This week on Inside Reproductive Health, Griffin Jones is joined by Dr. Rony Elias. They discuss how Dr. Elias is able to attain hundreds of positive reviews online by deliberately putting service first and friendship second. Contrary to many popular social media doctors, he believes in firm social boundaries with patients because ultimately, patients are there for a service, not a relationship.
Listen to the Full Episode to learn:
How to set social boundaries with patients
When you should or should not reach out to your patients
How to talk to patients about sensitive topics like weight and age
How to increase patient satisfaction whether treatment was successful or not
Inside Reproductive Health is sponsored by EngagedMD. For technology that educates your patients with true informed consent, visit engagedmd.com/IRH for 25% off your implementation fee.
Want to put a strategy in place to improve your reputation both online and offline? Visit us at fertilitybridge.com.
Transcript
[00:00:00] Dr. Rony Elias: They can maybe relate to more on a personal level or so, by the end of the day, they're coming to receive a service. They're not coming to make a friend. They can't, they have a lot of friends.
[00:00:49] Griffin Jones: Today's show I've got Dr. Rony Elias. We talk about patient satisfaction and reputation management. If you just took a sound bite from either side, you might think that Dr. Elias is all about being a warm and fuzzy doc. And on the other side, you might think this is a stone cold rules physician, is likely the balance between those two that has allowed Dr. Elias to be a very highly rated physician. Having hundreds of positive online reviews in several different platforms. I first noticed it in 2015, when he had only been in REI at Weill Cornell for four years after finishing his fellowship in 2011 and that trend continues today.
So we talk about the success that he's had in patient satisfaction and developing so many positive online reviews. And you might take note of the balance that he strikes in this conversation.
Dr. Elias, Rony. Welcome to Inside Reproductive Health.
[00:01:50] Dr. Rony Elias: Thank you so much for having me. I'm very much looking foward for this Griffin.
[00:01:54] Griffin Jones: The nature of today's episode is the nature of the same way you and I met. I don't know, but you were one of the earlier docs that I met in the fertility field had moved back to the United States in 2015.
And that was probably the year that we met and I came to see you in your office and I was trying to think of how well, how did we connect in the first place? And I'm pretty sure it's this topic of patient satisfaction. And online reputation, which dovetails where more of my space. And, and you had won a good one back then, and then I just checked up on you again this morning.
I was like, oh, darn Rony is doing really well. And so let's start really broadly. Because there's some thing that causes patients to say that they love you and not just do that, but do so in mass. And there was a difference there because there's a lot of people whose patients love them, but they don't always say so publicly in mass.
So let's start with what you believe the tenets of patient satisfaction are. What do you think it critically boils down to?
[00:02:59] Dr. Rony Elias: Again, thank you for having me. Actually, I remember when we first actually met, you had to reach out to me and I find the model to be like amazing. I didn't know that there's anybody like it was out there, like looking to just focus on fertility social media, marketing, all of this other stuff.
I think we contacted when I had first started that point out. Actually I never moved outside the country. I was always here, but I was just starting my practice consignors later. And that's when you contacted them the same thing you asked me, like. I don't want to be too foot philosophical, but I think to simplify it, Since when I was a med student, I always felt that it's kind of a matter of pure luck that I'm on this idol, this side of the bed, meaning any day I could be the patient any day, I could be the one struggling for infertility men, women, whatever.
So I just try as much as possible to put myself in their shoes. What do they expect from that provider or from that healthcare provider? Whatever. What do they expect? What would I have these. And I think even when the fail over and unfortunate negative cycle, are there just being, putting yourself for two seconds only?
Like what would you want the other person to tell you when there is that bad news? And obviously when there is a good deal, it's easy. I think that's what made me make the patient more. Being more grateful whenever I tell them about the first negative cycle. And obviously whenever they have the positive results and they can even advertise it more, but what keeps them and the practice and they feel like they just did not just another, , like another number, essentially.
Like what everybody's saying. I think it's being in their shoes is very like simple, but at the same time, it's very hard to do, especially when you have a lot of people that you be in that you have to be in their shoes everyday.
[00:04:44] Griffin Jones: So you're trying to be empathetic to what they expect and expectations can be divided into circumstantial.
There are people that have different expectations based on their personality types. And then maybe there are some things that are universal. Do you see some universal expectations that fertility patients expect that it doesn't really depend on personality type? These one or three things are what every fertility, patient expects from you?
[00:05:13] Dr. Rony Elias: I think every patient in general, they're coming for you the same way you go to, I mean any other, you go to a plumber, you want them to fix your, your toilet. You're going to fix your, your bathroom. You're not looking to become friends with them. So they're coming to you to help them with their care. Once you provide this help, as much as you can.
I think from this point on that they can maybe relate to more on a personal level or so, by the end of the day, they're coming to receive a service. They're not coming to make a friend. They can't, they have a lot of friends they're not. So I tend to always focus on. Many of them who we have to do share I'm in the age group where many of them are similar to my age or a little bit younger that we happen to have common friends they're sent to me by friends or something.
