Gently remind patients to always consider the source. Government agencies? University medical centers? Great – enjoy your tax dollars at work. Ed’s Prostodynia Blog sponsored by Flomax? Not so much.
• Be responsive to trends and seasons. When I find myself answering the same question more than three times in a day, I put the answer online for everyone to read. If it saves me even one repeat of these conversations, it’s time well spent.

Bottom line? Make yourself the go-to source for your patients: online, in person, all the time. You know you’re better than old Doc Google – make sure your patients know too.

The Twitter Treatment: Thoughts on a Patient on Social Media

Interesting. Full of good ideas, bad ideas, and an important two take-home messages. My thoughts:

• “Tell me what to eat!” Ah, “Eat fruits and vegetables”. You don’t need a nutritionist of MD to tell you this. It isn’t what most patients want to hear. It isn’t what I want to hear which I say with a Snickers Bar in my hand and a giant latte on my desk. It takes 20 seconds to Tweet, though, and if that little burst of 140 characters can convince a patient to reach for something healthy and not something harmful, that’s a reasonable use of my time. Thumbs up on this idea.
• “Keep patients updated on good reads”.AMEN! Two thumbs and two big toes up on this. Physicians need to be leading the educational charge in this brave new world of information by fire hose.  Medical information should be coming from us, not idiots or corporate hacks. We’ve let it get away from us, though, as we slash through FMLA and disability forms, prior auths, and endless patient encounters. We’ve let lunatics (Jenny McCarthy), the misinformed but mouthy (Oprah), and $-mongering MDs (Dr. Oz) take over the conversation with OUR patients. Take it back.
• “Check in via Facebook”, “Support parents of sick children”: I have no beef with either of these in theory. What so many patients fail to realize, however, is how many of them there are. Twenty five patients with multiple medical problems into my day plus another 20 phone calls, letters etc. (on an easy day) later and well, I just don’t have time. Then there’s the HIPAA police threatening to rain hellfire upon me should I so much as glance at a patient in an unencrypted way. This just isn’t going to happen, especially on FB or Twitter. I run a business. I move a whole lotta meat everyday because primary care just doesn’t pay. If I could see ten patients a day and keep the lights on and pay my staff and fund everybody’s 401K sure, I’ll call you and ask what you had for breakfast, and I’m not being too sarcastic. I can’t help for free, though. It’s a strange relationship, your health being my business. While I’d love to not worry about money, the electric comany and my employees insist on being paid in cold, hard cash.
• “Tweeting mental health tips”. To everybody, sure. To an individual, no way. HIPAA and its relatives are very clear about unencrypted conversations with patients. I won’t risk a fine or jailtime. However, just like diet and nutrition tips, I’m happy to broadcast general tips for anybody. Good idea, in fact.

TPL take-home messages:

1. Your patients want to connect with you. They’re begging for it; this patient in a very articulate way. There simply isn’t time in the office for all that connecting, though, so take it online and broadcast to anybody who is interested.
2. Your patients need to be reminded that this is a business. Primary care is the big box grocery store of medical care: high volume, low profits. They’re not giving away milk at my Giant Eagle. Now, I’m not saying to nickel and dime patients to death. Until phone calls and emails pay (Ha!), until appointment reimbursement increases (Double ha! That’ll be the day with looming Medicare cuts on the horizon), if it doesn’t happen in an exam room and I can’t slap an ICD-9 and CPT on it, I can’t do it.

Yesterday John and I were out for a stroll at lunch. He was no doubt mocking me about something, and probably I was talking about 37 things at once and didn’t even notice. Suddenly, a weird breast cancer experience. We were accosted, yes accosted by pink-clad breast cancer terroristas. About five women (maybe it was two, but five makes a better story) came hurtling towards us, hands extended with brochures and petitions at the ready. They yelled, yes yelled at us to take them. I have breasts; I wanted to protect them from these well-meaning but misguided awareness-raisers.

John wrote a terrific piece for an online literary journal about his experience with a breast cancer survivor. He muffed the encounter, and as his wont, had angst about it for a long time, then wrote movingly about it and the larger role rhetoric, agendas, language–baggage we often don’t think about in the course of a day full of patients–play in nearly every encounter. Long but wonderful piece.

The Misplaced Rhetoric of Medicine from Harlot: A Revealing Look at the Arts of Persuasion

I spent a good part of my day yesterday nodding sympathetically, handing out tissues for snotty noses, and assuring my young patients that they were going to live through their viral upper respiratory infections. I dusted off, for oh, I don’t know, perhaps the 8,674,284 time my “thing is, antibiotics don’t help with viral infection” set piece. By the 8th time yesterday I’m pretty sure I was having a little trouble infusing my lecture with freshness and enthusiasm. I fingered the “Amoxil” stock Rx button on the EHR….”Don’t do it,” I told myself, but oh, how I didn’t want to give the lecture again. How easy it would be to give a teeny, weeny little Amox Rx and let the patient go, clutching their useless prescription.

