Managing Practice & Patients

Shriyal Sethumadhavan assesses the impact of the last two years on practices and connects with aesthetic practitioners and experts to delve into how they have managed their practice and patients.

Patient and practice management has now become a vital area to ensure a successful medical practice. It involves complex and diverse areas such as communication, knowledge of web and social media, electronic medical records, teledermatology, devices and machines, and more. We reached out to some of our experienced dermatologists to delve into their approach in recent times.

“Managing an aesthetic skin clinic has become interesting and challenging. Owing to increased awareness among people due to social media, patients do have their own demands. In the past six months, post-

COVID, the patient footfall in the clinic has been increasing. The patients have realised that COVID is less severe, and with the third wave being mild, people have become more and more confident to come to the clinic for a procedure.

At the same time, people have also opted for many paramedical treatments or self-medicated buying stuff online resulting into more damaged skin. And treating and counselling these patients is challenging. Patients are now well-versed with the availability of procedures such as chemical peels, lasers, microneedling RF, Dermapen, HIFU for anti-ageing, botulinum toxin, fillers and PRP as anti-ageing treatments.

My clinic is well-equipped with all the facilities, and I ensure that the machines are USFDA approved. Treatments are as per medical guidelines and my team and I at the clinic make every effort possible to satisfy the patient to maximum. We also ensure the use of up-to-date Software and up-to-the-mark in-clinic system to ensure smooth functioning and timely patient management.”

“In the wake of the recent COVID scenario, patients were definitely anxious about walking into the doctor’s clinic for aesthetic concerns. Initially, life was again at its basic best with each one anxious about survival. People with dermatological reasons were nonetheless visiting the clinic. Initially, we doctors were also worried about patients’ health and well-being.

Gradually, with clarity on the virus, we could also focus better on efficiently serving our patients. The focus essentially was on effectively carrying the triage of patients. Avoiding contact in waiting rooms, hygiene, safety, social distancing norms, educating the staff and patients to alleviate the fear, and ensure strict sanitation policies. As we now move into the post-COVID era, the focus on sanitation yet persists since we must not get complacent. Also the focus is on educating staff and patients more and more towards hygiene, sanitation and to ease their fear yet asking them to follow precautions. Also treatments need to be made more affordable for people as certain small businesses and sectors have also had their share of difficulty in the COVID era.”

“The last one and a half year has been a major phase of evolution and adaptation for all of us, or at least for me at Cutis. The situation did not cut down the need for skincare, and so people started seeking out ways where they could connect with their dermatologist. And for Cutis, we had one way, which was social media. We also started a portal for online consultation during the lockdown itself and the main effort was to connect to patients, especially those who live far off or are old, who have not come for follow-ups as well as new patients who wanted to connect with us. The cost of consumables went up too, and this affected the availability of products, especially international products. Hence, availability and affordability of the cartridges, consumables and disposables became a big challenge.

We reduced working hours for the staff. We arranged for medical passes for them so that they could travel. We asked them to work from home and got their early vaccinations done. And of course, they all needed some pep talk. They needed to be paid during lockdown, obviously, because that was their sole source of income, and so, we did that. We recorded a lot of in-house videos to reach out to our patients. We started a portal where the patient could send videos or pictures of their skin, and me and my other doctors could connect with them. We started online consultation, which today has become pretty big.

Other efforts also included ensuring a seamless check-in for the patients. We shared videos with the clients prior to their appointment as this would reduce the consultation time and we ensured they are more informed. Our video links on YouTube, our own in-house videos, informative videos, educating our patients about details and ensuring regular follow-up with them helped. And yes, in all of these, we did not tax the patient by increasing prices.”

“The months gone by have served as a testament to the year gone by. Unpredictability and uncertainty emerging as the order of the day, and chaos everywhere. Fortunately, the turn of 2022 brought about some semblance of stability and sensibility. Omicron came and went like a breeze, barely affecting private practices. Practice owners have emerged smarter and better equipped to handle adversity, something that might be the only silver lining in the COVID cloud, alongside tele-dermatology and remote consultations. The major challenge(s) faced by our centre were (maintaining) patient satisfaction, (up keeping) staff morale, (increasing) clinic productivity and (consistent) social media outreach. A reduction in waiting time at the clinic was one of the key focus areas – almost a resolution, of sorts. That helped us quite a bit, and casual probing by the front desk regarding treatment or consultation satisfaction also helped us gain insights into the same.

