We've covered staff hiring and firing many times in Practical Dermatology. But have you ever worried about your patients firing you?

A recent article in US News and World Report offers consumers nine signs they should fire their physicians. Among termination-worthy offenses listed in the article: long reception room wait times, failure to educate, discourteous staff, and inaccessibility of the physician for phone or electronic communication.The article is a good reminder to dermatologists that a significant proportion of patients—medical as well as cosmetic— are adopting a consumer mindset when it comes to healthcare. It may no longer be enough to be great at what you do; Keeping patients satisfied and loyal means meeting the full range of their needs. It's also a reminder that clinicians ought to critically review their practice operations from the point of view of a patient to assure everything is running smoothly. In many cases, the time patients spend face-to-face with you is but a sliver of the time they spend interacting with your staff or being at your facility.

Luckily, keeping patients satisfied and eager to return to your practice is usually rather simple. (You can find articles on practice enhancement on the “Practice Management” channel of PraticalDermatology.com or watch experts discuss patient experience and staffing at DermTube.com. Check out this month's “Business Advisor” on p. 25, too.) For example, try making a secret call to your office one day and see how staff treat callers. If you identify problems, plan a workshop on phone etiquette.

Relatively recent surveys suggest that dermatologists are already among the medical specialists leading the way in use of electronic communication with patients, which should please patients. Dermatologists and medical oncologists are the physician specialist groups most likely to communicate with patients online, according to Manhatten Research. They're followed by neurologists, endocrinologists, and infectious disease specialists. Overall, 39 percent of physicians currently e-mail, secure message, or instant message their patients. That's a 14 percent increase since 2006. For those venturing into electronic communication with patients, we'll be covering the topic in an upcoming issue.