Tag Archives: unmet need

For best results engage the entire decision making apparatus

I’ve been sick for two days. I have a runny nose, headache, cough and I’m tired.

We agreed that it was very unpleasant having these symptoms when you are moving boxes around a warehouse all day. I examined him and found signs of an upper respiratory tract infection but nothing worse. Now comes the crucial part. If you are a doctor what do you say in the circumstances? You must have your speech ready because you will almost certainly consult someone like this every day, probably more than once a day. In an essay published in the BMJ Trisha Greenhalgh and colleagues wrote:

Evidence users include clinicians and patients of varying statistical literacy, many of whom have limited time or inclination for the small print. Different approaches such as brief, plain language summaries for the non-expert (as offered by NICE), visualisations, infographics, option grids, and other decision aids should be routinely offered and widely used. Yet currently, only a fraction of the available evidence is presented in usable form, and few clinicians are aware that such usable shared decision aids exist. BMJ 2014

What she appears to be hinting at is that words are not enough and may not efficiently convey what this man needs to make a decision for himself. He has already decided for whatever reason that he needs to see a doctor. He was probably able to ‘self-care’ by taking ‘over the counter’ symptomatic measures. Setting aside the notion that he might have presented to get a medical certificate to claim time off what else may be on his agenda? If we postulate that he might want prescribed medicines believing that they will hasten this recovery then there is the prospect of a disagreement with you as the ‘evidence’ suggests otherwise. He probably has a viral illness. But as David Spiegelhalter and colleagues wrote in Science:

Probabilities can be described fluidly with words, using language that appeals to people’s intuition and emotions. But the attractive ambiguity of language becomes a failing when we wish to convey precise information, because words such as “doubtful,” “probable,” and “likely” are inconsistently interpreted. Science 2011

What the person with the cold needs to know is that we cannot be sure what precise ‘bug’ has caused his symptoms. That the most likely cause is a virus but that his symptoms now do not predict the duration or severity of his illness. However most people get better within 10 days and he is probably suffering the most he will through this illness today. The worst symptoms are those he now describes. the cough may linger for a couple weeks.  Symptomatic treatment might help him feel better and that people who have been prescribed antibiotics do not get better any faster (that last bit is my team’s research which hasn’t yet seen the light of day in a peer-reviewed journal). However he may not factor all of this information into his thinking without pictures. We need to consider how he makes the decision to take your advice. Scientists have studied this and come up with some helpful advice recently. For a start the patient is unlikely to make a decision based on logic alone.

Behavioral economic studies involving limited numbers of choices have provided key insights into neural decision-making mechanisms. By contrast, animals’ foraging choices arise in the context of sequences of encounters with prey or food. On each encounter, the animal chooses whether to engage or, if the environment is sufficiently rich, to search elsewhere. Kolling et al

There are three treatment options; prescribe an antibiotic now, defer prescribing for a couple days or prescribe nothing. The latter is the appropriate course however a goal in this situation is to reach consensus with this person. To present the data to him in a way that engages his entire decision making apparatus. You are able to usher him out the door without anything only to find that he has lost faith in you. How he feels about the matter is critical:

A few years ago, neuroscientist Antonio Damasio made a groundbreaking discovery. He studied people with damage in the part of the brain where emotions are generated. He found that they seemed normal, except that they were not able to feel emotions. But they all had something peculiar in common: they couldn’t make decisions. The big think

The more challenging approach is to communicate respectfully, appropriately and effectively. Pictures can now assist as never before. Yet the habit of using pictures is neither taught nor practised consistently in clinics. Spiegelhalter again:

   The most suitable choice of visualization to illustrate uncertainty depends closely on the objectives of the presenter, the context of the communication, and the audience. Visschers et al. concluded that the “task at hand may determine which graph is most appropriate to present probability information” and it is “not possible to formulate recommendations about graph types and layouts.” Nonetheless, if we aim to encourage understanding rather than to just persuade, certain broad conclusions can be drawn, which hold regardless of the audience.

