Who's more important: the patient on the
phone or the one at the front desk?
Adam Clarin, OD (background), asks
Candace Rodriguez at the front desk to be
attentive to each.
The first impression a patient has of your practice is not of you, but of your front desk staff. If the patient gets a negative impression from the person behind the desk, it impacts the patient’s overall opinion of your office and can even affect your business.

Knowing some of the most common mistakes that staff can make and how to remedy them can help ensure that your practice is seen in the best possible light. “These mistakes consist of those incorrect, impolite or improper actions that make us all cringe,” says Brett Paepke, OD, of FirstView Eye Care in Plattsburgh, NY. “Reciting credit card numbers out loud for all to hear, telephone rudeness and gossiping about patients” are just a few examples of behavior that’s unprofessional and unacceptable, he adds.

Here are the seven deadly sins of front desk staff, and what can be done to change them.

1. Telephone Rudeness

Problem. Opinions vary on phone etiquette. Some say that a business should always answer the phone by the third ring. Others say that patients who are standing at the front desk in person should take precedence over patients who are calling on the phone.

No matter how a business owner chooses to have their staff prioritize and balance patients in person and on the phone, each patient should receive the staff’s polite, undivided attention whenever possible.

Adam Clarin, OD, of Clarin Eye Care in Palmetto Bay, Fla., says that one thing that always irks him is when “the phone rings while the front desk is having a conversation with each other or another patient as they pick up the phone and they finish their last sentence before saying hi to the person calling so that person [on the phone] gets to hear the end of a conversation before they are greeted.”

Dr. Clarin says that he thinks that this is “totally unprofessional and doesn’t show the caller that we’re attentive or interested in them, and that might be their first impression of the office.”

Solution. Train your staff on how you prefer phone calls to be handled and have them “stick to the script” whenever possible. Create guidelines for answering the phone, the greeting each patient should be given, and a format for how you think patients on the phone and in person should be juggled. Obviously, there are times when exceptions will be made, but having steps will help to steer phone conversation behavior in the direction that you think is correct and best for your business.

2. Personal Cell Phone Use

Problem. Since cell phones have evolved into smart phones with enhanced perks such as mobile email, web, social media and texting, their popularity and the frequency with which people use them has increased tremendously. It seems that the new social norm is for people to check their cell phones repeatedly throughout the day; however, should this include the workday?

Distractions from cell phones and smartphones could lead to errors in data entry, incorrect recording of information, inattentive customer care and an overall air of impoliteness. If the wrong thing is said or data is entered incorrectly, it puts the practice at risk for certain liability issues.

Solution. Consider limiting or banning the use of cell phones at the front desk, and recommend that employees check their phones only during lunch or while on break. Reassure employees that the office phone number may be given as an emergency contact number to schools, relatives and the workplaces of relatives so that if someone urgently needed to speak with them, they would be able to reach them via the office’s landline.

If you do choose to allow the discreet use of cell phones at the front desk, make sure your employees have them silenced so that the gadget does not beep, ring or vibrate when calls and messages are received.

3. Using Work Computers for Leisure

Problem. Using work computers for personal use not only causes a distraction and takes time away from other job responsibilities that need tending, it could pose a risk if a virus is mistakenly downloaded or if indecent material is associated with the computer’s IP address. It also may look unprofessional to patients who happen to see or hear someone using the computer for leisure, and suggests that the employee is not attentive to their job and is indifferent to patients.

Solution. Establish your own office policy about computer use for personal reasons. If you decide to allow employees to use work computers for leisure, make sure they are not abusing that privilege by using it when patients are present or when there is other work that needs to be done. So, instead of viewing the latest YouTube video that has gone viral, employees should be focused on the to-do list of secondary responsibilities that will help the office run more efficiently. Examples: purging old files, calling patients who haven’t picked up materials, cleaning/dusting the office or rearranging the optical frame boards.

4. HIPAA Violation

Problem. The definition of a HIPAA violation is “the disclosure of personal or identifiable patient information to a non-privileged or non-authorized source––regardless of whether it is intentional, accidental or otherwise,” according to Pamela Miller, OD, JD, an attorney and private practice owner in Highland, Calif.

The consequences are serious. Significant fines can be incurred “as well as potential litigation by the patient if the patient suffers injury or harm as a result of negligence by the doctor or staff under the theory of respondeat superior,” Dr. Miller says. Respondeat superior is a legal doctrine that means an employer can be held accountable for the actions of their employees during the course of their employment.

“Potentially, the patient could also sue for defamation if the case could be made, loss of employment or punitive damages depending on what information was released,” Dr. Miller says. She also adds that the reputation of the practice and the doctor can be harmed if the patient posts about the privacy-violating incident on social media, shares it with the newspaper or verbally with third parties.

Solution. If fines are incurred due to a HIPAA violation, “the doctor might be able to come to an agreement because the fines are per violation. Generally, fines are not based on an innocent error but rather on the severity and the frequency of the violations,” Dr. Miller says. Also, “if the doctor has changed the policy prior to the issuance of the fine, it can be presented as evidence of correction,” she adds.

