The Things We Say to Our Patients That We Should Be More Tactful about

With the increased focus on patient satisfaction and improving the healthcare experience, how we communicate with our patients is becoming more important than ever. And it’s long overdue. From our patients’ perspectives, being sick is bad enough without feeling disrespected or having an inappropriate message communicated by those who are supposed to be caring for them. Yet every day in hospitals across the nation, conversations take place that unintentionally give the wrong impression and add to our patients’ stress levels.

Unfortunately many of these incidents occur in the hospital medicine arena. While we’re all well intentioned and generally do communicate excellently, slip-ups still occur, usually as a simple matter of words, tone and perception. Based on my own experience, here are 3 everyday examples where we can improve. To make this more interesting, I’m going to give some analogies from other situations.

1. Discussing code status with younger patients

How we inquire about code status needs to be done with the utmost sensitivity. I shudder when I think of the way I’ve seen some residents and experienced physicians ask the question so nonchalantly: “If your heart stops, what do you want us to do?” Imagine how this could come across to a younger patient who is already scared to be in hospital for the first time. In fact, I believe this is nearly always an inappropriate question to ask in an otherwise healthy younger patient.

I usually give this example to my residents: Imagine the consequences if such a patient said (either due to depression or not understanding the question) that they wanted to be DNR/DNI, you documented that, and then they had a cardiac arrest for whatever reason that night. If the medical staff “just let them go,” it would probably be all over the news the next day. A blanket “rule” to ask every patient that enters our doors doesn’t make sense for the 42-year old active healthy male who comes in with a first bout of cellulitis. When it is appropriate to ask this question, in a much older patient with multiple comorbidities, it still should be asked sensitively and with no assumptions that the patient understands the terminology.

Analogy: Your newish car’s check engine light keeps going on, so you take it to the auto shop and the mechanic asks, “If we discover that your car’s transmission is dead and the motor completely fails while it is with us, what would you like us to do?” You’d probably run out of the service shop.

2. Giving the impression of wanting to push the patient out the door from Day 1

Despite the pressures to discharge, avoid pushing this agenda when the patient is obviously still very sick. Worse are administrators, usually case managers, walking into the room first thing on hospital Day 1 (often before the doctor) and appearing to be planning for a quick discharge. This scenario has happened to me more times than I can even count, and has upset numerous patients, not to mention caused intense anxiety among relatives who receive a telephone call about discharge before the doctor has even had the chance to tell them the diagnosis. The observation versus inpatient status problem is a whole other discussion. See Burke’s post on that conundrum.

Analogy: Arriving at a house for dinner and the hosts keep emphasizing to you from the second you walk in the door that they’re looking forward to an early and good night’s rest as soon as you leave.

3. Learned helplessness

Telling our patients that there’s nothing we can do, or just shrugging our shoulders, when they complain about the fact that they couldn’t sleep or cannot tolerate the food. These are two of the most common complaints I hear, and as the “Captain of the Ship” the hospital doctor should at least try to address them—especially if the complaint seems justified. Food and sleep are two of the most basic things any human needs to function. Whether it’s telling the charge nurse to move a noisy neighbor or passing on a request to food services, we can certainly try to help, even if we expect the attempt to be futile.

Analogy: Being introduced to the hotel or restaurant head honcho, lodging a complaint about something that really bothered you, and having them seem indifferent and focused completely on something else.

These are just three situations that play out daily in our hospitals. Despite our best intentions, everyone in healthcare needs to take great care of how our words come across. Saying something that scares, disappoints or frustrates is often more important and memorable to our patients than their actual illness or, even dare I say, a medical error. To quote the great Maya Angelou and apply her famous saying to patients: “People will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

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