Religion in the Workplace





A few years ago, a staff member in our office became a born-again Christian. Everyone was supportive, but unfortunately she mistook their politeness for an invitation to proselytize. It got to the point where I had to privately tell her to stop, as it was interfering with work and wasn't appropriate.





Religion is a tricky thing to deal with in the workplace. We have no direct written policy regarding it, since we don't want to be seen as discriminating against anyone's protected freedoms. However, here a few good rules to follow should the issue come up:

• If an employee wishes to display religious items in their workspace, consider whether or not it is in view of the public. Obviously, more discretion is required in an open area. Also, anything inflammatory should not be allowed (for example, a poster calling abortion murder).



• If an employee attempts to practice their religion in the workplace, give them a polite verbal warning. (In the case of my employee, this solved the problem.) If that doesn't work, put your next warning in writing. Remember that documentation is an important way to avoid potential legal issues.



• The main thing is to avoid creating hardship for the practice. If a patient or co-worker complains about an employee's behavior or what is on their desk, it must be evaluated. The key is to use tact.

If you do have to fire an employee over the issue of religion, then it's always a good idea to consult a lawyer first. Several years ago, I worked with a woman who was a Scientologist. They have specific notions of healthcare, and when this woman (who was not a doctor or a nurse--she was in billing) began offering co-workers and patients medical advice based on her faith, she was fired by a reckless administrator who was personally offended.

When this employee threatened to sue the practice, we rehired her with great embarrassment, and the administrator almost lost her job. The fact is tolerance is crucial for any successful workplace. When the limits are tested, it's important for management to isolate the problem and deal with it in a calm and professional way. What are your thoughts?

How To Have More Timely Collections



Having a problem with claims that stay in accounts receivable longer than necessary? Do you have a system in place to deal with the problem? At our practice, the billing staff is small, but efficient. Still, to help them maintain their workload, I created the following criteria:


1. We have a written policy that office visits are entered by our staff into the system within 48 hours, and surgery within four days.



2. We also strictly monitor the documentation provided by physicians, since the more time which elapses after a visit, the more likely there will be errors in billing.



3. Copay collection at the time of the visit is crucial. It is an unfortunate reality that insurance companies and employers are squeezing the patient to make higher copays, but a doctor's office is a business and sympathy has its limitations. We train our staff to courteously and firmly request payment whenever possible, and to monitor every patient zealously should a past due situation occur. Sometimes, it's not what you ask, but how.



4. We also have a written policy regarding collections for unpaid patient deductibles or any out of pocket expenses. We follow a set pattern regarding statements, and an established time frame before sending any account to a collection agency.



5. The people in our billing department have clearly defined roles. The senior person runs reports every month to track appeals and maintain a percentage of which denied claims are ultimately paid. This same person is responsible for writing appeal letters and any related follow-up.



The main point is to have a system. As medical professionals, we can easily forget that without a stringent collections process, the success of our practice can be seriously affected. It's as important to have rules in place for the business side of things, as it is to have stated ethics for the compassionate, medical side. What do you think?

Family Matters



One of the many issues that comes up in our office is the push and pull of family responsibilities. When I was younger, before I had a family of my own, I wasn't very sympathetic to women who had child care issues. I was a perfectionist who saw the job as paramount, and anything that interfered with it as an unnecessary distraction.



To say motherhood opened my eyes to the situation is an understatement. I learned the hard way just how difficult it is to maintain a career and raise children.



At my current office, I wasted no time implementing flexible scheduling, and time off for new parents. When working mothers request sick days or exploit the system to care for their kids, I don't judge them, but rather to help them use it to their best advantage.



The thing I never anticipated when I was younger was just how beneficial such humane policies would be for morale. People like their jobs much more when they don't have to overly compromise their lives to do them.



The great thing about working in medicine is that it makes you aware of how fragile life is, and how connected we all are to one another. It makes me proud to think I help foster a workplace environment where everyone knows their lives outside of the office truly matter.

Office Romances

My sister-in-law is married to a doctor, and works in his practice. She does a terrific job and it saves them a bundle. The strength of their relationship translates into a strong practice.

Although they met in the workplace and I admire how they make it work, I admit that I am prejudiced against romance in the workplace. In my experience, it leads to many potential problems.

For one thing, we have mostly male doctors where I currently work (the two female doctors are married), so automatically any dynamic that might occur between those available for dating would be a nurse to doctor. The inequality of that relationship isn't necessarily a hindrance when things are going well, but once difficulties arise, it can be a nightmare.

In our office, the policy is to inform the office manager (i.e., myself) of any inter-office romance. There are legal and practical reasons for this, of course, but in the few instances when it has occurred, I've dreaded it immensely.

Most recently, we lost the best nurse on our staff after her relationship with one of our doctors went south. By the end, they could barely speak professionally, and the tension between them spread throughout the office like a plague. We were good friends, so it made her private conversations with me even more painful. I knew every sordid detail, and had to somehow navigate between being her friend and keeping the peace in the office.

I half-considered instituting a zero tolerance policy after she left. Then I talked with some of the doctors and senior staff. The point was made that the long hours and intense nature of the work sometimes made romances inevitable. It was decided that it would happen regardless of any perceived rule.

I called my sister-in-law afterward, and told her how I wished every office romance could wind up as blissful as hers. She laughed and told me nothing is as blissful as it seems. She then admitted that she felt overworked and that her staff took liberties because they viewed her and her husband more as family than employers.

I hung up the phone and shook my head. Sometimes there's no clear answer to a problem. Sometimes you just have to muddle through and hope for the best. What are your thoughts?

Doctors For Sale

I was just devastated after reading this article about how pharmaceutical reps target physicians for sales:

"Drug reps are selected for their presentability and outgoing natures, and are trained to be observant, personable, and helpful. They are also trained to assess physicians' personalities, practice styles, and preferences, and to relay this information back to the company. Personal information may be more important than prescribing preferences. Reps ask for and remember details about a physician's family life, professional interests, and recreational pursuits. A photo on a desk presents an opportunity to inquire about family members and memorize whatever tidbits are offered (including names, birthdays, and interests); these are usually typed into a database after the encounter. Reps scour a doctor's office for objects—a tennis racquet, Russian novels, seventies rock music, fashion magazines, travel mementos, or cultural or religious symbols—that can be used to establish a personal connection with the doctor."

The article goes on to detail how doctors are rated according to their susceptibility to sales pressure, and the methods the reps use to weaken the resolve of skeptical ones. It also mentions how when the doctor is resistant, they often go after their office staff.

In our office, we do like the drug reps and their occasional meal or two, but we have a written policy regarding such things. There is a very clear line drawn, because the outside forces to push or cross it are neverending.

Pharmaceutical reps and their companies will use false information, flattery, and the all-important drug samples to influence good doctors. Often, physicians are overworked and underappreciated, and it can be tempting to see the reps as an aide in the practice, even a friend.

I think it's extra important for office managers such as myself to keep tabs on this kind of thing. I make sure our receptionist doesn't allow any calls from pharmaceutical companies to go through, unless the doctors have made a specific request. She's very well-trained as to their tricks. Our doctors actually appreciate this due diligence, as they feel the reps are a nuisance.

Read the article and tell me what you think. There are so many things which don't contribute to the practice of good medicine. I'd say this rates pretty high on that list.