I type to always avoid to interact with them socially, till when their kid is over, although many of them would say, well, how about we do something together with your wife with this, especially the one that even have kids before they come in for a second. If I tried to avoid that because why they here is for this and that's universal. Every patient is coming to receive certain care and you have to provide that. Then you go to the next level. Then you can try to be funny, can fact associate interact with them, whatever, once you give them what they can do for that's. I think the common denominator for all patient, not patients coming to make a friend, you know, they would like to have a friend as a buck.
They're coming to get the care.
[00:06:39] Griffin Jones: I want to talk about that a little bit, because I've always felt that way. Even when I was earlier on in business, I could feel someone was too interested in what I was selling or offering because of my personality, because they got along with me, they thought I was funny.
They thought it was a good guy. Yeah. And I really try to not lead with that. And because I found problems when I did that earlier on, you know, people were buying Griffin Jones, Fertility Bridge for the guy with beard and the haircut and the cool ideas and the red pants. And, you know, they just had this idea of whatever it was that I did.
But then when it came time to servicing them, they weren't buying into a process. They had some idea in their mind and, and it wasn't an into a process. And so I then sometimes aired the other way, Rony where people are like, you know, you're almost like a ** in the sales process. I try not to be so strict, but I do. If we're not getting to business first, then I worry that we're not going to be able to have a good social relationship later. And so I just want to make sure that I can serve people and if not, we can be friends outside. But so talk to me about how you don't go too far to where you're just it's all business or do not try to mitigate that.
[00:07:55] Dr. Rony Elias: No, I mean I am hundred percent agree with you. I think that the personal parts was the cherry on top. Like I tried it, it is hard, especially like I said, because socially I'm at the age, but still some of them are coming friends to somebody else. Anyway, I actually prefer not to see those patient essentially.
You know, if I feel like if it's gonna become like, you know, my sister-in-law or something, I definitely want to see you. I was not somebody else, but a friend of a friend, you know, I try to, they try subconsciously to, to divert you into somewhere else. Like for example, I can give you an example of a patient of mine.
She had failed multiple times after the first cycle. After the second cycle she became pregnant with us and it happened that they have a very close friend. It's a friend of mine. We have been to spend a year with together. We were, this is like four or five years ago. We spentthe years and we share a phone number and I have to give them my phone number.
We share phone number. Now I show they've done with their family you know, having children a year and a half later the hospital each out for me has my phone number. I have my Facebook on my Facebook then, hey, how are you? We want to go? I didn't respond to that. It's a message on Facebook. I didn't respond to that.
And then finally he emailed me. I just am sure I CC somebody in the office. So I just, patients subconsciously are going to want to go there because they also want a friend, especially when something's stressful and all of that. And they felt like, but now that they become back a patient, I had to shift my mindset to back to being you deal with my office, you come in there and then sure. I asked her about how they're doing socially. I may ask this for everybody, especially now with COVID how you guys knowing how you're coping all of that. So you have to show some empathy, but you know, the interactions shouldn't be through those other platforms or through personal connection.
Like, you know, especially that this is very private, what we do. I mean, you know, it's very private, like, you know, for them, for me, for everybody, I mean, so many times some patients. This is an or close friend to my wife. That's how they came to me. I don't even tell them, I don't even mention it to my wife that, you know, and you have to really make that mental switch that this is one thing and that's something very different.
And then regroup at the end. If the outcome was successful if they stopped here. I mean, some of them do stuff. They don't push it, not successful, but I think they appreciate that. They appreciate that.
[00:10:13] Griffin Jones: Is this contrary to conventional wisdom or is it conventional wisdom?
And it's contrary to maybe what's popular about the idea of bedside manner right now. I think there's some people listening and they think, yeah, well, I tried to do that. I tried to, to address the issues first and to. To make sure that we understand everything and to show how we can help. And then I'm more personable because that's what I understand to be professional, but then I'm getting lit up on reviews because people are saying that my bedside manner is cold.
And meanwhile, there's all of these physicians on social media specialties that seem like influencers, they're like people you want to hang out with and that's part of their personal brand. So is what you're talking about is it contrary to what people are consuming of?
[00:10:59] Dr. Rony Elias: We do not need to cut into practice across the board.
I think not just infertility, but so many other different thing. I think it is contrary to that, but maybe this is the, maybe that's how a fortunate in my reviews, maybe I see all my patient that they saw that I'm kind of like different with that now by no means you should be. Not like not showing empathy, don't care for patient because not just because I personally care, but again, I remember what I said earlier.
I keep it up other patients just before we spoke today, there's a patient of mine who had a successful outcome. She's pregnant. She's with her OB she's four months pregnant. I'm not allowed to see her medical now because we don't carry him out of practice past 12 weeks. She's 13 weeks. I got a message today at an email that's a 40, she was Adobe and there was no heartbeat. I grabbed the phone and I call her, see how she's doing. I told her what I advise next, not to be discouraged because I mean it, you know, like I, like, I mean it, and also it's fair for her to hear. She reach out to me. I didn't look around. If she had told me if it was social media or whatever, I mean that wouldn't be the way to go, you know, but back to your point, I don't want to kind of like diverse too much, but yes. That's how many practitioners or in any industry, not just in medicine, you just follow the trend, the social media they're friendly. He's funny. They do all of that like there is a reality shows about this, it just, I don't think that's fair for the patient and it's definitely not my personality, but you mentioned also something about the code. I just recently heard of, I have a group of patient that are actually from overseas, that they come here just for their care because they had failed multiple times in their own country or in Europe.
