Episode 3: Keys to Real Patient Relationships

It all starts with a relationship in which the patient feels comfortable and knows that the doctor cares about them. Dr. Craig Greene, an orthopedic surgeon in Baton Rouge, Louisiana, is a champion of building that relationship from the moment a patient steps into his clinic. Little things build trust and show empathy, and patients can tell when it’s just an act. This week also marks the debut of a new segment called Social Shift, highlighting when healthcare goes right.

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Full Transcript

Announcer: It’s time to think differently about healthcare, but how do we keep up? The days of yesterday’s medicine are long gone and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans. And many of those humans have unbelievable stories to tell.

Here we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together, and here’s some amazing stories along the way. Ready for a breath of fresh air? It’s time for your Paradigm Shift.

Michael: Welcome to the Paradigm Shift of Healthcare and thank you for listening. I’m Michael Roberts with co-hosts Scott Zeitzer, and Jared Johnson. On today’s episode, we’re talking to Dr. Craig Greene, an orthopedic surgeon from Baton Rouge, Louisiana which is just down the road from us in New Orleans. Hi, Dr. Greene, and welcome to the show. Thanks for taking the time.

Dr. Greene: Hello, everyone. Thank you for having me.

Scott: Doc, I have known you for quite some time. I was trying to pin that down. I know that we’ve created your online presence back in 2011 if I’m not mistaken, so it’s gotta be close to like eight years or so if I’m not mistaken.

Dr. Greene: I would say we’ve known each other not too long but not long enough, so I hope the relationship continues. The friendships I value the most are the ones with the lowest maintenance. There’s people that speak in book volumes, there’s people that speak in chapters, people that speak in paragraphs, some in sentences, and some can just go with words and nods. And I find that Scott and Michael and Mudbug [the company behind P3 Inbound], we’re usually on the same wavelength so a word can be very concise at conveying that we’re on the same page.

Scott: Yeah, I feel the same way. We’ve done quite well with each other. And one thing we were working together on trying to get a sense for your practice and we decided that video would be a really good option to just show off, frankly, how nice a guy you are and how open you are with your patients. And I remember that a couple came in and they drove for about an hour to come in and just say how nice you were. Am I remembering that correctly?

Dr. Greene: Yes, sweet couple and we’ve become very close. They’ve had a rough going with orthopedics elsewhere and they found me and, you know, I really view the doctor-patient relationship as just that, it’s a relationship. They’re entrusting me with something that’s very valuable. I don’t take that lightly. And so, you know, one of the things I tell people if they come to me for a surgery I say, “Look, this is kind of our first date, all right? So, we’ll just get to know each other.” Unless they come, “Hey, I’m ready for a hip or knee replacement.” So, we do have this relationship and that’s important because I think trust is so important, especially when you’re going into surgery. But yeah, they came from outside of Opelousas. I can picture them right now.

Dr. Craig Greene from NolaVid

Scott: For people who are not to knowledgeable of the geography of Louisiana, that’s a good ride to come in and just say that, “My surgeon who already completed the work was really good at what they did,” and wanted to talk up the surgeon. And that was what I was leading with, what kind of impact does a real connection with the patient make in terms of overall care?

Dr. Greene: There’s so many ways to connect now but not all of them are meaningful. You know, you’ve heard of social media where I have this many friends. I’ve heard it said before that you can really only have about 150, which is a lot of meaningful relationships at one time. I have a multitude of children and so that tends to max out a lot of the relationships I have.

But I say that to say in the past prior to the media outlets that exist now, it was purely word of mouth and convenience that somebody would go see a doctor. And nowadays, they Google, they do their research, they also talk to their patients. And so they found me, I’m not sure how they found me but I always try to connect whether it was their cousin, their aunt, a Google search so that I can kinda connect the dots with them.

And one other thing I would say about that, and I use this when I lectured some residents about fixing fractures, I tell them about the young couple that got married and come Thanksgiving the wife goes to cook a ham and she puts it in, she cuts the two ends off, puts it in the pot, and puts it in the oven. And the young husband foolishly says, “Why’d you do that?” And she said, “Well, that’s the way my momma did it.” And so they go to the mom’s house later and sure enough, she does the same thing and she said, “Well, that’s the way my momma did it.”

So they went to the grandma’s house and he said, “Look, I just have to ask. Your daughter and your granddaughter both cut the two ends off of a ham, put it in the pot, put it in the oven, and they say they do that because that’s the way you did it. I’m just curious, why did you do it that way?” And the grandma goes, “Oh baby, back then we didn’t have pots big enough.” And I say that because they have different pots and pans now that empower patients to find the doctor that they feel comfortable with, and that’s different media outlets, there’s reporting agencies, there’s still word of mouth but they have a lot more pots and pans right now to explore their options, which I think is good for patients.

