Two practices in the same area, similarly qualified, similarly equipped, similarly priced. One is busy and one is not. The difference is rarely clinical, and the clinicians at the quieter practice usually find that hard to accept.

The reason is that patients are not choosing on clinical grounds. They cannot. They have no way to compare diagnostic accuracy, and they know it. So they decide using the evidence available to them.

What they can actually assess

  • Whether they were treated with respect at the front desk.
  • Whether anyone explained what was happening while they waited.
  • Whether the clinician looked at them or at a screen.
  • Whether they understood what they were told.
  • Whether the place was clean, and whether the equipment looked cared for.
  • Whether the practice did what it said it would, when it said it would.
  • What someone they trust told them.

Every one of those is a proxy for competence. A patient reasons, not unreasonably, that a practice careless about the things they can see may be careless about the things they cannot.

The consultation is judged on being understood

Patients consistently rate clinicians on whether they felt listened to and whether they left understanding what was wrong and what happens next. A clinically excellent consultation that leaves the patient confused is remembered as a poor one.

This is not a call for longer consultations. It is a call for the last two minutes to be spent confirming the patient can repeat back what they are meant to do.

The front desk carries more weight than the clinician

Uncomfortable and consistently true. The receptionist is the first and last interaction, and it happens while the patient is anxious. A dismissive greeting colours everything that follows, including the clinical encounter.

Practices invest in equipment and neglect the training, workload and conditions of the person who determines most of the impression.

Reliability is a differentiator

Results arriving when promised. Calls returned. Being told the clinic is running late rather than discovering it. These are low-cost, unglamorous, and they are what patients describe when they recommend a practice to somebody else.

Word of mouth is still the main channel

In Nigerian private healthcare most new patients arrive because someone told them to. Everything above feeds that. Search visibility and a good website determine whether the recommendation can be acted on, which is a real and separate job, but they do not create the recommendation.

Ask your own patients

The cheapest research available: ask people who chose you why. Not in a survey, in conversation at the end of a consultation. The answers are usually specific, occasionally uncomfortable, and more useful than any assumption about what patients value.