It reminded me of an essay John wrote a while ago for the LA Times about an urgent care patient of his, both timely in this URI season and timeless in its reminder to check your ego, your irritation, your boredom (let’s be honest….it happens) at the exam room door. But oh, it can be so hard at the end of the day to step back from the sometimes irrational, seemingly endless needs of patients and rewind a little. What is going on in this encounter? What is the patient’s agenda, and aside from surviving the rest of my day, what is mine? Read more about it:

When ends justify means (originally published in the LATimes September 18, 2006)

courtesy Wikimedia Commons

“…and that didn’t include my website.”

My jaw dropped when I heard this from a primary care colleague yesterday. What did he get for this horrendous outlay of cash?  Glossy brochures, nice stationary (he had to pay for printing!), and a cool logo. I did some quick math: $24,000/$80 per patient average reimbursement=300 patient visits.  Divide that by 48 working weeks a year=6+ patients a week just for marketing. Ouch.

The Practice Lab can do better.  In fact, I’m going to give away our marketing plan for free:

The NOT 24 Thousand Dollar Marketing Plan:

• Get a website. Think you don’t need it? In a year or two no new patient will look at you without it.
• Keep the website looking clean and neat, like your waiting room. Update it often. Make it so it looks inhabited.
• Have a blog on the site. Update it. We’re not talking hours of your time. Just post: staff changes, hours, interesting medical news, etc. Again, it looks like you give a damn.
• Have a Facebook page that picks up the feed from your blog. Post little chatty bits of news there, but don’t let patients post. Trust me.
• Use Facebook for what it is: a place to advertise to the willing masses. Do impression or click-through ads to patients in your area with specific diseases, for sports physicals, flu shots, cholesterol screens, whatever. Cheap and effective. Same with Google ads.
• Be nice to everybody in your neighborhood. Stop by the barber shops, hairdressers, pharmacies (Oh Lord, be nice to pharmacists), bookstores, urgent cares, nursing homes (if you dare) or any other businesses you have going on in the vicinity. Shake a hand, leave a card and be sure everybody knows you’re right down the block for a sore throat, splinter, plantar warts.
• Primary care docs, meet specialist. Specialist, meet primary care docs. Bring gifts. I never, ever refer to any hand surgeon besides the hand surgeon who dropped by with the most fantastic rum balls her first Christmas in practice. Of course, she’s competent; patients like her; she gets gets my patients in fast. For the sake of a dozen rum balls she had a referral source for life.
• Specialists, make it easy for me to refer patients to you. Primary care physicians, be kind to your specialists. Include contact information on your web page to make it easy to transfer information.
• Get on hospital physician referral directories. Be nice to the employees in the medical staff. Yes, it is going to take 14,034 phone calls to get your name listed everywhere with the right phone number. Grin and bear it.
• Be up front with patients about everything. How you roll, what you charge, what you do, what you don’t do. Get it all on your website. No surprises because….
• Yelp, Healthgrades, RateMDs, Angie’s List, and any other “Bitchaboutyourdoctor.com” rating sites will let everybody on the internet know if you irritate a patient. This is painful. Patients can say anything about you; your hands are tied. I guarantee you that the crack addict for whom you would not prescribe Oxycontin 80mg TID will post something truly hateful about your practice. But you will, on occasion, find some love. You will also find some constructive criticism of you, your staff, your space, you phone system, even your haircut. If you fix something go beg your mother, a patient, your cousin, etc. to post a review on the website letting everybody know.

That’s it! Be attentive, keep your website neat and clean, press a lot of flesh, and consider the rum ball (or fruit plate, lattes, donuts . . .) Will these things fill your practice overnight? No. You’re going to have to move meat, smile and work your front and back office like a politician, but you have to do that anyway.

How can The Practice Lab help?

• We’ll get you a website. Already have a website? We’ll try to break it. We’ll tell you what we think is wrong with it, then help fix it. You’re only as good online as your user interface.
• We’ll set up your blog. We’ll set up an editorial calendar to keep your blog updated. We’ll give you sample posts. We’ll write posts if you like!
• We’ll set up Facebook and we’ll make it a safe place for your practice. We’ll do the back-end techno stuff so your website talks to Facebook. We can get you started, or we can manage the whole thing for you.
• We can set up Facebook and/or Google ad campaigns. They work and they cost pennies a click or a few bucks a day.
• While we don’t think there’s any substitute for reaching out and shaking somebody’s hand, we can draft a nice letter of introduction to consultants for you. We can help you put together a marketing package to send them that won’t cost $24,000.
• We’ll keep track of what the internet is saying about you and your practice. We’ll send you a report. When we see a public relations disaster happening–your own personal Deep Water Horizon–we’ll let you know and work with you to fix it.