Scott: Yeah, then you get the patient to come into the office and this is where I think you’ve got that ability to kinda gain that rapport. So, they’ve done their research online, as you’ve mentioned, whether it’s via reputation marketing or whether it’s done just by doing Google searches, or the old-fashioned friends and family referral. But now they’re in your office. And is gaining the trust of your patients like one of the things that you have in the back of your head as you’re talking to them so that you can help take care of them? Is that part of what you’re doing, or does that just come across naturally?

Dr. Greene: Both. I think patients can tell if it’s just an act or if, you know, the doctor just doesn’t care. In some regards, in my profession, I had my old chemistry professor at LSU. I saw him yesterday and he said his son did not go into orthopedics because, “Y’all are just a bunch of carpenters.” It’s not untrue but if you’re a patient you should want to know that your carpenter cares a lot and can work himself out of a jam.

So, yes and no. But I think that’s also something that either you have or you don’t, and the keyword there, and I learned this thankfully at an early stage, that do you know what the world’s most powerful emotion is? And the answer is empathy. A handful of people I see each day, I listen to them and I hear them out and I put my hand on their shoulder, and I might say, “I don’t know how you do it. That must be so difficult. There’s nothing I can do to help, but I don’t know how you do it.”

And then they still had a good experience. That has to be done where I’m listening. I try to have somebody in the room to where I’m not just looking on the computer or writing on the paper the whole time. I’m asking them deeper questions about, “Where do you work and what is retirement like?” Just trying to get to know them a little bit.

Michael: You know, Dr. Greene, one of the things that I’ve kind of seen happening more online with, you know, patient communities and with some of the different folks involved in healthcare talking about, it’s trying to make empathy more a part of sort of ongoing care making it more, you know, standard operating procedure, whatever phrase you’d wanna use there. Is that something that you see happening among your peers? Is that something you see happening yet in all the local levels or is that still something that we’re just trying to get towards?

Dr. Greene: It’s so competitive. I’m almost like you get the wrong and fastest on the wrong syllable because the test scores have become so important and what’s not in a test score is how empathetic are you. And granted, you still have to have the skill level but you also have the hear you out, listen, and try to connect. So, patients weed those doctors out more than a process weeds them out.

Scott: That’s an interesting point. I know the old school definition of the “great surgeon” was this gruff person that was brilliant in the operating room but, you know, horrible with the patient, terrible bedside manner. And I’ve noticed over the years that I’m seeing less and less of that type of surgeon. And I’m not sure if that’s just a potential outgrowth like just from a competition perspective, if that’s medical schools and residency programs trying to tell their trainees that, “You’ve got to do a better job of connecting with your patients because it’s better for their care.” I think that’s kind of where I’m going on that. I know that comes naturally to you, but it doesn’t come naturally to everybody.

Dr. Greene: If it could just get better every day. And I think about that about myself for physically, spiritually, relationally as a surgeon. Like, how can we get better every day? And I even pull my staff aside and emphasize, “What can we do differently? I mean this entire patient experience reflects on me and I don’t want it to be about me but how long do they wait? Why do they have to fill out forms all the time? Are there new pots and pans for getting you from the parking lot into in front of me? And how can we make that better for the patient?” And look, we’re not there yet, there’s a lot of obstacles to that, but I think there’s also a lot of pots and pans in force that have been used.

Scott: You know, you’re right. So often they talk about… I remember when I first started in this business and I would talk to orthopedic surgeons and the first thing that they would always say to me would be something like, “Man, you’ve got to take a look at how nice the cuts were on this total knee. Look at those chamfer cuts.” And I’d kind of laugh and go, “You know, I’m not sure your patients wanna see a picture of total knee during surgery, I think they’d rather know what’s happening before the surgery, what’s happening after the surgery. That’s the scary part, not when they’re knocked out.”

The difficult part is before and after, and I think you’re right, that team approach is so critical. You have somebody in the room taking care of the EMR/EHR, the Electronic Medical Record, the Electronic Health Record stuff entering all that information and so you could actually look at your patient. “Hey, that’s an extra cost to have another human being in there doing that work.” But the outcome is better for the patient, and overall from a long term, it’s probably a very cost-effective option. But somebody in your practice had to say, “This makes sense, we’re gonna spend the extra money to do this. It’s better for the patient.”

Dr. Greene: It’s interesting where you pick up little things along the way. My mother-in-law went to an internist and I saw her and I said, “How was it?” She goes, “Doctor never even looked at me, he just looked at the computer the whole time.” And I thought, “Okay, you experience through the eyes of the patient.” And so whether that’s a PA or a medical assistant, it’s essentially a scribe but that can tell the story. And telling the story is important because the story is to me, to my staff, to a jury, to another doctor. That’s important as well. But you’re right, I think people appreciate the fact that, “All right, this doctor’s not doing anything else. He’s listening and actively listening,” you know?