His team’s recommendations:

  • Use multiple formats, because no single representation suits all members of an audience.
    Illuminate graphics with words and numbers.
  • Design graphics to allow part-to-whole comparisons, and choose an appropriate scale, possibly with magnification for small probabilities.
  • To avoid framing bias, provide percentages or frequencies both with and without the outcome, using frequencies with a clearly defined denominator of constant size.
  • Helpful narrative labels are important. Compare magnitudes through tick marks, and clearly label comparators and differences.
  • Use narratives, images, and metaphors that are sufficiently vivid to gain and retain attention, but which do not arouse undue emotion. It is important to be aware of affective responses.
  • Assume low numeracy of a general public audience and adopt a less-is-more approach by reducing the need for inferences, making clear and explicit comparisons, and providing optional additional detail.
    Interactivity and animations provide opportunities for adapting graphics to user needs and capabilities.
  • Acknowledge the limitations of the information conveyed in its quality and relevance. The visualization may communicate only a restricted part of a whole picture.
  • Avoid chart junk, such as three-dimensional bar charts, and obvious manipulation through misleading use of area to represent magnitude.
  • Most important, assess the needs of the audience, experiment, and test and iterate toward a final design.

The last offers a call to arms for innovators.

Picture by Alan

Am I going to be like this forever doctor?

There is an opportunity in nearly every medical interaction to make a substantial difference to the outcome by reassuring. What nearly every patient wants to know is:

How long will this horrible feeling last?

We can be reassuring in the various ways in which we conduct ourselves in healthcare. On the stage, with the props, in the persona we adopt, in the dialogue and in the action. All of it matters. Much of what appears on this blog speaks to these aspects of the consult.

People attend doctors for one main reason. They are worried. It doesn’t matter whether the cause is a minor self-limiting illness or a life-limiting cancer. Symptoms ultimately drive us to the medicine man. Here are the results of a study entitled ‘Why Patients Visit Their Doctors’:

We included a total of 142,377 patients, 75,512 (53%) of whom were female. Skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%, excluding asthma) were the most prevalent disease groups in this population. Ten of the 15 most prevalent disease groups were more common in women in almost all age groups, whereas disorders of lipid metabolism, hypertension, and diabetes were more common in men. Additionally, the prevalence of 7 of the 10 most common groups increased with advancing age. Prevalence also varied across ethnic groups (whites, blacks, and Asians). St. Sauver et al

For each of these conditions it is possible to prepare a response that will reassure the person that things will improve.  It is interesting to read the lay commentary on the data:

What’s funny is that while skin disease is the most common reason for doctor visits in America, it’s usually the least detrimental to overall health……Pretty much everybody (and I mean everybody) has experienced a cold before. You know the symptoms; runny nose; coughing; sore throat; congestion. Due to the high volume of people who get colds every year (most people get multiple colds per year), it’s no surprise that some of those people will see the doctor about it. Therichest

And the implications of this commentary is that the response to patient is a ‘set-play’. Doctors and healthcare organisations can prepare to host a visit from most people who present for help. If you are a doctor what is your interaction like with someone with acne or eczema? How do you respond when this is the reason for attendance is a cold? What do you do? What do you say? Is that reassuring? How do you know? For most if not all these problems much of the treatment includes prescribing ‘tincture of time’ essentially that means reassuring the patient that they will not suffer forever.

There is evidence that such an attitude reduces the impact of the illness:

Clinician empathy, as perceived by patients with the common cold, significantly predicts subsequent duration and severity of illness and is associated with immune system changes. Rakel et al

Picture by Christophe Laurent

The encounter could end well if you give it a chance

There is a moment in any consultation when someone could take an unhelpful perspective. That perspective could severely undermine the subsequent exchanges between those concerned.