And I just have a certain buildup of those patients that come in here and they happen to reside in one building because the company who sponsors their stay has a building that they put them in it. So they all talk essentially. And I heard from a nurse, the nurse that go provide their care. They said, they all love me.
That's why they even sent their relatives and whatever, but they don't like that. I don't socialize with them because we have the same culture, the same background, this from the middle east, et cetera. And I think if I did that, if I did the opposite. You know, like I wouldn't have had the same quote-unquote success or following up because they didn't come here to make.
It will be nice, but I didn't. So, but she mentioned something which I'm starting to work on, is that when I'm seeing them, you tend to be a little bit quicker to visit. They would want to spend more time now, now it's COVID I cannot spend a lot of time inside the patient inside with the patient inside the room, but that's something that I start to say, maybe I should, you know, I tend to feel like, Hey, you're here for this care.
I'm addressing it, et cetera. Once they start to do go about other stuff, maybe I should take a little bit more time to address that not to feel that quote person, but I'm not going to be their friend at least for the time being until they finish there care.
[00:13:55] Griffin Jones: So you're appreciating the perspective of the patient is that they're coming to you for a problem. They could do a number of different things to make other friends. Most of them have plenty of friends and they're coming to you to solve a very serious problem. And it's your job to address the case at hand and to explain how you're going to solve that problem. So how do you do that? The first time that you meet someone? How do you set the stage of this is how this relationship is founded?
[00:14:24] Dr. Rony Elias: I mean, first I heard that directly and indirectly from any patient, I take a lot of number 50 with all of the records aspects.
Sometimes more than like if there's 200 pages and I go over every single thing, the relevant stuff and the kind of not relevant stuff. And I make sure that they know that I went through that. Many of them went to multiple cycles before, no matter where those were done. They're very valuable. You cannot just say, because we're Cornell. We're a big center.
We're not going to look at what other people did, especially if they had partial success or maybe some of them didn't have children so that I make sure that I review it and I mentioned it to them and they know that the ambiguity, so I am thought they could be from my home country, from my town, from other, I don't go over like which school you went to, what did you hang out with? And like I said, many of them are more or less than my age or a little bit younger. I leave this at the end of the discussion so that they know that, you know, and I actually, I speak to other languages very comfortably. I speak French and Arabic, and if they are French or Arabic, I just say the hi and bye.
And those things, which is the whole care, the whole medical discussion is done in English basically, you know, assuming they speak English, of course. And then after that, If they start to ask me for occasionally some of the, okay, we get your number, except that I'd like to kind of, you know, just, I was like the best way to reach me, which is to get my email and my assistant email.
Because now I'm talking to you. If somebody has bleeding something urgent, they reach out to me. I'm not going to disrupt this, and it's, and I mentioned it to now, it's like, if I'm doing surgery on you, I'm not going to stop that in order to address somebody who could have something urgent need to be addressed.
So I make sure they understand that the way of communicating is my direct email, you know, as well as always to see my, somebody in my office, the nurse, as well as the medical secretary, Japanese therapist, and et cetera. And I think then they start to feel like this is not like we chose him maybe because of his background, maybe because of he's review, but he's not just focused on that.
He's focused on my care, what I did before and where are we going to go move forward. And lastly, I always make sure to tell him. Which is I believe it, I don't just say I'm very fortunate that I've practiced in this area. We all actually get very fortunate in those where fertility centers are present, that there are like, for example, New York city.
We're fortunate that I think we live here because there are amazing restaurants, amazing hotels and amazing fertility doctor. Many of them, you can just walk across the street. So by me reviewing another, another practice protocol, it's just a different point of view. It's never like, I can't believe they did that. and most of them, they were not happy with the care there.
So you could kind of build on that if you wish. I tried to avoid doing that because I'm sure that other, he or she doctor who took care of them, one of their best interests in mind, it's just that we're not successful. And the opposite is true. And I make sure they know that from the first visit, whenever I'm seeing somebody who did care before, I was like, I'm going to tell you my point of view.
And this is by no means a reflection back on the other places because they should, who are not successful with us or with me, they're going to go there because they're very good and vice versa. And then they feel like I really focused on them. I'm not focused on making myself look better. Of my center or my statistics for the better and et cetera and all of that.
[00:17:46] Griffin Jones: One of the things you talked about was the delineation of communication. It's not the best place to text you very often. There are some people that are just on every single text, email, phone call. That's how their brain wires, they can respond instantly. Many of us aren't that I'm not one of those people either.
And if they're asking you some questions, it's lost outside of the chain of communication of the people that can respond to it. If my clients text me and ask me what's going on, it's like, I don't know, let the project manager knows what's going on. The account manager, the project manager knows what's going on with the work that we're doing.
The account manager knows what's going on with you are needs what you're doing. The strategists know what's going on with what they're helping with. They can still text me. Hey, Griff. I just want your advice on this, but even then I have a different phone number to my same phone.
When clients see, I have an iPhone, they're like, why do you show up is green? Because they're going to a separate work phone number so that I can keep that. Because if it's mixed up with group threads of my cousins about the Buffalo bills or to my fiance, then, talk a little bit more about that delineation of communication.
