The butterfly effect is the idea that small things can produce large impacts, and this can happen even in medical practices. The concept states that a single butterfly flapping its wings on one side of the planet can cause a typhoon on the other side of the planet — that a butterfly flaps its wings in the Caribbean and a tornado or tsunami occurs in Japan. Although this may not generally be the case in climatology or physics, it’s a good example of one small idea causing huge effects. Another example that is closer to home is when, for example, a bat infects a pangolin in Wuhan, China, and the whole world shuts down.(1)
The concept of the butterfly effect is used to illustrate the way that some complex dynamic systems exhibit unpredictable behaviors such that small variances in the initial conditions could have profound and widely divergent effects on the system’s outcomes. Because of the sensitivity of these systems, outcomes are unpredictable. This idea became the basis for a branch of mathematics known as chaos theory, which has been applied in countless scenarios since its introduction.
What are some examples of the butterfly effect in modern healthcare? What small actions can have a profound effect on the patients we care for?
Especially during the COVID-19 pandemic, it became imperative to demonstrate empathy more than ever before. This required us to be open to our patients’ emotions as we asked them how they were feeling and how the pandemic wass affecting their lives and the lives of their family and friends. You can demonstrate empathy by making at least one empathetic statement with each patient. If the patient reveals how difficult their lives have been, you may respond by saying, “I understand how this situation is impacting your life.” If the patient expresses something positive, then remark, “You have been so helpful volunteering to the local food bank and distributing food to those who need a hot meal.” You can also convey your empathy nonverbally by nodding your head in agreement or pause as they are talking to confirm that you are actively listening or offering a gentle smile that indicates approval and active listening. By demonstrating empathy, you add depth and meaning to the encounter; and you build trust, which improves compliance and even outcomes.
Make every effort to create a positive first impression, especially when the patient calls the office to schedule an appointment. The receptionist can start the patient experience by using proper telephone etiquette. The telephone is the first opportunity to create a good first impression. There’s a world of difference between “Doctor’s office. Please hold!” versus “Good morning. Dr. Strangelove’s office. This is Gwendolyn speaking. How may I help you?” The first scenario is likely to turn off the caller, who is thinking that if this is how they handle the initial phone call, how are they going to manage my medical concerns? Also, I recommend that the receptionist smile, as the smile can be heard on the other end of the line. How to motivate the receptionist to smile? Put an inexpensive mirror in front of the phone so that the receptionist can have feedback and actually see her- or himself smile as they speak to the patient.
Prepare the patient for their first appointment. Identify the patient’s purpose for an appointment. Then direct them to the practice website or provide other educational material related to their visit. For example, if a patient calls a urology practice because their primary care provider obtained a PSA test that is elevated, the receptionist should direct the patient to the area of the practice website where there is an article on the interpretation of the PSA test and what follow-up is required. Now the patient is informed on the condition before the visit with the doctor. This educational material allows the patient to understand what is likely to take place at the time of their first encounter with the doctor.
Have the patient provide demographic information and complete a health questionnaire before they come to the office. Patients can clog up the reception area and wreak havoc with your schedule if they arrive for their appointment and take 20 or 30 minutes to complete their paperwork. This can easily be done from your website, and patients should be told that they will be seen on time if the paperwork is completed before they come to the office. If this is not possible, then request that the patient arrives in the office 30 minutes before their appointment, and a staff member can assist the patient in completing the paperwork.
Call patients at home after a procedure or after they have been discharged from the hospital to be certain that all of their questions have been answered. Years ago, I had a dog that had a procedure at the veterinarian’s office and the veterinarian called to check on my dog. What an impression it made when he called to hear about my dog’s progress and to answer any questions I had. I felt that if the vet could do this on behalf of my pet, then I could certainly provide this service for my patients. I decided that from then on I would call all patients who were recently discharged from the hospital or had a procedure in an ambulatory treatment center, and check on their progress, answer any questions they may have, and make certain that they had the necessary medications and that they made a follow-up appointment.
Contact patients via telephone or telemedicine with negative results from lab tests or procedures. If a physician orders a procedure or test and the results are normal or negative, then it is appropriate and appreciated by patients to receive good news via a phone call or a telemedicine visit. Patients don’t really need to come to the office to receive negative results.
Offer a one-stop visit to the doctor. Obtain the blood work before the patient arrives in the office. If you can accomplish more procedures and tests in one visit, you will enhance your efficiency and make your practice user-friendly for your patients. For example, if you are caring for a middle-aged man with an enlarged prostate gland and need a follow-up PSA test and testosterone level, then order the test to be done before the patient comes to the office and have the blood work in his record to discuss with him so that a follow-up phone call or telemedicine visit won’t be necessary.
Never has it been more important for the doctor to be on time for his or her patient. In the past, it was possible for doctors to be late for a patient’s appointment with no consequences for that tardiness. Being chronically late is an imposition on your patients, however, and gives the impression that you find physician time more important than the patient’s time. Chronic delays also impact your staff, because patients may take out their frustration about the doctor’s tardiness on the staff, making the staff anxious and requiring them to cover for the doctor who is frequently late. Running late impacts your efficiency and your productivity. One common explanation for doctors arriving late is the complaint by the physician that the patients aren’t in the exam room at the beginning of the day. The doctor then attempts to “remedy” the situation by arriving 20 to 30 minutes after the first patient is scheduled to be seen. This is a recipe for creating a schedule that starts late and causes the whole day to run behind. If the staff is informed that the doctor will be on time, then the staff recognizes the importance of having the patients in the exam rooms at the start of the day. This process also begins with the receptionist informing patients who are to be seen at the beginning of the day to be on time so that the doctor sees them in a timely fashion. Similarly, telemedicine patients who have a virtual appointment with the doctor expect that the doctor will be on time. It is my opinion that patients will not sit waiting by their computer for their doctors to call. If the doctor is routinely late, the patient may find medical care elsewhere. Of course, there are always going to be patients who must be worked into the schedule and who are told to come to the practice, and this is certain to throw off the practice’s schedule. One solution to this common situation is to introduce the concept of “sacred time.” That means leaving a 15- to 20-minute opening in the schedule during morning or afternoon office hours to accommodate add-ons, urgencies, or emergencies. Do not fill that half hour until the office opens in the morning and the phone has been transferred from the answering service to the office phone. Do not worry about this open time slot. That half hour almost always gets used — if not for seeing patients, then for completing your medical records or returning phone calls.
Bottom Line: The butterfly effect, a concept where small changes make a large impact or effect, certainly applies to medical practices. I have provided a few examples of small changes that can be made in nearly every practice and will create positive dramatic outcomes for your patients.
Reference
Bats, pangolins and humans: COVID-19 virus likely emerged from recombination of viral genes across different species. American Association for the Advancement of Science. May 31, 2020. https://scitechdaily.com/bats-pangolins-and-humans-covid-19-virus-likely-emerged-from-recombination-of-viral-genes-across-different-species/ .