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AAOS Now

Published 5/1/2009
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John R. Tongue, MD; Lewis Jenkins; Angie Wade

Low-touch surgeons in a high-touch world

Ten years later—Study reveals what patients think of you

In 1998, the AAOS researched the image of orthopaedists in a groundbreaking baseline study. It surveyed the opinions of 700 member surgeons and included 800 telephone interviews with the public. The results were both surprising and revealing.

The survey showed, for example, that orthopaedic surgeons believed they had both high technical skills (tech) and high interpersonal skills (touch). The public, however, viewed orthopaedists as high-tech, low-touch. Other differences between the way fellows viewed themselves and the way the public viewed orthopaedic surgeons were also identified.

As a result of that survey, the AAOS established a public relations department, instituted a far-reaching public service campaign, developed a series of communication skills workshops, and reached out to print and broadcast media to ensure that orthopaedic surgeons were quoted on issues relating to musculoskeletal health.

Fast forward a decade. In 2008, the AAOS conducted a similar survey to measure any changes in member and public views, particularly regarding the following three facets of an orthopaedic surgeon’s image:

  • The image orthopaedic surgeons wish to project
  • The image they have of themselves and their peers
  • The image of orthopaedic surgeons held by the public

Ideally, these three facets are consistent and compatible with each other. The 2008 Image Tracking Study found much closer alignment between surgeons and their patients than in 1998. Still, orthopaedic surgeons have a lot to learn about succeeding in a high-touch world.

What image do you want to project?
Meet Dr. Amalgam, a 53-year-old orthopaedic surgeon and a partner in a mid-sized orthopaedic practice in a metropolitan area. His model of clinical care is simple: “find the problem and fix it.” During new patient visits, Dr. Amalgam enters the examination room, briefly greets the patient, then begins an efficient sequence of questions to establish a medical history.

Although his practice is reasonably busy, it is not expanding. He’s confident that his knowledge, experience, and past patient outcomes will help his practice weather the current economic turmoil. But he does wonder, “Is there something else I can do to enhance my status in the practice and the stature of the practice in the community?”

Actually, there is. Dr. Amalgam can reconsider the image he pro­jects as an orthopaedic surgeon. The Academy’s research clearly identified the important characteristics that appeal most to orthopaedic surgeons and the public alike. Each group has a clearly targeted wish list that includes seven overlapping areas.

Both groups expect orthopaedists to 1) be highly trained, 2) deliver successful results, and 3) do so in a cost-effective manner. Both groups also highly value interpersonal communication skills, such as 4) careful listening, 5) dem­onstrating caring/compassion, and 6) taking time to answer patient questions. And when it comes to seeing a physician, everyone wants it to be 7) easy to get an appointment.

Most orthopaedic surgeons believe they project these characteristics, but not as strongly as in the past. “Our self-image is an evolving construct,” explains Frank B. Kelly, MD, chair of the AAOS Communications Cabinet. “As a group, we’re constantly barraged and influenced by the news, personal experiences, conversations with our spouse, hospital politics, financial fluctuations, and hearsay—in other words, almost anything that’s going on in our lives and practices.”

What the survey shows
Differences between the self-images of orthopaedic surgeons in 1998 and 2008 are to be expected. Comparing a series of traits used in both research projects,
Table 1 shows that orthopaedic surgeons now have a more modest view of themselves.

Although orthopaedics has trended toward greater specialization for some time, the Image Tracking Study suggests that orthopaedists are concerning themselves with more than just surgery (Table 2). The percentage of fellows who believe their patients see them as providing “comprehensive musculoskeletal care” has increased significantly over the past decade.

Surveyed fellows were asked to rate the performance of orthopaedic surgeons—from a patient’s per­spec­tive—on nine distinct traits (Table 3). Fellows attributed increasing values to technical aspects of care while continuing to believe that the public gives less weight to communication skills (caring/compassion­ate, listening), paralleling the results of the 1998 research.

Although these results show that the orthopaedic specialty is still “high-tech, low-touch,” the disparity is not quite as large in 2008 as it was in 1998—primarily because the public believes that orthopaedic surgeons are doing a better job of meeting both “high-tech” and “high-touch” goals.