In social categorization, we place people into categories. People also reflexively distinguish members of in-groups (groups of which the subject is a member) from members of out-groups. Furthermore, people tend to evaluate out-groups more negatively than in-groups. In this way, social categories easily lend themselves to stereotypes in general and to negative stereotypes in particular. Cohen

The problem with such categorization is that we then rate aspects as positive and negative disregarding evidence to the contrary. In a series of classic studies researchers recruited a group of 12 year old boys to attend a summer camp. The boys were divided into two teams which were then pitted against each other in competitive games. Following these games, the boys very clearly displayed in-group chauvinism. They consistently rated their own team’s performance as superior to the other team’s. Furthermore 90% of the boys identified their best friends from within their own group even though, prior to group assignment, many had best friends in the other group. M&C Sherif

Healthcare professionals can also be prone to social categorisation:

It is equally important to recognize that physicians and other health care workers are not mere empty vessels into which new cultural knowledge and attitudes need to be poured. They are already participants in 2 cultures: that of the mainstream society, in which some degree of bias is always a component, and the culture of medicine itself, which has its own values, assumptions and understandings of what should be done and how it should be done. Reducing racially or culturally based inequity in medical care is a moral imperative. As is the case for most tasks of this nature, the first steps, at both the individual and societal levels, are honest self-examination and the acknowledgement of need. Geiger

The patient opened the consultation saying ‘I don’t sleep well’. He wore a raggy teeshirt, torn jeans and old trainers. A baseball cap was perched atop an untidy mop of greasy hair. He was overweight verging on obese and had two days of growth on an unshaven face. He worked in a warehouse. Thirty seconds into the encounter I caught myself thinking ‘he wants a prescription for a hypnotic’ but stopped myself launching into a prepared speech on the addictive dangers of hypnotics. It turned out that he had worked to lose 15kgs, studied and practiced sleep hygiene and was keen to explore any option other than drugs. He was far from interested in a script for Temazepam. It turned out that he was keen to hear if I approved of his low carb diet and wondered if yoga and meditation might help. The next seventeen minutes were a mutually satisfying consultation which ended with a handshake. A sure sign that it had gone well.

This small study suggests that most handshakes offered by patients towards the end of consultations reflect patient satisfaction — ‘the happy handshake’. Indeed, many reasons were recorded using superlatives such as ‘very’ and ‘much’ representing a high level of patient satisfaction — ‘the very happy handshake’ BJGP

Therefore there is a point in the consultation when the healthcare professional needs to scan their impressions for evidence of  stereotyping.

Picture by David Baxendale

Does encyclopaedic technical knowledge make a doctor?

Life as a clinician is challenging.  Hours are long and resources limited. People may not be helpful, not even the ones who are supposed to be working with you or even for you. There maybe joy but there will also be sadness and even anger. You can expect to feel tired. You may be concerned and even confused. Occasionally you will be very intuitive but just as often you can expect to be wrong. However, you cannot let any of that have an impact on the care provided to patients. And yet each day clinicians respond as if none of this is ‘fair’ and should not be so.

The practice of medicine is more than a technical science. Medicine requires a great sense of personal mastery. An uncommon mastery in which the doctor is resilient and resourceful. Do we prepare young people for such a life?

This week after 30 years I stepped into one of the rooms now decommissioned but where I once spent my teens learning anatomy. It was a core part of that school’s curriculum, the only subject in clinical medicine that was introduced within the first year of a six-year course. The author of one of the seminal texts taught there. His dissections were legendary and the specimens are still preserved to perfection. I reflected on whether the experience of being taught by his protege prepared me in any way for the subsequent years in practice. Did my encyclopaedic knowledge of how the body is constructed allow me to better handle the following years in clinical practice?  By comparison, we learned relatively little about what drives people to make decisions that make no sense. And yet over the 30 years, I have practised medicine it has been more often problematic knowing how to handle someone whose choices will lead to self-destruction than working out exactly which nerve is responsible for the numbness of a portion of his thigh.

Picture by Rosebud23

Can the patient relay what was done for them?

