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Today's Practice | February 2019

Wearing Your Patients’ Shoes

Consider the encounter with your practice from the patient’s perspective.

Reader alert: This is a story about breasts. Mine. Are you wondering what a bare-all story like this (pun intended) has to do with ophthalmology? This is a story about an experience that opened my eyes, once again, to the vital role that little things can play in creating a positive patient experience.

My mother had breast cancer when she was 31 years old. When I lived in the United States, I was diligent about attending all of my annual exams. However, since moving to Italy 8 years ago I have been lazy. Turning 40 last November, I decided I needed to ensure that my own health was staying on track.

I scheduled an appointment with one of the largest, most reputable hospitals in Milan. Because the waitlist for a mammogram in the Italian public health system is about 12 months, I opted to be seen privately. I have had multiple doctor visits in both private and public offices since moving to Europe. Honestly, except for the fact that I pay out of my own pocket and can usually be seen rather quickly, I cannot say that I have experienced much difference between the public and private settings or the services they provide. Regardless of public or private, most medical visits in Italy require a considerable amount of time, waiting in line to register and pay and then waiting to see the doctor.


I requested an appointment online and received a call within a few hours offering me an appointment the next week. Wow! This was already exceeding my expectations. The day of the appointment, I made my way to the private ambulatory wing of the hospital, took a number from the automated system and waited for my turn to register and pay. To my surprise, the wait was only about 10 minutes. The registrar understood that I am a native English speaker, and, though she herself did not speak English, she noted in the computer system my language preference.

After about 5 minutes at registration, I was sent to the next waiting area. This is the part where things usually go bad. I have had to wait as long as 2 to 3 hours for a private visit. This time, I waited about 10 minutes before I was called into the diagnostic room. The radiology technician spoke to me in English and instructed me to disrobe completely from the waist up and leave my belongings in the attached closet. She performed the mammogram and then promptly instructed me to grab all of my things and to follow her through a closed door and into the next room. I asked her whether I should get dressed, and she said no, just to grab my things.

Although I don’t consider myself a prude, I can’t say I enjoy walking around bare-breasted when everyone else is completely dressed. You can imagine the difficulty of carrying a computer bag and a blouse, sweater, and coat, while trying to maintain some sense of modesty and cover myself. I walked through the closed door (wondering what was on the other side) into a room with a desk and a bed against the wall. Two doctors, male and female, were chatting away and, in an offhand way, motioned for me to have a seat and said they would be with me in a moment.

There I sat, topless and somewhat embarrassed, waiting for them to finish their conversation—which, incidentally, was about another patient.

Until this point—the actual visit with the doctor—I have to say that I was completely blown away by the efficiency of this facility. I got the appointment right away, registration was quick and easy, and there was no wait for the exam. It was unlike any other private medical visit that I had experienced in Europe. Unfortunately, however, the final and most important part of the visit—the part that would leave the lasting impression—completely negated all of that good.


A patient having a mammogram (or a Pap test or a prostate exam) is in an uncomfortably vulnerable position. He or she may be embarrassed or fearful of a diagnosis requiring surgery or therapy.

What does this have to do with ophthalmology? These patients are just like your patients who are visiting you for cataract or refractive surgery. They may be new to your practice. They may not comprehend how vision works and what is happening to their sight. They don’t understand all of the tests you are conducting. And in the end, they may need surgery on their eyes! Everything you and your staff do or don’t do either contributes to or alleviates their anxiety. Your actions and those of your staff shape their experience as a patient, and they shape what that patient will eventually tell others.

Obviously, the hospital had given considerable thought to optimizing the schedule and the efficiency of the clinic. But in doing so, they forgot about the patient, and instead focused on the doctors and staff. Had I been given something to cover myself—a simple hospital gown—I would have had absolutely nothing negative to say about this experience. In fact, I would have been raving about the visit to all my female friends. Instead, I will never be able to recount the positives of the experience without also telling about the negative. By not considering a small act of compassion that would have cost next to nothing, the hospital lost a big opportunity.


Private health care is not simply about access. Getting patients in the door is no good if you can’t retain them as patients and have them eventually generate word-of-mouth referrals. If you want to create raving fans, and if you want to set yourself apart and grow your practice, I implore you to consider your patients’ experiences from the patient’s perspective. The smallest details sometimes have the biggest impact. n

Amanda Cardwell Carones, MPH
  • Cofounder, Eligite, an international patient experience consultancy based in Milan, Italy
  • amanda.carones@eligite.com
  • Financial disclosure: Employee (Eligite)