How do we do all this for you? John and I have years of experience with patients in nearly every conceivable practice setting.  We’ve also written innumerable blog posts; managed websites (I did my first practice website 9 years ago); managed Facebook, Twitter,  and Google accounts. We’ve done our share of old-school hand shaking too.  We have a network of cost-effective, experienced, talented web and graphic designers we use to get you what you need. Call or email us today to find out how we can help you.

Dr. John is fire these days. He’s everywhere. I wish his notoriety would get us a spot on Oprah or a trip to Hollywood for a movie premiere, but I guess I’m going to have to be patient about that. Instead of bedbugs or social media, his recent attention both at work and at home (he has two small kids, as do I) is all about Halloween and candy. He was quoted recently in a wire story about Halloween candy safety and golly gosh if he wasn’t picked up immediately by the local Youngstown paper.

Candy Tampering Isn’t A Big Concern

Don’t tell my children that candy tampering isn’t a big concern. Every Reese’s cup in their Trick or Treat bucket seems to be tampered with, really, they have, and I am forced to confiscate them for safety purposes. My husband and I selflessly put ourselves in harm’s way by taste-testing all of them. We haven’t found a tainted Reese’s yet, but we’re going to keep looking.

But like it or not, websites have become a necessary cost of doing business.  Why?  I’ll spare you the “everyone has one” argument (I’ve been scarred by too many maternal “if your friends were all jumping off bridges” retorts) and go to the converse – because everyone expects you to have one.  Your patients.  Your colleagues.  Your vendors.  And if we’re being honest here, you.

Where’s the first place you look when when you need to find out if a store is open?  When you need directions to a friend’s house?  Whether a restaurant is worth trying?  When was the last time you opened the Yellow Pages?  Would you even go to a hair salon if you couldn’t find them online?

But in the spirit of spirit of making lemonade out of lemons, I would argue that if you put it in terms of staffing costs, your practice website will be the best money you ever spend.

• It’s the cheapest employee you’ll ever hire

Websites never call in sick.  They work 24/7/365 and you don’t have to pay them overtime.  For a fraction of what you pay a receptionist per year, they can answer the majority of questions that keep your staff on the phone and away from doing the patient care that generates revenue.  They can broadcast important information out to all of your patients at once, instantaneously – new hours, flu shots are in, sports physicals next week.  And if they can’t answer the question, they offer an easy, convenient way of passing it along to someone who can.

• It can actually make you money

In addition to increasing your operational efficiency and freeing up staff to focus on work that directly generates revenue, a website can have a positive impact on your bottom line in many other ways.  It offers you new, effective and inexpensive means of promoting yourself to potential patients.  And even if you have more patients than you can handle, your website offers you ways of generating significant passive income for your practice through the selective use of advertising.

• It’s really popular with every kind of patient and is glad to introduce you

Grandma’s doing Facebook.  People under 25 haven’t even heard of the yellow pages; email is formal communication for them.  And if done right, your website will appeal to both of them and everyone in between.  If you want to do a certain procedure or promote a certain service or shape your practice around a specific disease management, your website offers you many sophisticated ways to do that and reach exactly the people you want to reach.

• It never strays off message

How many times do you or your staff answer the following questions?  Will you call me in an antibiotic?  Will you call me in some Percocet for my toothache?  Why won’t you just give me a Z-pack for my cold – you gave one to my Mom? Will you fill out this 20-page disability paperwork and have it ready for me to pick up by tomorrow morning?

It’s hard to answer those questions over and over without getting a little annoyed, especially when you’re answering it at 3 in the morning!  But your website will be happy to.  Any time, day or night, they’ll give your patients a consistent message no matter how many times they ask.  You get a break, and just as importantly, you know everyone is being told exactly what you want.

• Your patients love it!

Ultimately, this is why you should embrace the idea of having a website.  As strange as it may seem, your website imparts a personality to you and your practice that your patients can really connect to.  It may not be quite as personal as the relationship they’ve built up over the years with your or your staff, but it can become a real extension of it.  By helping you manage some of the mundane details, and allowing you to share a little more about you and your philosophy of practice, it will remind people why they come to see you in the first place.

John