How the public sees orthopaedic surgeons
In both studies, what the public wants in healthcare providers remained consistent and essentially unchanged (
Table 4). The rank ordering of important healthcare values and needs essentially remained unchanged over the decade; so these characteristics outline a stable, desirable profile for a care giver.

Although clinical outcomes are vitally important, they are not the only prized performance characteristic. The public also highly values training, interpersonal communications, effectiveness, and access. The interpersonal skills can be learned just like surgical techniques.

As often seen in patient satisfaction surveys, patients may not be able to clearly assess their surgeons’ training or the exact quality of their surgical procedures, but they highly value and are comfortable evaluating a physician’s interpersonal communications skills.

When asked to rank orthopaedists on these performance characteristics in 2008, the public gave them better ratings in every category measured as compared to the 1998 results (Table 5). In the public’s view, orthopaedists are performing better than ever.

Improving your image
Maybe you’re like Dr. Amalgam. You’ve studied and practiced your specialty for decades. You’ve worked hard to reach your current position in your community based on a history of good patient outcomes. Why should you care about something as fleeting as your image—whatever that is?

Your public image is the set of beliefs, ideas, and impressions that your patients have about you; it begins to form as soon as a patient visits your Web site, phones for an appointment, glimpses your building, parks in your lot, enters your reception area, and finally meets and interacts with you.

“The reasons for caring about your image are, at the same time, straightforward and somewhat complicated,” says John R. Tongue, MD, who helped direct the initial research in 1998 and led the 2008 effort as well.

“Your image affects your practice in a number of ways—patients exercise choice when they self-refer or accept the referral advice of their primary care physician. They don’t have to see you; they may choose another musculoskeletal care giver offering alternative treatment options or another surgeon down the hall or across town. Even within your practice, patients may exercise choice by consulting with your colleague instead of you,” says Dr. Tongue.

Your image is yours to manage or ignore. It is a very real part of your practice that can be harnessed to make you and your practice more marketable and competitive. The accompanying article “Image enhancers” has some tips on how the AAOS can help you improve your image.

John R. Tongue, MD, is chair of the AAOS Communications Skills Mentoring Project. He can be reached at jtongue.md@verizon.net

Lewis Jenkins is director of the AAOS marketing department; Angie Wade is the marketing research manager.

Image enhancers
Drs. Tongue and Kelly recommend the following resources to help Dr. Amalgam and other colleagues who are dealing with similar issues. Implementing only one or two can help improve your image—and enhance the public’s perception of orthopaedic surgeons.

Assess your communication skills. “We can all improve our ability to express empathy, demonstrate compassion, and listen to our patients,” said Dr. Tongue. Consider planning an Academy Communication Skills workshop for your practice group or orthopaedic department; contact Charmain Rachal (rachal@aaos.org) to discuss timing.

Measure your patients’ satisfaction. Staff in the Academy’s practice management group can help direct you to resources for measuring patient satisfaction through surveys; contact Steven Fisher (sfisher@aaos.org) or visit the practice management center online at www.aaos.org/pracman

Get your name and story on the Web. Command your very own digital real estate. Create a practice and/or a personal Web site that describes your approach to care. Use the Academy’s collection of templates or develop your own. For assistance, contact Pam Butenshen at orthodoc@aaos.org

Enhance your patient education program with free resources from the Academy’s patient education Web site (www.orthoinfo.org). You’ll find information on more than 400 topics of concern to patients, including many articles in other languages (Spanish, Chinese, Japanese, and Portuguese). You can even edit and personalize the information. Don’t forget to check out the Academy’s Web portals on osteoporosis (www.aaos.org/osteoporosis) and knees (www.saveyourknees.org).

Address your changing patient base. Order the Academy’s free Culturally Competent Challenge CD and Guidebook at www.aaos.org/diversity

Tell your patients and community what you do. “The Academy has an extensive array of free resources to help promote your practice and yourself,” says Dr. Kelly. Choose from toolkits, ready-to-present slide programs, posters, brochures, and more; e-mail publicrelations@aaos.org