As with many blunders, the best solution is to prevent the mistake from even happening in the first place. Take steps to make sure that your staff is taking HIPAA seriously. Dr. Miller says that practice owners “need to make certain that the staff is appropriately educated [on the HIPAA law], that the policy manual is current and that the doctor is running an ongoing spot check throughout the office” to ensure HIPAA compliance.

“Staying on top of privacy is a never-ending task,” says Dr. Miller, “and if and when anything is amiss, the doctor or the manager needs to rectify it immediately, note it, follow up and then reassess [to make sure] that the corrections or changes are ongoing, effective and reinforced constantly.”

5. Gossip/Negative Words

Problem. A patient comes into the office and does or says something that is impolite, inappropriate or downright rude. A stone has been cast into the calm of your staff’s workday. Will they let that the incident cause a flustering ripple effect, or will they stay cool and keep everything copacetic? It can be tough to remain firm yet polite when a patient is giving staff a hard time for whatever reason. However, staff members need to know how to recognize a disruptive situation, to remain calm and respectful, and to choose the best way to defuse it.

Solution. Patients are people. They have bad days and, for all you know, they may be having the worst day ever. Try to give patients the benefit of the doubt. Remain calm, don’t raise your voice and keep your tone professional. Maintain good eye contact and listen to what the person is saying. If a patient feels like she or he is not being heard during a complaint, the situation can escalate or continue on and on.

If there’s no reasonable way to resolve the problem immediately, tell the patient you’d like to give the problem further consideration and time, which you’re unable to do at the moment, and then take down their contact information. A resolution to the situation may be more obtainable once both parties have had a chance to cool down and think more rationally. If the person refuses to “let it go” and a staff member feels attacked or threatened, it is best for the staff member to calmly walk away from the situation and have another staff person take over, again suggesting that the person be contacted at a later time by the office manager or the owner of the practice.

Obviously, front desk staff should know to not engage in hostile exchanges with patients, but it is equally important for staff to understand that they should not talk about the situation at the front desk after the person has left. Other patients in the waiting room or the optical up front may be within earshot—even if the patient was inappropriate and rude, you don’t want any patients thinking that they might also be talked about when they leave the office. If something needs to be discussed about a patient and the staff member needs to report it to the office manager, it should be discussed and documented behind closed doors in another room and away from the front desk.

6. Improper Insurance Charging/Billing

Problem. In an ideal world, patients would walk into an optometric office with a working understanding of their insurance coverage and the staff would be proficient in matching chief complaints and diagnosis codes to determine whether it was appropriate to bill under the patient’s vision or medical insurance. However, this doesn’t always happen.

“In many optometric offices, the front desk staff themselves don’t understand the difference between these plans, and therefore can’t help a patient to understand how to apply them to their visit, which results in a frustrated patient, a frustrated front desk and in turn, a frustrated doctor,” says Carrie Kislin, OD, of Associates in Eyecare in Springfield, NJ.

Solution. To avoid errors in billing, at least one person in the office—whether it be the office manager, head of the front desk staff or the doctor—should understand all of the different insurance plans that the office accepts and how they work, Dr. Kislin says. “Once this person is established and trained via Internet research and calling the individual companies to verify their level of understanding, they can then train the staff.”

She also suggests having a binder at the front desk that contains information on each insurance plan, including the office’s login and password needed to access each plan’s website. Front desk staff should be reminded that in order to bill medical insurances, a chief complaint and diagnosis must be provided. It is also best to avoid surprises in billing whenever possible, so some doctors prefer to give patients a rough estimate of charges they might incur and have to pay out-of-pocket after looking at their insurance allowance at check in.

It is helpful to have the front desk staff explain the patient’s copay for an exam, the out-of-pocket for a contact lens exam, and then how much their allowance may cover toward that exam and any materials they may order before they see the doctor,” Dr. Kislin says. This will help the examination and the front desk check-out to flow more smoothly, and the patient will feel like the office staff is knowledgeable, making their experience more enjoyable.

7. Front Desk Presentation

Problem. Although optometric offices are not hospitals, patients have certain expectations for the environment in which they see their health care provider. For example, a messy or cluttered front desk may give the impression that the office is run inefficiently. Also, some patients have allergies or chemical sensitivities to dust, pets, smoke or perfume. Strong smells on the clothes of the employees or at the front desk such as fast food might be offensive to a small segment of the population. Some patients may also see food and drink consumption at the front desk as out of place, unsanitary or impolite.

Solution. Desks should be well organized and clutter should be kept to a minimum. Staff should be dressed appropriately and professionally and ideally they should be as “scent-free” as possible. Eating at the front desk should also be discouraged, unless the staff member is unable to leave the front desk to take a break or eat elsewhere. Drinks should have lids or caps on them and should be kept in an area where they won’t get bumped or spilled.

By keeping the front desk and its staff as clean and neat as possible, the patients and staff members will see the office environment as more pleasant and professional. Take the first step in successfully building a loyal patient base by making a good first impression with a stellar front desk staff. By giving staff explicit guidelines and clearly stating expectations for front desk staff behavior, you can keep your office running smooth and help to ensure that patients and staff alike will enjoy the time they spend there and look forward to coming back.