How do you formalize that?
[00:18:55] Dr. Rony Elias: You do the exact same thing that I do, like, you know, I tend to, however, I respond to email by the end of the day, every single day, I have an OCD seen Red and if you look now at my phone, like on the Gmail or whatever, the email tab you're going to see.
Like now I just, because we start to talk, I have 14. I can assure you by three, 4:00 PM. They're all gone. They're not basically. So I do respond by that way. If they put something on WhatsApp, I have international patient that I don't know how some of them would able to find my number. And sometimes it's like 9:00 AM and Dubai, it's 2:00 AM here.
So my phone, I actually sign the Whatsapp communication completely. I only see it whenever I look at. And whenever they like, typically we do the consult, especially in our virtually and I, as of any records that you haven't. I'm going to send you an email, please reply all to CC everybody.
Because if you sent me your blood count, just to me, there is a very good chance. We're going to have to repeat it when you come in. Because I mean, you got like 30, 40 emails sometimes. So they always ask and if they, especially the international ones, they tend to still, despite that reply, just to be reply back to them.
And I put everybody else from your team, like similar to your team, your project manager, et cetera. It's a training exercise and now initially I would miss it sometime. Now. I became allergic to the fact that that's not done. You know, I just like tell the nurse, please make sure you spoke to Mrs so-and-so because she emailed me as supposed to email you or something before I forget. And it is honesty for their best interests. If they, I have occasionally for example, the patient that come in and they want to, I'm part of a group I'm part of we're like 14 different fertility doctor and some patient wants to everything to be done by one person. And I explained for them why that's not for their best interest when it's a big room. It's like, you don't want me to be doing an ectopic pregnancy at 6:00 AM in the morning and come to your retrieval at nine, you know, and I think that's also something that you have to train the patient to understand that, it's for your own interests to have things divided appropriately.
And whenever you have a problem for somebody to focus on it, obviously it's going to be me in your day to day activity. But if something urgent, don't just reach out to me. Especially not like on social media or anything like that. Most of them don't actually I have to say.
[00:21:25] Griffin Jones: So you are setting the stage for how the process of communication is going to go.
Do you set the stage of your personal philosophy, meaning in the very first minutes of your first consult with a patient, do you say, look, I understand a lot of people like to be friends. I really enjoy my patients and I do like getting to know them, but I'm very focused on getting to business first because I want to make sure that I serve.
Do you do take like a minute or two to set the stage?
[00:21:55] Dr. Rony Elias: I don't directly like that, but I think indirectly, they probably understand that early on, most people don't want that. They want it, like you will attract them if you do that. But I don't think they expected early on. They might expect it that later on and the middle of the care or something.
Now the one that are, this is at the 90% of the patient. The one that are really like came to you through a personal contact, I tried to ask them to the least amount of like, for example, somebody who just came to me because they want a doctor and a little bit, and they find me, I asked them, where do they live?
When they come to the visit, I ask them if they have children or whether they shouldn't go to school, et cetera, the one that they came personally because I kind of know that I don't really pretend to ask them those questions. I try not to ask them to social question, to let them mindset focused, you're here just for that, you know, essentially, but I never do it like directly like that. Cause I think there might many of them, I mean, also they might feel like that's kind of a little bit too aggressive and I have to also actually forgot to mention something many of the patient I became very close friends with afterwards.
One of them is actually my very good friends. Some of them became friends with my wife. Like they're very close, but once they finished their care. So I enjoyed was the interaction I have with the patient split, but I don't want this to change why they have to see me. That's the priority.
[00:23:17] Griffin Jones: So I wouldn't necessarily recommend setting the stage in that way for you because you're doing really well across platforms.
You have a really high rating and coming from dozens, if not hundreds of reviews and that isn't the case for everyone. So if someone is listening and they're thinking everything that Dr. Elias has said so far, I'm doing, and people come on and they say, I'm cold. They say I'm a jerk. And I would say, if that's the case, if that's the type of your response, That you're getting then setting the stage can really be useful and you just end it with, is that okay?
And you pause and you let people digest it even if for a second. And I've seen a lot of success with physicians doing that. Even if they change nothing about their personality, sometimes people can say, listen, I'm not a warm and fuzzy type of doctor. I just want to put that out there. Your care is extremely important to me.
I tend to deliver facts without a lot of social softening. And I tend to be very direct. Is that okay? And people, even if they are not okay with that, at least they know what to expect.
[00:24:25] Dr. Rony Elias: Yeah. I mean, for those cases. I agree with you. I think setting the tone early on, but also saying why you're not doing it.
It's not that you're not doing it because, I am focused on your care. I think actually, since you mentioned it again, I mean, I haven't checked recently, but I think one of the. And I loaded this actually indirectly. Interesting for you, basically. I never know, because when you mentioned about, I never really looked mad if you, because I know that people are going to be, I have five stars and little Starbucks, but whenever you told me, many years ago, I actually went through a few websites and I did not look at the five stars one.
