Be Patient with Patients
It seems that health practitioners have taken language lessons from the police department. Anonymous health care bureaucrats call patients by their first names, while the patients are expected to refer to physicians by their title and last name. In a health care universe characterized by entitlements, this imbalance in forms of address is symptomatic of issues that cloud relationships.
Attitude can have a substantial impact on health and healing. When patients feel ignored or belittled by the system, their commitment to the process may be reduced, and their enthusiasm about their health care provider and the health care itself may suffer. Patients are entitled to good medical care; they are also entitled to be treated with dignity.
It is not just that physicians should have a good bedside manner and that nurses should be effective patient advocates. Health care management must also encourage non-professional staff to communicate respectfully with patients. One of my very favorite hospital CEO's name badge bears the title, "Customer Service Representative". A committed leadership sets the tone for organizational behavior.
The major lesson for health care personnel in dealing with patients is to understand the need for good preparation. It is important to determine where the patient's judgment is relevant in making determinations about treatment and other elements of health care delivery. Unless you know your limits, as well as the presumed limitations of the patient, you cannot begin to negotiate with him or her about their care.
Preparation involves breaking down the situation into its constituent elements: Who are the parties with an interest in this patient? - the patient, family, insurer, primary care provider, specialists, nurses, other hospital personnel, hospital roommate, and others who have a stake in the outcome. What are the interests of each of these stakeholders? - recovery, getting paid, saving money, satisfying professional ego needs, not having to listen to the patient complain, family members concerned about spending down their inheritance.
A second element of preparation involves looking at options available to the parties, including yourself: What will it take to respond to the parties' interests? - look at the information available to you and make a series of assumptions about how the parties' interests can be met. Keep psychologist Abraham Maslow's hierarchy of human needs in mind, remembering how important it is for people to feel a sense of belonging, of being taken seriously.
Be prepared to abandon assumptions as you listen to what the parties are saying. - remember the old saying that the word assume makes an ass of you and me. Patients may reveal tremendously important information if you listen to them, information that can yield a better informed diagnosis and even ideas that can contribute to better management of your health care organization. The same is true for other stakeholders.
Preparation also includes thinking about strategy:
Given your assumptions, how can you act to save face for yourselves and other parties? - if patients are made to feel like children, better seen and not heard, they can end up depressed, frustrated, and angry. No professional or organization wants former "customers" going around bad-mouthing them.
Remember that no one person or entity has all the answers. - unless you leave room for other parties to contribute to the resolution, you have painted yourself into a corner: if you end up changing your response under those circumstances, what will it do to your long-term credibility?
There is a tremendous amount to learn from patients. They have been observing themselves for a long time. Patients can provide a good medical professional the clues needed for effective diagnosis and treatment. The observations of non-medical personnel may also yield information not available from other sources. Someone may have to be boss, but remember that in the business of health care delivery, the best boss has to think of himself or herself as a Customer Service Representative.
Published in Healthcare Review, March, 1996
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