Staff burnout is underrated, and the sudden influx of patients did disrupt the clinic milieu, to some extent. Maintaining mandatory off-days and breathers during a packed OPD also eased that out, albeit minimally. Clinic productivity seemed fine for the quarter gone by, which ended on a relatively positive note. Despite having a decent social media presence, we did find it difficult to stay consistent, as we manage our clinic handles personally – something that we will be outsourcing, starting next quarter. A dedicated digital marketing team would definitely streamline our practise, to some extent. On a personal note, teaching and training does help us to keep ahead of the curve, something that we feel should definitely be allocated for, in one’s timeline. We still believe in doing a major percentage of procedures personally, something that has helped us with higher retention. This, in short, is how we managed our practice. As Peter Drucker aptly said “Management is doing things right. Leadership is about doing right things”. We must all aspire to be practice leaders, rather than practice managers. However daunting that may be.”

“The increasing in work hours to overcome the backlog of consultations and procedures has undoubtedly led to a burnout of staff at some level. Hence, a comprehensive approach to promote their well-being is crucial for a smooth practice. It is important to create an empowering work environment from the receptionist, clinic helps, therapists, to the assistant dermatologists – we need to show interest in our staff and encourage them to utilise their talents. It is important to ensure and make them feel that they are a major contributor to the success of the clinic or practice.

While money is definitely important, many people work for more than it. They need to feel appreciated regularly. In this regard, little gestures like a compliment, regularly celebrating their birthday, training for doctors, complimentary gifts, treatments to the therapists and staff, and regular meetings to understand their expectations and observations, makes them feel much happier and will be beneficial for the clinic in the long run.”

“Aesthetic dermatology took a back seat during the first and second waves of COVID as people did not want to take non-essential procedures and we as doctors were also being careful due to the high exposure risk. As the restrictions decreased, there was a boom in the number of procedures as people returned for their maintenance aesthetic treatments. Initially, we took extra precautions of donning the whole PPE kit, but with the third wave, the dip in procedures was only temporary as people recovered sooner and the pandemic had taught them to take care of themselves.

The patient inflow at our clinics is almost similar to the pre-COVID days although we are still cautious and take proper sanitisation measures as well as follow strict appointment schedules so that too many people at one time in a closed space can be avoided.

Telemedicine has become popular in the recent months due to the lockdown. This has been a new way of consultation for patients and doctors. Since procedures, especially the aesthetic ones, were not possible we have tried to be in touch with our regular procedure patients so that they could atleast be on a maintenance home regime when they were not being able to take their follow-up in-clinic treatments. With the relaxation of restrictions when our clients started returning, there was an initial hesitation due to exposure risk. We had to follow strict protocols and even after vaccination anyone suffering from minor ailments was not allowed in the clinic. The situation has improved now but our double masking and precautions continue so that aesthetic procedures can continue uninterrupted as a source of stress relief for many people.”

“Effective Practice management: In recent times we witnessed a rise in patient flow due to increase in skin health awareness. The practice management landscape is undergoing a similar transformation at it led to increasing time demands of dermatologists and maintaining patient satisfaction at the same time has to be the most important and critical goal.

Effective patient management: When I started my practice before two decades, I was the sole person who handled patients, therapy treatments, technicalities, billing and staff. Now many of those tasks are managed with management software. Now, advancements in technology change the way we physicians practice. It is no wonder that medical practice management is growing more complex day-by-day. The capabilities of newer systems have changed drastically over the last half-decade or so.

For us, being present in 14 cities with 24 clinics, we customised patient management software 10 years ago that is highly scalable, flexible and has capabilities that can manage patient’s seamless flow throughout the clinical process.”

“The major challenge was a decrease in the demand for in-clinic skincare and inhibition about skin treatments in the initial days of the pandemic due to the fear of unknown and lack of proper information about the infection.The second challenge was financial constraints of patients to invest in clinic procedures. There were also economic challenges as there was the responsibility of clinic team monetary needs, technology up keep and other overheads. Our effort towards effective practice management always has always been about holding the team together, boosting their morale and concentrating on safety of our patients. There are concentrated efforts towards maintaining consistent safety protocols in clinic and adapting dynamically to the patient concerns by understanding the evolving global practice trends. We were also mindful of the economic implications in the current scenario.

We have developed a unique protocol for our clinic telemedicine to assess and consult our patients. This enables us to provide the customised treatment solutions for our patients online with our philosophy “Best in beauty, just for you”. It also helps us cater to a larger population of patients. The technologies and procedures are reconfigured and newer procedures are implemented in the clinic to cater to the fluctuating financial status of the patients. The clinic team is regularly assured of our commitment to their well-being in all aspects. The awareness about clinic protocols and procedural upgradation is disseminated through various social media channels.”