One I looked at, like, for example, I had one, I forgot what it was 7 out of 10 and I so why now that patient, I remember her very well because she so far had two children with us. When the first child is when she had an ectopic pregnancy and I operated on her and when I finished the surgery, I went, spoke to her husband and her family explained everything. There on she came back into the cycle and she got pregnant before the pregnancy though, she, the one who wrote the seven, she was not happy that I didn't call her the next day. Now in my mindset, did inform them everything I knew. Everything that happened and not that I saved her life, but I help her out with the ectopic this would have been a serious condition.
But since then I'll make sure I call the patient if not the same day, the next day, because I figured this was a mistake on my end. I forgot that if I was a patient, I would want to hear from my doctor, not just from my wife, what the doctors told her. So I looked at this, that I think for those providers or people who are listening, who they feel like they're getting less video.
I think I would look why the patient, if something is unreasonable then of course not. But I would look what they said and don't like, rub it off. So, whatever, she had two children with us where she was denied care at another large academic institution in the Boston area. Like they told her, we won't treat you because you have no chance.
She came back, had a second baby after the first baby. And that if you're still out there, seven out of 10 basic, which is not bad, but still like it was seven out of 10. And, you know, I would ask those people who are listening, who are interested in deliver the bad news yourself and live with the news yourself, not your staff, not your nurse, not you wherever.
And back for her. That was my mistake by not go to answer this, then I'd be calling everybody. And most of them do appreciate it. I mean, it's not, everybody's like, oh, thank you for checking. Thank you for calling.
[00:26:50] Griffin Jones: We're talking about patient satisfaction today. And I can't think about patient satisfaction without thinking about EngagedMD. I'm on EngagedMDs website right now, and there's fertility center after fertility center, the UK, the United States, Canada, some are in academic practice. Some are privately owned, some are in larger networks and patient satisfaction has been a result for all of these centers adopting EngagedMD because EngagedMD allows patients to access your learning plan and sign their consent forms on their laptop, on their tablet, on their smartphones. They get to do that at their convenience. It's on their schedule and they get to do that in the comfort of their home.
They can repeat it when they need to. So when they come in to see you, they're getting real care from you because they have that access to you in such a way that you're able to customize that interaction to their needs and they're coming in with a much better educational foundation. So if you want to take advantage of a couple dollars off, if you're one of the few people that still hasn't signed up for EngagedMD, go to engagedmd.com/irh and mention that you heard Griffin Jones talk about them, or you heard them on the podcast and they'll give you 25% off of your implementation fee. That's engagedmd.com/irh.
[00:28:20] Griffin Jones: I'm Interested in where this personal philosophy overlaps with and segues into process, because you were, are talking about your personal philosophy is that we take care of the matter at hand.
And because that's what you're coming for is for me to deliver care and socialists and more, a little bit more of that personal touch comes later and you've talked about how you break that into communication to account for that. So talk a little bit more about process because I'm looking at one of your positive reviews right now, and the person says one of the reasons that I know why he has a big following, I don't have to stay on top of the process, like with other clinics.
And so what is that process to stay on top of?
[00:29:10] Dr. Rony Elias: I think it's starts on like a set from the transparency from the first visit. Basically make sure that they, I reviewed all your records. This is what I have, and I tell them maybe I missed something, correct me if I'm wrong.
Second is like, when you said, you know, we remain on top of things. That is a constant line of communication with the patient almost on a daily basis in the midst of an IVF cycle. If she ask the nurse a question, I'll make sure I train not to wait till 5:00 PM after sending the message to send me the message right away and I'll respond with it.
So the patient feels that she had a question today it's answered by the end of the day. And I tell the patient, if you don't get an answer by 4:00 PM to call us essentially. And if, for example, somebody who had like today, they should have had an egg retrieval yesterday. Her results were sub optimal today. I got some information from the embryologist before just talking to her and given her results.
You had this result today. I told her why, I think that happened, but I'm going to wait for the final embryologist report before I discuss with it. So she feels like I am on top of it. It wasn't like, wow. I did this stimulation from this point on it's on. And the lab is on your egg and whatever. And lastly, I probably, this is the most important one is whenever they get a negative pregnancy test, which is basically the, the measure of success in what we do, I'd like to call them myself either before the nurse or the same day.
I don't wait like five days later or something, but now I'm sure some days I didn't do that because I finished late or there was something, or my aunt. If they're positive, the nurse could call them before me. Those everybody wants to hit up, but once you hit a negative result, you want to add whenever you call them with that, you ideally want to have some, some idea by future, not just to give them false hope, but to tell them that, you know, you're on top of that case. Again, it wasn't like, well, just try again. We're going to do the same thing over again.
[00:31:11] Griffin Jones: It sounds like there's a lot of manual who involvement from you, even if it's not from you, it's directing your staff. And so how does that work? You mentioned that you're in a big group and you have many other physicians.
How does that work? When one physician has a process, but maybe it is, or isn't the same as the other docs in a bigger group?
[00:31:34] Dr. Rony Elias: That's a tricky question and it's a very good point. Now what I tell patients patient, because patients ask the same question every day. I look at every single patient of my increment, seven days a week, even when I'm not here, because we have now with the iPhone, with all of that we can log in.
So I do micromanage my patient behind the curtain everyday. So there is a certain place in the chart that is, I actually communicate to the nurse typically by one or 2:00 PM because the results are back what to tell the patient at that point. But I do tell the patient also because we are the back group, don't expect it.