Scott: I agree. You know, when a patient is sick they’re nervous. This is very important. This is not going in to buy a cup of coffee, they’re sick and they need…with orthopedic surgeons as silly as it sounds like you said carpentry but, they’re in need of repair, you know, they’re in pain. And if you’re sitting there typing tons of stuff into a medical record instead of listening to why they’re in pain and how you can help them, it’s gotta be frustrating from a patient’s perspective.

Dr. Greene: I learned early in anecdotes and stories that led to this. And one of them is a good friend of mine is a guy named Alan Levine and Alan, he was Jeb Bush’s Secretary of Health & Hospitals when Jeb was the governor of Florida for eight years. Alan was a good friend and still is. And he said, “Jeb Bush was amazing. He gave everybody his saw his email address, jeb@jeb.org and you could email and he would email you back. He said, “We found out that hospitals were down and had eight hurricanes that came across Florida while he was governor, and they would find out about it from somebody emailing Jeb Bush.”

And I said, “I don’t really believe you.” So I emailed him, “Mr. Bush, my name’s Craig Greene, I’m friends with Alan Levine. He said you always respond to emails.” I go to the hospital 5:30 the next morning and I had an email from Jeb Bush at 3:43 in the morning. And he said, “Yes, I do. Please, tell Alan I said hello. Let me know if I can help you with anything.” Now, either he has a really good staff member who does that for him or he did it, but sure enough, like, at 9:00 that morning I was in surgery and I needed to get in touch with my staff.

So, I called the direct line, nobody answered. I called the main line, I got listen to music, press a number, got put on hold, got transferred to PA area, got put on hold again, and then got answered to the same voice mail I just… And I thought, “That’s me calling my staff.” They were probably busy doing something. But what if you’re a patient calling saying, “I have drainage from my wound,” or, “I’m out of medication.”? I would have given every patient my email address. And it’s a little bit of a risk because, man, they’re gonna… And guess what? They just wanted to know that they could get in touch with me if they needed to. Most of them were like, “I didn’t wanna bother you.”

But when they would reach out to me and I had a disclaimer at the bottom that my lawyer helped me come up with because they were contacting me. When I responded I would just copy my staff. It was usually either, “Come in tomorrow. Yes/no, or come in tomorrow.” And they could send me data. I would have information and it cut down on the number of phone calls I’d had to call at the end of the day and oftentimes it would be, “Hey, you took care of me. My son hurt his knee at football practice. Can we see you tomorrow morning?” I would respond including my secretary, “Yes.” It’s done. I said pot and pan and it also gives patient assurance that, “If I really need him, he’ll check it.”

Michael: Yeah. Dr. Greene, you talk a lot about some of these different…I love this pots and pans way of referring to it all. And so, you know, Jared has been…he was just recently speaking at healthcare conferences talking about this from a marketing standpoint as well. Jared, I know you had some questions around this sort of pots and pans approach of about just sort of that mix of new patients as they’re coming in.

Jared: Yeah. Thanks, Michael. And you’re right. Dr. Greene, first and foremost, thank you for your approach to patient relationships because I get in touch with a lot of these empowered patient communities and I hear, you know, the types of things they’re asking their providers or their primary care physicians to do actually create that relationship and treat them as a human being and the word “empathy” that just rolled off your lips, I mean that is very refreshing so first and foremost wanted to thank you for that.

But as Michael said, there are a lot of things about just how relationships with patients begin, and a lot of it has to do with as we are searching for a provider to provide care. So, I was curious from your standpoint and your experience, I was curious as how often you’re seeing referrals from family and friends versus seeing people that you have no pre-existing connection with, and then how you approach each group whether it’s the same way or differently.

Dr. Greene: Well, that’s a good question. You know, the same mentor that told me that about nice guy, good hands. We were walking down the hall to surgery from clinic one day. This is one of my training. And another doctor of some sort, an anesthesiologist or somebody else stopped him and said, “Hey, my knee hurts.” And Dr. Hamilton instead of saying, “Just call my office,” he stopped and listened for 5 or 10 minutes and then he said, “Hey, I think this is what you have but come see me.”

And we’re walking away and he said, “You know, Craig, if somebody in the medical field asks you to take care of them or their family, that’s the highest honor because they know all the possibilities of all of them they’ve worked with and they pick you.” That really stuck too. And I also think about patients that refer their family, that “Hey, I trust this person so go see them.” And I see a lot of patients that don’t actually need me and at first, I was like, “Well, this is a waste of their time and my time,” but really they just wanted my opinion. “Hey, you need to ask your surgeon.” “Well, who do you recommend?”