A perennial source of dissatisfaction in healthcare (as documented here and here) is the poor flow of information from one sector to another. ‘Joe’ (speaking here– video from BMJ open) couldn’t tell me, his doctor, anything helpful about what had been done while he had been in hospital. That means we have to schedule several appointments to try to unpack it all. He was an in-patient for two weeks and someone had decided one Thursday morning that it was time for him to go home. It wasn’t really clear to Joe or to me why that particular morning or what was to happen when he got home other than that he should contact his ‘local GP’. A letter would follow some time in the future. There may have been good or bad reasons for sending him home. We could only guess what was in the mind of the person who made the decision:

We needed the bed. Joe was fine. His observations were normal, he was ambulant his wife was happy to take him home.

But of course Joe comes home with lots of questions, which I now struggle to answer without making phone calls to track down the busy medical team. The problem is articulated by several ‘stakeholders’ members of the ‘multidisciplinary team’ on the ward none of whom feel they own the problem of telling this man what he needs to know. There is only one constant in this story- Joe. If Joe can collect the information we need during the course of his hospital stay we might begin to improve the outcome:

In addition to increasing the burden on GPs, it engenders a need for a subsequent GP appointment; it limits GP capacity to respond to patient concerns and queries, at least on one occasion; it may result in a re-referral to the specialist; and it increases GP dissatisfaction with the care provided to the patient by the hospital. BMJ

The problem is Joe often does not know what he needs to know by the end of his hospital stay. It isn’t impossible to work out how to trigger questions for Joe to ask throughout his hospitalisation. What is far more difficult is to motivate every hospital ward and every discipline in a team to address this challenge consistently. It is ‘easier’ to nudge one individual than enlist the cooperation of the dozens of health professionals who will come into contact with Joe. Making people active in healthcare processes has achieved results before:

Influence at Work, a training and consultancy company that Cialdini founded, worked with the United Kingdom’s National Health Service (NHS) in a set of studies aimed at reducing the number of patients who fail to show up for medical appointments. They did this by simply making patients more involved in the appointment-making process, such as asking the patient to write down the details of the appointment themselves rather than simply receiving an appointment card. Sleek

Picture by Michael Coghlan

The country needs general practice to be the provider of choice

Ever since I came to Australia as a foreign graduate I have been obliged to work in a so-called ‘area of need’. Directly opposite one practice in such a location, there is a large shopping centre. I sometimes go across the road to get my lunch. I noticed several very busy outlets full to the brim with customers. Here is a price list of some of what they offer:

  1. Reflexology Foot care (20 mins) $40
  2. Deep tissue and relaxation oil massage 30 mins: $50
  3. Headache treatment (30 mins) $30
  4. Sciatica relief $45

The practice across the road is a ‘bulk billing practice’ (i.e. they do not charge more than the government subsidy). The practice feels that people ‘can’t afford to pay’. I often see the same people queueing up for the treatments mentioned above. Today ( Sunday 26th February) there is a full page add in local newspaper headed:

Hope has arrived for men over 40 with low testosterone. Now, as part of our national health drive , a limited number of Australian Men can get free assessment before 5/03/17.

A box on the page asks:

Do these symptoms sound familiar?

  • Sleep problems
  • Increased need for sleep/ feeling tired
  • Physical exhaustion /lacking vitality
  • Deceased muscular strength
  • Irritability
  • Nervousness
  • Depressive symptoms
  • Raised cholesterol
  • Erectile dysfunction
  • Lowered libido
  • Prostate symptoms

The advertisement claimed that:

Studies show that only 10% of men are receiving treatment for low testosterone.

Citing as evidence one academic paper. The other citations are to reports on a news channel. The conclusions of the academic paper are based on a survey of 2165 men attending a primary care clinic in the United States regardless of the reason for attendance. Hypogonadism was defined as follows:

Given the lack of a widely accepted single threshold value of TT to define hypogonadism, <300 ng/dl, which has been used in clinical studies of hypogonadal men, seemed a reasonable choice. (Mulligan et al)

On this basis man with testosterone, levels below 300ng/dl were classified as hypogonadal and their symptoms were attributed to that condition. The team concluded:

The difference in the occurrence of four of the six common symptoms of hypogonadism (decrease in ability to perform sexually, decrease in sexual desire or libido, physical exhaustion or lacking vitality, and decline in general feeling of well-being) was greater in hypogonadal vs. eugonadal patients (p < 0.05).