I'm going to be able, I'll try to do your retrieval if I'm available, but that's not the most important part of the patient because there is so many of us and. We're all trained here because we all do a lot with all very experienced with that technical park, essentially. Like, you know, but the actual, which is the patient understands, once you mentioned it, you tell them, you know, like everybody does a lot every day. Everybody's trained. They think this is the critical part. It's actually not this particular part. Managing the cycle, not as much doing the actual physical, the retrieval or embryo transfer in a big group, but people are experienced, right. So you're not doing it. You're not having first year resident doing something like that.
So I think that's what it comes down to like on those 14 days, let's say leading up to your managing the certain days of them. And it's the last day that somebody else and the date of their fertilization is off. Meaning the day after the retreival either me or my direct nurse is calling them and telling them what I was going to tell them if I could get ahold of them, like I quite had four patients yesterday.
I called three of them already. The first one, by the time her results were back, I didn't have just a called her yet.
[00:33:18] Griffin Jones: When does physician preference overlap? When does it become something that should be adopted as a process wider within a group? Like hopefully no group is saying. Is laying down every guideline of the way physicians should communicate with patients that has to be up to the physician but at a certain point. Wow, this really is necessary for our process. So we should adopt this into the page. Like there should be a step that happens in the patient portal or we should adopt another software or a two because this, these two doctors are doing this so frequently, manually. We should just get this software for the group. When does physician preference become a process that, that should at least be pitched to the wider group, if not adopted, by the wider group.
[00:34:06] Dr. Rony Elias: I think it depends on all parties involved, meaning the patient, the doctor, and the supporting staff. Meaning if you have a lot of patients, you have to do that.
I mean, you're just gonna miss things something. If the doctors prefer that, which like in our group, 14 doctors, maybe 10 of them to something like that, four of them, four of them do not. You know, they typically the more senior one, the less busy one, et cetera. And obviously they're amazing doctor people come from all over to see them, but they haven't. And certain as importantly is, which I find it, most nursing said supporting staff. They would want something like that. Like they want that, that could, because the nurse was also like, you know, it's a lot when things are documented, especially if the nurse covered two different doctor, that varies is a little bit in the way that practice, you know, you would want to know, you're not going to be remembered.
You know, when you have, I mean, we do like more than 5,000 IVF cycles a year. Almost a hundred thousand visits a year or something like that, like between the different providers. So I think when, when you're going to have to start somewhere, I think either the patient dictating and the doctor being open-minded to do that.
And obviously I think the nurses that hold onto supporting staff should that the board on that I'm just fortunate that, you know what I mean, I'm busy enough to need to have to do that, to simplify my life and for safety. My nurses loved that. And I adopted it since whenever, you know, like we have the electronic system in place and I tried to do more and more and more and more.
[00:35:34] Griffin Jones: So what if it's about process that requires resources and this is kinda my obligatory time to always I do have a little bit of skepticism of the freedom of. REI is in academic institutions. I don't believe that it's as draconian as it can sometimes be described, but I do know that when I talk to people on face value, they're always the ones that get to decide everything.
And then, you know, you, you peel the onion a little bit, and there's a lot of red tape. And an example that I talk about on the show is EngagedMD and full disclosure. I'm a sponsored for the audience listening and they sponsor our show. But they do because it's something it's like, man, that's just such an easy win.
Like that's something that people, everybody should use. Not everybody's even able to make that decision. That's one, I think of another. I remember being in an actually in your office. This was several years ago. And I saw a magazine there and it just said, you know, property of Weill Cornell.
And I was thinking, oh Lisa Duran patient experience consultant would say, you know, never do that. So is like, well, is that a decision they can make or is the decision to hire a consultant like Lisa, a decision they can make? Like, so what about when you really believe in something. But, and, and it's part of the process that you feel is necessary to have patient satisfaction at this level, but it requires resources.
[00:37:00] Dr. Rony Elias: I wish you, you know what I mean, I agree with you. You are right. I'm not going to like, get, are when you're an academic face, even academic based, but get in a private place. And you're not the senior person or the partner, there is a limit on something that you can or cannot do. But I think with what we were talking about earlier, It's not a major thing basically. It just evolved maybe more work on my end too. I talked to the ITT develop, something in our, we all use epic. We have a software that actually web design it's called IVF for windows. It was designed back in 2000, 20 years ago. It's just for us, so we have four of three or four it guys that worked just for our department.
So they don't have to go anybody to add something in it. So that part I was able to get. But if it comes back to something like this set up at the magazine or marketing or advertising, I have to go to the higher up. And unfortunately many of them do not agree with what I would say less senior people are willing to do that just from a different mindset.
And you're right. That's a challenge. That's a challenge across the board. And I don't really know other than. Trying to navigate the system. I don't know if there is a theater answer here, how you can just force somebody to do something that they're not used to, although it's very helpful.
[00:38:21] Griffin Jones: 153 positive Google reviews on one listing alone, seems like it would be leveraged in a conversation like that, you know, in terms of.
If there's something that you feel is really important for the group to do, you do at least have, you know, it's not randomized control, but you at least have something that's more quantifiable than anecdotal data that says this might work.