And so I value that they trust my opinion on whether it’s something I do or I send them. And so what I like to do is make the connection of… So, the staff usually helps or they put it on a form, “How did you end up here today?” “Oh, he took care of my uncle,” or, “So and so sent me,” or, “I found him on the internet.” And so when I walk in the room if I took their cousin Stephanie, I’ll say, “How’s Stephanie?” That connection while I’m with them. A couple of things I try to do to enhance the patient relationship that really the patient…

I’ve heard a saying before that bad doctors make 2 minutes seem like 2 and good doctors make 2 minutes seem like 10. And so I kinda engineered the wrong word but often as to where I sit on the other side, like, my patient is between me and the exit and I have a chair, a rolling…so I sit in a relaxed position and I listen. And then I examine and then I tell them what I think. We get to the bottom of it, and then they always leave having my email and then I always ask them, “Do you have any more questions?” Because I read once that doctors…reasons either feel rushed or condescended upon.

So, it’s even to the point where if they’re on the exam table, I’m sitting…they’re above me, I’m not talking down to them, I’m listening out in front of them. So, I really want them to feel like they have the power. And more and more we can get into this. I think the future’s gonna be data and I think if patients have their own data, then they have the power. And really, I want them to feel like they’re in control and not me saying, “Yep, you don’t need me. This is what we’re gonna do for this review.”

Scott: Well, I think when you’ve got a good sense of who you are, you feel more comfortable allowing the patient to feel more empowered with information, with data, etc. I think you mentioned that. And I remember you saying this to me before when we did the video with you about how you have a set…how you set yourself up for success. “I sit lower than the patient, I look at the patient, I actively engage and listen to the patient.” I think these are just good ways to set yourself up for success.

Michael: Doc, along the lines of, like, around patent expectations, do you think that those expectations are changing over the years or does it seem to kind of have the same through-line as when you started?

Dr. Greene: I think they’re changing. I think they’re separating somewhat from reality. In my communication with patients, the sum of it is what’s the most precise way I can convey that or communicate that? So, in emphasis, precision and empathy.

Social Shift

Jared: Hi, I’m Jared Johnson and this is your Social Shift. This is where we focus on the things that are going right in healthcare. We talk about recent changes in developments and news articles that we’ve seen and read and heard about things that are making healthcare a better place for you and me.

And with this Social Shift I wanna give a big shout out to Benzer Pharmacy, which is an independent pharmacy chain in many states throughout the country, and they had a recent announcement that I just wanted to share and kinda give them a congrats for on behalf of all of us, because Benzer Pharmacy just announced that they’re partnering with Uber Health to offer their patients free transportation to their pharmacies from their home or hospital, so in my mind, that doesn’t only help patients who currently have a means of transportation, it also will improve patient medication adherence.

It will help just make more patients overall stick to their meds a little bit better and I just wanted to give a quick shout out. I saw that come through recently and I thought, “Man, that’s really cool.” This isn’t the first time that a healthcare organization has partnered with Uber Health. There are other transportation partnerships happening. I know right here in my backyard in Phoenix, Arizona, Banner Health, they have a partnership with Lyft. They’ve been doing that for at least a year now and so this isn’t the first time it’s going on but it’s pretty cool to hear that it’s happening with pharmacy chains as well.

And I just wanted to give that a big shout out because I think this is just the beginning. I think there’s going to be a lot of opportunities and a lot of attempts and progress made to make healthcare come closer to us and not have to go find it ourselves. And so that was just a really cool news article that I saw when it came through and I thought, “You know what? I ought to give them a shout out in Social Shift.” So, there you go, ladies and gentlemen. That’s your Social Shift for this time. Tune in, in the future where we’ll be offering more highlights of just cool news items that are happening about healthcare going right.

Conclusion to Interview with Dr. Greene

Michael: This has been great. Thank you so, so much for your time. I really appreciate you coming on and giving us a glimpse into your practice. The video recording that Scott talked about, you know, I had a chance to be there and to meet with these couples and to talk about some of the patients. Even when you were off in another room, just how glowingly they spoke of you and how much they appreciated all these things that you’re talking about, the attention, hearing them, actually listening to them and hearing their pain, so it’s clearing making a difference. It’s clearly making a difference not only in the relationship but also in the outcome themselves so, doc, we just really appreciate it.

Dr. Greene: Well, I appreciate you having me. And if I could tell patients one thing, find a doctor you’re comfortable with because the journey of life can be very difficult, and then that’s gonna make that difficult journey better for you.

Michael: Definitely. Definitely. Well, guys, thank you for joining us today. Paradigm Shift of Healthcare is brought to you by P3 inbound. You can find our full archive of episodes at paradigmshift.health and recommend a guest or topic on Twitter @p3Inbound. Thanks.

Announcer: Thanks again for tuning into the Paradigm Shift of Healthcare. This program is brought to you by P3 Inbound, Marketing for Ortho, Spine, and Neuro Practices. Subscribe on iTunes, Google Play, or anywhere you listen to podcasts.

Dr. Greene quote from episode 3

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