“Doctor shopping is a great menace of recent times. By the time the patient comes, she/he would have already met a couple of other doctors and adding to this is Dr Google. So when we try to explain things, it goes the other way round where we are being told what to do. And I have noticed that more than senior doctors, the young dermats really get troubled by this. We can spend enough time with the patients, understand their worries and concerns, their budget and the plan of action that will best suit them as well as the other options available and let them decide.

From the receptionist to everyone who handles the patient or has conversations with them, it is important in effectively managing the patient’s concerns and queries. The doctors as well as the staff should be clear in explaining everything properly. Even before they come to the clinic, they will have certain queries that can be clearly answered by the receptionist if properly trained. Once they are in the clinic, the effort should be to minimise their waiting period, and the doctor should spend enough time with the patient explaining the solution for their problems, the medicines as well as their applications. If the patient is undergoing any procedural treatment, proper pre and post procedure care needs to be given as well as there should be a phone number on which they can contact us if some emergency arises after leaving the clinic.”

“In my 20 years of practice, while in a lot of ways, practice today is fun and enjoyable with innovation and technologies, there has also been some challenges. To begin with, I am still struggling to find a good software that will take care of my aesthetic practice. Most software cater to medical data capturing and probably are good for a hospital and pure clinical practice but when it comes to aesthetic data capturing there is a gap. To order to address this, we do depend on professional software available, but not completely; we use it only for appointment scheduling and billing, I have had some unpleasant experience with a few currently available software, and data safety is definitely an issue.”

There is a clear information explosion as far as aesthetics practice is concerned. The newer trends keep coming in and the patients keep expecting to see instant change and results without committing to discipline themselves. We address this by spending a lot of time in the first consultation and do not start any services until the client is fully convinced about what we suggest. Continued counselling is key. In fact, we have a clinical psychologist on board to help address any underlying stress that the clients may be dealing with.

Furthermore, Instagram makes everything look simple and attractive and just about everyone is suggesting various methods to cure skin concerns. We regularly get youngsters treating themselves till they reach a point where they cannot find any more solutions and have worsened the skin condition. We addressing the same by using the same Instagram to spread information that emphasises on following the qualified dermatologist for skin problems! Additionally, given the tough times each one has gone through, we consciously make an effort to spend time with our clients. We constantly work towards treating the individual, not limited to treating the skin concern. We believe in building a long lasting relationship with them. We are completely equipped with the advanced technologies so that we can serve our clients the best.”

“The pandemic has undoubtedly been the darkest hour of the century. It affected every individual world over – be it mentally, physically and/or economically. Timeless family and I also went through a bumpy journey. We observed the power residing in digital media, and utilised that time to incorporate various practices to increase our voice reach. When this journey started, we noticed that on one side, where people were low on hopes and happiness, they also started taking care of their personal well-being and the self-pampering they deserved all along. And we just became a medium to provide them with the kind of skin and beauty treatments they were looking for with medical grade sanitisation. The most significant step that helps us go long is sticking to the standard protocols that we follow and the quality of our treatments we provide. Understanding the needs of the patients and clients coming to us, putting a vision to their expectations and then delivering the results they are expecting from us is the best protocol we follow.

Maintaining a proper sterilised practice has been one of the most crucial challenges that we faced. To ensure the same, we scheduled all our appointments in advance and restricted the walk-in practices. An hour gap between two consecutive appointments was the protocol followed. This is done to ensure that the clinic space was sterilised and made ready for the next appointment. Patients were asked to carry their RTPCR test reports. In order to avoid contamination via paper, the prescriptions and all written aftercare steps were shared with the patient on their registered mobile numbers via WhatsApp. Digital billing modes were also made available. Zoom call consultation sessions were made possible for our patients. The staff was asked to wear PPE kit in the working space area. All these steps along with the basic medical grade sterilisation techniques have been strictly being followed by us in order to keep our space safe for our patients.”

“The last two years have been a lot of work in terms of constant outreach to keep a continuous form of communication with all clients, to check on their well-being and their skin’s well-being while at home. Now with things opening up and moving back to 100 per cent offline, aligning all resources to go back to pre-COVID times is the new challenge.

Key to effective patient management is to have a well-integrated software that can manage all the technicalities of running a clinic from appointment booking, maintaining electronic medical records to invoicing, and most importantly, a team of people who are aligned with your brand’s ethos and patient satisfaction. A good balance of these two makes for an ideal day-to-day operational scenario at the clinics. It is essential to do the following on both sides – clients and the team.

Morning meetings to align the day for the team sets the tone for the day. A good consultation is always where expectation setting is done right from day zero as skin and hair clients come with high and sometime unrealistic result expectations. It’s important to be available, i.e., being a phone call away for your clients even at odd hours.”