Patient-Provider Interactions Part 2: Improving the experience for everyone

Let’s explore a few areas where just a simple change in our own actions can reap huge benefits for both ourselves and our patients. 

1. Clear your mind. Before you enter a patient’s room, take a moment to clear your head of all the other distractions going on around you and focus on what you are about to do.  It is difficult to fully engage a patient when you are also thinking about all of the other things that you have going on at the same time. Clearing your mind will allow you concentrate on your next patient and why they are here, which will make them feel like you care more and have spent more time hearing their concerns.  If you have trouble with this, try to stop outside the room for a second, take a slow, deep breath, and then enter. After you have introduced yourself, quietly close the door before asking any more questions. This will give you a physical separation from the rest of the department, which can help mentally separate you from it.
2. Introductions. It is a good idea to always knock before you enter the patient’s room, even if the door is already open. Besides being polite, it gives the patient a sense of control in a situation where they feel completely out of control.  Once you enter the room, slowly introduce yourself to the patient giving them your name and title. Shake the patient’s hand, and then acknowledge the other family/friends in the room. Ask if it is okay to discuss their medical concerns while everyone is still in the room.  Not only does this meet privacy standards, it again makes the patient feel like they have some control, and it makes them feel like you are concerned with their emotional and physical well-being.
3. Sit down and listen.  After you have introduced yourself, have a seat somewhere where you can face the patient and make eye contact.  Ask them about the events that lead to them coming to the ER, and what their concerns are. Patients report feeling like their Healthcare Provider spent more time and was more caring when they sat in the room and made eye contact instead of standing at the foot of the bed or facing a computer.  Even if you are very busy, sitting down conveys to the patient that they are important and that you care. If you have to make your initial visit brief, still sit and explain to the patient that you will get some basic tests started and return in a bit for a more thorough discussion of their concerns and a proper examination.
4. Tell the patient what to expect.  Address their concerns as best you can initially, giving them whatever information you currently have available to you.  Then explain what they should expect to happen next and why, as well as approximately how long you think it will take. Don’t be afraid to overestimate time, that way if it takes less time they will feel like you’ve gone above and beyond.  For example, using this scenario, your conversation with the patient after your H&P could go something like…“I understand that you are concerned that you may be having a heart attack.  The good news is that at this time, there isn’t anything on the EKG that indicates an acute heart attack.  However, often times symptoms like this can be ‘warning signs’ of a future heart attack. So, I would like to run some blood tests and have the nurse give you some medication to try to make you more comfortable.  Even if those tests come out ok, they only give us a snapshot of what is happening and not the entire picture. So, expect to stay in the hospital overnight for a thorough cardiac evaluation regardless of the test results.  I will be back to discuss these results in a little bit, but expect it to take 2-3 hours. And of course, if you have any questions or concerns, let your nurse know”.
5. Follow up/ Closure.  Once all of the results are in, make sure you go back and reassess the patient. Again, find a place to take a seat.  If it is busy, close the door and tell the patient you are “hiding from the nurses”, that way you aren’t distracted and can focus on the patient. Ask how they are feeling, even if the nurses have kept you informed.  Explain the test results and any concerning findings and what they may mean. Re-affirm your previously stated planned disposition if it hasn’t changed. And allow the patient time to ask any questions. You may not have the answers, but it is ok to tell them that.  Explain that those questions may be better answered by one of the Physicians who will see them in the hospital, if that is what you feel is appropriate.

If you reread our previous scenario and imagine the differences that could be made using these 5 steps, I’m sure you can see how it would change the patient’s perception of their visit even if the care given was exactly the same.  And believe it or not, these steps will force you to slow down mentally and be more mindful and “in the moment” with your patients, which can greatly decrease the amount of stress that we feel build up throughout a shift. Less stress equals less burnout, which leads to increased patient satisfaction.