None of the men were examined for other causes of their symptoms or problems. And on the basis of this research, a clinic operating in Australia is marketing therapy that:

….stimulates natural testosterone production

There is no mention of the cost of this treatment anywhere on the advertisement. The only protection that we offer people in the face of this very questionable marketing are the services of a trained general practitioner able to help people navigate this minefield of nonsense designed to part people from their hard-earned money. However, we need to create an experience that competes effectively with the powerful commercial offerings that are triggering people to spend their money so that they are then considered ‘unable to afford to pay’ for better advice.

Picture by Angie Muldowney

The first thing people see is an ugly great barrier

For effective engagement with their quarry, the service provider has to be open. When the first point of contact with that person is a tall desk it sends the wrong message. The reception counter says:

  • You are on that side, we are on this side.
  • We are hiding things from you back here.
  • You are here to ‘get something’ from us, we’re not sure we want you here just now.
  • We are very busy and your needs are one of many things we have to cope with today.

There are many aspects to designing the ‘ideal’ reception counter but first, consider the reason for having one in the first place:

What kind of impression should it make? Should it be warm and inviting, or bold and austere? What kind of reaction do you want to create in the visitor? Is it purely functional or a real ‘statement piece’ aimed at dominating the whole area? Jo Blood

For many practices, it seems that the counter is designed to process a queue much the same as the counter at an airport check-in or a vehicle licensing office. It speaks to what we think of our visitor:

Who will be using it from the visitor side? Will it be treated with respect by all who come into contact with it, or must it be able to withstand some abuse? Maybe a tough, metallic finish plinth would help to prolong the counter’s working life. Jo Blood

When you arrive you must:

  • Check in.
  • Prove that you are entitled to be there ( i.e. you have an appointment)
  • Prove that you can pay or that someone will pay or make a payment.
  • State your business clearly and briefly.

The counter hides PCs, printers, fax machines, security equipment. It’s there to keep people from abusing staff and to keep people out. To complete the ‘look’ the walls may be covered in mismatching posters and the counter stocked with leaflets dispenser full to the brim. Who reads this stuff? There is limited evidence that such communication has any impact. There are suggestions from the retail industry that less is more.

As for the counter, it is generally as tall as it can be.

An able-bodied visitor with a typical minimum height of 1540mm approaching a raised counter tall enough to hide a large monitor on a desktop height of 740mm, would clearly struggle to make eye contact with a seated receptionist. As a rough guide, a counter height of over 1200mm will create a potential ‘blind spot’ resulting in the visitor remaining almost unseen and making the counter simply too high to be practical for signing in.

But what if the reception counter were removed altogether? It’s not unthinkable if hotel chains are beginning to consider it:

Two bloggers walk into a hotel …No, that’s not the opening line to a joke. We’re talking about two travelers who picked the same hotel chain — Andaz, a boutique Hyatt property. One stayed at a Los Angeles Andaz, the other at a New York City Andaz. Neither lobby contained a front desk — a budding hospitality-industry trend that’s equal parts chic and shrewd. Bill Briggs

But of course, doctors clinics are not hotels or airport terminals. But that’s not to say that clinics should not be welcoming, comfortable and inspiring places to be. This issue received some attention in the medical literature last year- with the authors of the paper were cited as concluding:

96 percent of patient complaints are related to customer service, while only 4 percent are about the quality of clinical care or misdiagnoses. Kelly Gooch

There are umpteen ‘reasons’ why it is so. Primarily the process of dealing with payments. However such administrative tasks are also a part of many other industries and they are striving for better solutions rather than risk their customers take their business elsewhere.

