Choosing a family physician is an important decision for patients, but in most instances it is done without adequate knowledge or forethought. Some years ago, in an effort to begin my patient relationships on the right foot, I instituted an enrollment interview as both an opportunity and requirement for new patients. People who called my office seeking a physician were advised that an interview was required prior to enrollment. Those unwilling to participate simply were not enrolled. (We did not have any managed care contracts that obliged us to see patients unwilling to take part in our enrollment interview.) Those willing to participate were scheduled for the interview. Interviews were conducted initially on an individual family basis but subsequently in a group setting with as many as 35 families at a time. Here’s how we did it.

Appointments for the interviews were made during evening hours so that all family members could attend. While we did not specifically encourage the presence of small children, we did not discourage it either. Much of the discussion was boring to small children, so we tried to offer some type of entertainment (e.g., toys, books or movies) to keep them occupied. Older children, particularly teenagers, were included in the interview and given appropriate attention.

The interview began with introductions, showing the family around the office and discussing the significance of certain instruments or pieces of equipment. This perusal of the office was usually brief, and then we would retire to my private office for the rest of the interview. We made great efforts to communicate to the family that there was no obligation to enroll in our practice and no charge for the interview, as they were not yet patients of ours; it was simply a means for deciding whether we had the basis for an ongoing relationship.

During the interview, we covered the following topics:

• Family medicine. People have all sorts of ideas about what a family physician is, and it is helpful to establish a mutual understanding of the role of the family physician in the health care system. I would often explain that, as a family physician, I was able to care for all members of the family, providing not only routine or periodic examinations but also certain specialized services. For example, after I decided to stop delivering babies, I explained to new patients that I could take care of the mother and baby after delivery. Many patients are surprised to learn of the broad scope of services that family physicians can provide.

• Housekeeping. Housekeeping chores may seem trivial, but they can be important to the smooth functioning of your practice. These issues include explaining when you have office hours, how appointments are made, how you arrange your call system, etc. These issues are exceedingly important because unless you tell people what you expect of them, they have no way of knowing how to cooperate with you. By communicating these issues up front, many routine problems are avoided.

• Proactive care. One of the hallmarks of our practice was that we tried to keep track of the health care activity of our families and maintain an adequate database on them so that we could provide proactive care. We did not feel that it was possible to maintain a modern family practice by giving primarily episodic care. Beginning with the enrollment interview, we promoted the concept of preventive care. Individuals who did not agree with this philosophy were encouraged to seek care elsewhere. While this may sound somewhat autocratic, it helped us accumulate a patient base attuned to our goals.

• Team care. Also at the time of the interview, we established the fact that we considered health care to be a team enterprise and the patient to be the most important member of the team. We discussed each member’s roles and responsibilities and emphasized the importance of openness and feedback among all parties.

Group vs. individual sessions

The individual family interviews gave us a chance to discuss privately any individual or family problems that arose and helped us assess what the needs of that family would be when we enrolled them. In the group interview, this privacy was not possible; however, we did offer private discussions after the group sessions to those who requested them.

The group interview allowed us to present a more detailed and stylized program, including slides and transparency projections. For group interviews, our entire staff was present so that we could introduce them to the families and designate their duties. At times, we even had our medical students present, as it helped demonstrate that teaching was an important function in our office.

At the end of the group presentations, we always invited the families to ask questions, many of which reflected confusion about the role of family physicians. This furthered my view that we, as family physicians, have a responsibility to educate the public as to what we mean by family medicine. This is not an easy task that will be accomplished overnight, but the enrollment interview provides a perfect forum.

To join or not to join

If the family or individual decided to enroll in our practice, we initiated the enrollment procedure, which included collecting basic patient data and establishing a chart. In addition, we gave the patients forms to send to prior physicians or medical institutions to obtain past records. We then considered the individual to be our patient.

If the family or individual needed more time to decide, we simply waited until we heard from them before placing them on our enrollment list.

While some of my colleagues were initially skeptical of the enrollment interview concept and assumed we would foster ill will by requiring the interview and not seeing patients immediately, their fears proved to be unfounded. If immediate care seemed necessary, we directed those callers to other providers (e.g., urgent care clinics) and offered to schedule an enrollment interview. These prospective patients were impressed by our courtesy and the fact that we had such a system. No other office in town offered an enrollment interview, and individuals seemed to view it as evidence of an organized approach to health care – the main thrust of our approach. This introduction to our practice created patient confidence, understanding and goodwill, all of which are essential to the success of any practice.