Compliance is acting according to someone’s rules, commands, or recommendations. Urologists are effective when they help patients make the right choices at the right times and for the right reason. Patient compliance is crucial for enhancing patient outcomes. The art of motivation is an essential component of the art of medicine. However, in the current atmosphere of the necessity of seeing more patients every day, it is not uncommon for a busy urologist to recommend a procedure or prescribe a medication and find that the patient does not comply with our advice. Suppose the patient disagrees or doesn’t follow our advice. In that case, we might assume a take-it-or-leave-it attitude, eroding the urologist-patient relationship. As urologists, we often need more support when dealing with nonadherent or noncompliant patients. Noncompliance costs the bloated $4 trillion health care budget over $100 billion annually.

Please don’t confuse motivation with manipulation. These are polar opposites, as only motivation gets someone to do what is best for the patient. Manipulation often involves self-serving purposes and is only in the best interest of the urologist.

Suggestions for Improving Compliance

1. 1. Listen to your patients. As urologists, we strongly desire to impart information to our patients. However, listening does not come easy. The average doctor interrupts patients after 16 seconds when asked about their medical problems.¹ It is no wonder that trust, bonding, and compliance are thwarted when our listening skills are so deficient. Hear their words and hear their emotions. If you reflect on the patient through paraphrases, you will improve the communication and the impression of credibility and trustworthiness.
   2. Slow down. Effective communication requires speaking slowly and using emphatic phrases such as “I understand your concern about having a surgical procedure” or “I know this might be a financial burden, but I am sure we can work out a plan that will make you comfortable.”
   3. Use nonmedical verbiage. Explain medical issues to patients as if you were speaking to your grandmother. Use power phrases such as “it’s important” or “critical.”
   4. Show or draw pictures. Visual images can improve the patient’s recall of your discussion. If you are having an incontinence discussion, use an inflated balloon to represent the bladder; the balloon’s stem is equivalent to the urethra, and your index finger and thumb compressing the stem is the sphincter mechanism. There are also wallboards that can be placed in each exam room that allow you to draw and explain various urologic conditions (Figures 1 and 2).

Figure 1. Wallboard used to explain urologic conditions.

1. Limit the amount of information and repeat it for reinforcement. Information is remembered when given in small doses. Repetition further enhances recall.
2. Employ teach-back techniques. You want to confirm that the patient understands your message by asking them to repeat your advice or instructions.
3. Offer written instructions on the urologic condition and proposed treatment. Offer the patient a list of credible websites that they can use for more information.
4. Educate and train your staff to answer questions that might be brought up when the staff is on the phone with the patients.
5. Consider staff follow-up. With important decisions that need to be made, have a staff member call the patient to confirm their adherence to your action plan.

Bottom Line: Patients are nervous and anxious when eyeball-to-eyeball with the urologist. With good communication skills by the urologist and the staff, there will be greater understanding and compliance with your advice and their follow-through after they leave the office.

Fill Your Schedule: Using Recall Lists to Increase Production

Unfortunately, the last few years have seen an erosion of urologists’ income-reimbursements decreasing and overhead increasing. We cannot significantly impact reimbursements. However, we can fill our schedules with new patients and increase the number of existing patients returning to our practices.

The most valuable patient in your practice is your existing patient. These patients already have a relationship with you and have confidence in your knowledge and skills. These patients recommend you to their friends and family; they leave positive online reviews and readily come to you without solicitation when they need urologic care.

Figure 2. Wallboard used to explain vasectomy.

Many urologic practices spend time and money to attract new patients but need to pay more attention to their existing patients to fill their schedules and add to their bottom line.

You can track whether your existing patients followed up at the correct time intervals by (1) having follow-up guidelines, and (2) having a delegated recall coordinator.

You should establish guidelines for the follow-up intervals of specific patient populations. The Table shows the example that was used in my practice.

Next, delegate someone as a recall list coordinator. You might assign this position to a physician assistant, nurse practitioner, medical assistant, or receptionist. Consider creating a recall list monthly. The recall list consists of 3 categories:

1. A patient is already seen within the follow-up guidelines
2. A patient has an appointment already scheduled
3. A patient who needs an appointment for follow-up

Patients in categories 1 and 2 do not need to be called as they are within the guidelines. Those in category 3 are contacted to schedule an appointment.

To take this further, track the recall appointment rate by determining how many patients in category 3 made appointments.

Working on the recall list is a task that is frequently assigned to a staff member on days when I am in surgery, out of the office on vacation, or attending a meeting.

Bottom Line: Recall lists are an effective tool to fill your schedule and maximize your productivity by using your existing patient database. Remember, every time you call a patient, it jogs their memories that you are still there and care about their urologic condition. Patients are impressed that you are paying attention to their follow-up needs and will feel reassured that they are in good hands under your care. Thus, a recall list is a win-win for the urologist-patient relationship.