The critique of the paper quoted above included an insightful comment from a ‘front of house’ staff member:

Our role has developed from “just scheduling staff” to a more complex, and crucial, role for any healthcare organization. We are the start and end of every patient visit and also the start of the revenue cycle. In order for “customer service” to improve, an organization first recognize the importance of their Patient Access department and understand that their processes are directly related to the culture of the organization. Kelly Gooch

Is it possible that people who perceive that their visits are welcomed are more likely to take the advice on offer? Isn’t that what healthcare is about? We have had evidence for this for decades. This quote from the literature says it all:

…the feeling in the practice when you arrive, busy…exhausted receptionists, people fed up, waiting , a feeling of delapidation and stress…You can hear people being put off on the phone and you can hear ‘no no I can’t put you through to the doctor now’, ‘no no you’ll have to call back’ and that makes you feel worse because you don’t want to call back at an inappropriate time. Gavin  J Andrews

The reception area engenders the circumstances in which the outcomes of care are compromised. There is a better way and at least one Australian practice has redesigned the experience.

Picture by Barnacles budget accommodation

Some things in medicine need to be modernised

Many of our experiences in life have changed beyond recognition. Shopping for example- you can now choose whatever you want and have those goods delivered to your door. When you shop in person you can check out your own purchases and find out the nutritional value of the food you buy by scanning the barcodes on the packets using your phone. You need never visit a book shop or a library ever again and you can get all the music and films you might ever want delivered to your living room. You can even hear what other people think of these things before you buy.

You can hail a taxi, book a flight and find accommodation where ever you are going on holiday without getting off your couch.  You can draft a review of that taxi or accommodation as well as discover what others have thought of the same good or service. With minimum effort you can change the way these things flow into your life so radically that your grandma would hardly recognize it as ‘shopping’. You need never do to a post office again and you can even pay your taxes on line. While the way these things are brought into our lives have changed, we are still buying food, reading books, travelling and watching films as we did decades ago.

Similarly you make an appointment with a doctor from the comfort of your chair. You can even have a video consultation. In some places you can have the order for your medicines delivered to a pharmacist so that you pick it up on the way home or have it delivered to where ever you happen to be. For some conditions you can choose to see someone other than your doctor. Some supermarkets now stock some of the medicines that were only prescribed by doctors. However that experience is not the same as visiting a doctor face to face. That experience is a watered down version of what was available to your grandma. Your grandma’s doctor met her in person, he or she touched her and knew about her life. He might even have visited her at home. In many ways your grandma had it much better than you do even though she had to get herself across town to the clinic. It was even called the drug doctor and it was as potent as anything that has ever been distilled in a lab.

On the other hand the experience when you see a doctor in person is the same as it was decades ago. You still ‘take a ticket’ and wait with everyone else.  The receptionist still treats you like a number.  You still have a very short time with the doctor sitting in the big chair, in the same busy office surrounded by paperwork and dog eared posters. If anything the doctor might even just look at a computer screen throughout your visit. How could the experience be improved? What happens in every other service where you might still need to see someone in person? Your hairdresser, masseuse, your manicurist. How much do you value those experiences? How could seeing a doctor in person be modernized but retain its core value in our lives? How would we convey our gratitude if the experience met with our approval?

Picture by Francisco Osorlo

 

Create your own working conditions or deal with the headaches

It was Friday morning. S/he looked well so I was surprised when s/he said:

I woke up with a headache this morning. I’ve taken paracetamol. I feel a bit better but I couldn’t go to work this morning.

What do you do for a living? I asked. Insert into his /her response:

Teacher/nurse/social worker/call centre operator/forklift driver

Is it busy just now? I asked. Wondering how his/ her boss would take the news of this absence. The smile slipped.

It’s been terrible this year. Lots of demanding (patients/ clients/ kids/shifts).

Then- tears.

I’ve got to hold it together. I’m only six months away from ( holiday/ long service leave/ wedding/ boss leaving)

Is this sustainable? Really?