[00:38:49] Dr. Rony Elias: You're right. I tried, to be honest with you. I tried, with this stuff, I tried.
Do you remember back then when we met with you, we still don't have anybody who does anything for us. Like oldest reviews that all personally, like they're not microbes or managed by anybody behind the curtain. They're not even like, you know, like they're just, they just happen. So I think this is the tip of that, where there's a lot way to get somebody, you know, how to manage it better.
Even the marketing, like, you know, if you look at more specific to our website. I mean, it's, it's bad. I think the reason why you have this is because of the medical kit, not because of that other stuff. And ideally I can keep trying, which I tried before, but now that we opened this discussion, it just going to make me ask again, but I really, I don't know how to convince the higher up people, unless my title change and I became charged or something like that, then it will happen overnight, but that's a long way.
[00:39:45] Griffin Jones: Yeah, I think there's some things that are pure marketing. It's pure just getting people in the door and it's, it's a little bit less relevant when people are coming to an institution, but then there's other things I've talked about this when I had Dr. Amanda Kallenon the show from Yale and pretty much every guests that I have from an academic institution. I talk about this is that there is an overlap between what used to be business development and what is now the standard of care. And I put something like patient experience consult as a part of that, you know, it used to be, oh, it was just kind of a nice thing to call people by their first name and have everything ready for them when they walked in the door.
Get people to recommend the practice more, to get people in to get more new patients. But now it's not about getting more new patients. It's just, that's part of building rapport to deliver care or something like EngagedMD where it's, this is how we prepare our patients in order to be better educated so we can use the resources of our staff for them.
And so that overlap is something that I think I think are vulnerable to. Institutions, but let's try to make this useful for the people, assuming that they're on the end, where they can't make many of those decisions. What are some of the things that you would leave docs with that they can they have within their control, whether it's tied to any kind of system or process or not?
[00:41:11] Dr. Rony Elias: I mean, there's certain as much direct communication with the patient. Like I said, calling them not everyday, but calling them with the big results, positive tests, negative tests, miscarriages, et cetera, calling them after surgery. That's when people said no, but no academics. Call it or don't call or something. I think that it's just making me think of, obviously there's a lot of feeds do that already, but one of my favorites, one where actually the one from patient who were not successful, but they still live a commended me that actually really like, you know, had a special place in my heart. base the fact that, or getting letters or getting holidays card from patient who were not successful or for example said, I had a patient who I did surgery on her. She didn't multiple IVF. Didn't get pregnant. Did embryo donation get pregnant and made sure to reach out to me and telling me and other patients.
So I think, you know, being communicating with them directly, that's not everyday. Cause that's. It's impossible to do, basically. I think that's in your own hand. The other thing I'm just trying to think of something else that you could do is link up the expectation early on. I think telling the patient who is 45 years old, that the chances of you getting pregnant using your own eggs early on is this, it sets up the expectation somewhere versus patient expect one you have to be really different and that you have to make sure the patient understand this is not a mistake of her own. This is nothing that she could have done. That that's also something that you could do early on. This is human physiology, and this is the expectation you might do better than your average, but the average is such essentially, and actually ready important to what I do quite often, whenever something.
I told her I'm one of 40 people. I'm going to present it to the group and I'll come back to you with what everybody else was going to say. If they're going to say something different and I'll make sure I tell her when that's going to happen and to expect the call for me by that day. And it's not to each back, I do this very often for patient who 35 years old was they didn't get pregnant after two cycles, but everything else looked fine and make sure to do it internally.
And I encourage them. If they want to seek another opinion, everybody should be humbled. And I asked them. If you don't mind FTC telling me what they tell you, because maybe there's something I would learn from that. And that's not very common because typically most of those patients that come to us that are not pregnant, did fail multiple times.
They're not really the first, but occasionally patient goal, traveled to another state or something and get a second opinion. Or now remotely, they do it. What would I do? I mean, I have a patient now that she failed multiple plants before she did one cycle with us also. Unfortunately, didn't get pregnant.
She's actually doing donor egg from a center in Europe. But she has to do the monitoring with us, very happy, like the fact that she must, like, I didn't give her any positive outcome. She unfortunately didn't get pregnant, but she still wants to come do her monitoring here versus any other doctor that's around or the original doctor that she did with him.
That is also local. So that's also something that you could just. I think because I laid up the expectation early on, I retained her in a way essentially to, and I hope she's got pregnant with a donor and I think she was ended actually credited with that also.
[00:44:31] Griffin Jones: What about those, those expectations that can be landmines for negative reviews?
Like the example of the prognosis of the 45 year old patient, I sometimes read negative reviews that say, this doctor called me old, or if it has to do with BMI, this doctor called me fat. And in many cases, I don't see that doctor saying those words. It certainly can be the case that some doctors may be crass.
But in many cases, I think it's being. A totally different way than it's being delivered. And so how do you navigate that?
[00:45:02] Dr. Rony Elias: I think it's all how you word it. In other words, if you tell somebody I tend to use the word age group, I was like in your age group, this is what we expect and this is keep in mind.
This is not diabetes. It's not cancer, not type it. This is not a disease. This is a human physiology in your age group. The average is this. And you have your average results. This is what I expected to do more or less unacceptable, same thing when it comes with the BMI. I don't really stress too much about it because there is obviously it's better for everybody to have a normal BMI for many health benefit, but between asking the patient to lose that a hundred extra pounds and waiting those two years for the female patient, basically, that's going to have a major impact on her egg, quality, et cetera. So there is a fine line where you can use that within a certain BMI that we typically don't see above it in what I practice.
I agree with you. I don't think that most, if not all doctors say in your age or because you're old and et cetera, but I told them I tend to tell them actually, you know, your age as much as better than me, you know, your age and in this age group, this is what you should expect.
If you ask me, I want to do this once and all options at the table, of course, I would advise you to do it on an act, but that's a personal decision. You have to be comfortable with it. I didn't choose your partner. And I cannot tell you to choose donor egg, but to go through it. I don't want you to feel like we're dragging you into something with a certain success, knowing that you, you know, those are the us, and this is by no fault of your own.
You did not do anything wrong. This is humeral production and that's how it works. And then I think most patients. Kind of feel that not one of the times they didn't cause this, this is not, they didn't same thing. When I actually same thing along the same line, when patient have a miscarriage, I was like, before you asked me, you could not have caused that.
Except maybe if you smoked like crazy before you asked me to and they still ask by the way, but you cannot prevent the miscarriage nor cause one early on, and you have to know that. And I keep saying it over and over, over and over. And they still ask, but then they feel like they given them sense of relief.
Same thing with the age, nobody causes that age to be what they are. And you and I also another word, another sentence that I use comedy, which I also believe in the best time to get pregnant is when you get pregnant. It's not what I tell you. It's not what your mom tells you. It's not when your partner tells you, if you were not ready at 35 and now you're 42 and your ready. Now, it was a time to get pregnant. You know, if you're ready at 25, you would force that that's not good for you for the pregnancy for et cetera. And I think that makes many patients that kind of flight feel like, okay, I didn't do anything wrong. It is what it is. I'm going to do my best.
[00:47:42] Griffin Jones: Yeah, those are two really actionable pointers.
I hope people get some wisdom from there. I didn't make a distinction earlier on in the show that I'm going to make now because at our company, it's official point of view that patient satisfaction and online reputation are not exactly the same thing. Online reputation overlaps with patient satisfaction, but there are ways to get representation on online reputation one way or the other, that aren't always representative of the entire patient population. And then there's also things that you have to do with online reputation to maintain that online. But it's not the same as patient satisfaction. Do you use any kind of patient satisfaction measure, a press Ganey and net promoter score?
Any of those?
[00:48:51] Dr. Rony Elias: Not me specifically, but the center or the IVF center, they do that, but they tend to do that as more so I don't know how to kind of like explain it better, but we have the patient who is seeing there respective doctor, which we have different offices in my case, it's the office in Westchester and occasionally the one in the city.
But there's also when they kind of go through the IVF cycle when they go through that, let's say hospital essentially. So that's more so for the hospital part, the students with the IVF, with the billing with all of that, that goes, they don't really direct them towards the each specific physician, which now that you mentioned, I think we also should.
Maybe also look at specifically each of their doctor's office and practices within the bigger umbrella, they tend to be just for the bigger umbrella.
[00:49:16] Griffin Jones: How do you want to conclude about the topic of patient satisfaction? Knowing that our audience is, it comes from a cost of fertility field, but it's really heavy on physicians.
So how would you want to conclude with that?
[00:49:27] Dr. Rony Elias: I would go back to the first point that I said, and it's pure luck that we as a physician, wait on this end of the bed on this end of the table, anything we could be the other hand and it's not just saying it like which we would all use. How would you want to treat your sister or your yourself?
But I really mean it like, you know, once you make that mental note that what would I want to hear? What am I looking at? I think that. The patient will feel your doesn't matter if you socialize with her or not, she feels your friend at that point, you know, you really care about her. I think that's, if somebody could make it and, and it's, it's a practice you have to like, you know, remember that, you know, any day, one of us, all of us could be patient and how would we want to have be delivered the bad news? The good news is easy to deliver. Everybody could deliver them. It's more so the bad news. I think that's how I would advise the physician among the audience. For the patient, all our use our grade, but typically they're to the extreme, there not most people, most people are not going online to reviews.
Most people are taking care of their babies or doing something you know, or focusing on their care. So you should read it, but have the analytical mind to read anything that you see online, you know, it's typically not most people. I mean maybe you mentioned maybe I'm fortunate that most of the ones, you know, It's possible that all of my views are going to be good, but you know, I think most patients are not reviewing online most patient. So I always tell patients the best doctor is the one in our field is the one who gives you a baby, no matter what he's his or her reviews are no matter how much you socialize with him or her, the one, because I gained to my second point, you came for the service and you expect the service to be provided.
Once people provided it's become best friends with them. Don't ever go back to them. That's different, but make sure that all this focus on the chief complaint or the reason why you came in.
[00:51:26] Griffin Jones: Dr. Rony Elias. Thank you for coming on the show and sharing your thoughts about patient satisfaction. I think people are going to get a lot out of it.
[00:51:33] Dr. Rony Elias: Thank you. I appreciate it. Thank you.