How much time do you spend on things that are either distractions (not-urgent or important) or someone else’s emergency (urgent /not important)? How much time do you spend on the most valuable quadrant not urgent and important? Why are you always fire fighting (urgent and important) ? Icon made by Ocha from www.flaticon.com

What are you doing during the most productive time of the day? What do you focus on first in the morning? When you are fresh and rested? What are you leaving till later when you should be heading home? Icon made by Freepik from www.flaticon.com

 

It’s your responsibility to set limits to your accessibility. If your boss wants you to do this then s/he doesn’t expect you to do the other.  Are you sure you clarified the situation? YOU have created these unreasonable expectations because the word ‘no’ isn’t in your vocabulary. Icon made by Freepik from www.flaticon.com

 

Finally how much energy, stamina, good will or creativity is left in the tank? There is a limit- even for you. Icon made by Freepik from www.flaticon.com

You are not exempt even if you are a doctor. If you don’t create the life you want then one will be created for you. And it might just give you a headache. You have some thinking to do while you nurse that headache.

Picture by Kulucphr

Spend a few dollars to enhance the experience at your clinic

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Do you associate a smell with your doctor’s clinic? If you do it’s unlikely to be anything pleasant. I remember my GP’s waiting room when I was a child. He consulted, as did most doctors at that time, from his home and the patients waited in his converted garage. It was always cold and smelled-‘damp’. Not a nice place to be when you had a fever or anticipated an injection. The smell evoked the impression of being somewhere like the picture above which apparently is an abandoned hospital near Berlin. Research suggests this is not surprising:

Subjects then rated their memories as to how happy or unhappy the events recalled were at the time they occurred. Subjects in the pleasant odor condition produced a significantly greater percentage of happy memories than did subjects in the unpleasant odor condition. When subjects who did not find the odors at least moderately pleasant or unpleasant were removed from the analysis, more pronounced effects on memory were found. J of personality and social psychology

So the unpleasant memories of being ill and anticipating pain were reinforced by the musty smell of that waiting room.

We all know that smell can affect our feelings, whether it’s a loved one’s favourite perfume or the smell of a pastry in our favourite bakery. Humans are able to recall smells with an impressive 65% accuracy a year after smelling them, compared to just 50% of visuals after only three months, making it all the more important to use this additional sensory tool when trying to engage with customers. Engage Customer

Of all the things we consider about the experience we offer our patients smell is the least of them and yet potentially the most powerful. We carefully pick the colour scheme, the toys and magazines, may be even the floor coverings and the video entertainment but rarely if ever the smell. Perhaps it is because until relatively recently it was thought that humans had a poor sense of smell. However research has debunked that myth:

These results indicate that humans are not poor smellers (a condition technically called microsmats), but rather are relatively good, perhaps even excellent, smellers (macrosmats). This may come as a surprise to many people, though not to those who make their living by their noses, such as oenologists, perfumers, and food scientists. Anyone who has taken part in a wine tasting, or observed professional testing of food flavors or perfumes, knows that the human sense of smell has extraordinary capacities for discrimination. Gordon Shepherd, PLOS Biology

Here’s Engage Customer again:

Scent and sensory marketing have the potential to increase sales, boost brand loyalty, spur brand advocacy and create a strong lasting emotional connection with customers. Customer experience goes far beyond simply what meets the eye, or the ear, so try and create a lasting impression for your customers which appeals to all their senses.

Researchers shown consistently that scent has an important impact on satisfaction but also on the quality of the interactions between people in a public space. This has implications for the value of one of the ‘props’ in your practice i.e. the smell.

whats-it-aboutListen to Fred Lee  vice president at two major medical centers and a cast member at Walt Disney World in Orlando, Florida. He suggests in this TEDx talk that we should be focusing on ‘patient experience’ rather than ‘patient satisfaction’. More than 137,000 people have listened already.

We need to move away from the limitations of ‘patient satisfaction’ which is characterised by the cheesy phrase:

What else can I do for you today?

To patient experience which is all about engaging with the patient in all five senses. Some service providers are already on to this:

Airlines Infuse Planes With Smells To Calm You Down (And Make You Love Them). The Huffington post

Picture by Stefano Corso