Other than life-saving interventions, the most important service given by all medical providers is giving each patient a satisfying healthcare experience. Patients all seek a provider who treats them with attention and respect. From a patient’s perspective, “the time to make up your mind about people is never,” Phillip Barry. We learn early in our practice that each clinician makes their choices and that those choices make them.
My grandson, Harry, is an engineer, a Magna Tiles builder of just about five years old. He has creativity, focus, enthusiasm and never stops building until his tiles are depleted. His focus is as intent as a sniper in my military days, always anticipating, always alert and totally focused. Both analogies suggest to some degree, the ideal relationship between a new provider and a new patient. Each encounter should be unique. Otherwise, the clinician can easily fall into the trap of following a script, which could become routine and boring but more importantly, dehumanizing to perceptive patients. The clinician must focus on the presenting complaint only after focusing on the patient. A smile, a gesture of consolation with enthusiastic engagement will make the encounter meaningful. Each patient deserves our informed discernment so the consultation should not end until all patient questions are answered.
The bane of our existence – for clinician AND patient – is an open cell phone distracting the ebb and flow of our exchange and of course, the ever-present EMR. A skilled and compassionate provider learns how to note and reference these records without it being the eight-hundred-pound elephant in the room. So here we are at the starting line and the patient awaits the sound of the gun that translates that their appointment is starting. A warm greeting with a genuine smile and your name attached to it, is a reliable opener, as you address them by their last name with the appropriate prefacing title. This is where we need to focus on whether we are listening or just hearing. Use their name as the consultation unfolds and the patient will feel present and heard. This is the start of building the clinician/patient relationship.
As you start to gather information like a medical detective, stop to think of the patient’s perspective. Make the human connection with respect, courtesy, humility, listen attentively, respond appropriately and, most important, be non-judgmental. There are a slew of presentations which could be challenging such as gender identification, sexual preference, STD’s, multiple pregnancies, abortions, and marital indiscretions, just to mention a few. You are not called to be a judge or prosecutor – but a witness, the clinician. You are like a priest in a confessional – you will hear people open their hearts honestly and you need to be able to counsel them and formulate a comprehensive treatment plan. Above all, and regardless of the patient’s prognosis, you should reflect Hope.
As the encounter closes, repeat your diagnosis and treatment plan and ask if they have any further questions and have them repeat back your instructions. This is the best way to confirm your successful communication. Provide closure for the patient.
“Ultimately, the name that everyone gives to their mistakes is experience,” Oscar Wilde. Making patient errors is preventable. Some errors are akin to a pilot error at 37,000 feet at 550 miles per hour; it could end in disaster. “All we have to do is to decide what to do with the time given us.” Tolkien gives these words to Gandalf. Such wizardry wisdom can also apply to our time with each and every patient.
In closing, what could happen from a poor consultation, of not listening, of being judgmental and of losing focus because of personal problems or from phone or staff distractions? The greatest number of malpractice suits are not due to a major technical error. The greatest number of malpractice judgements all come from the same problem: failure to diagnose. You cannot diagnose what you are not suspecting because you failed to listen attentively as a patient described their history or their symptoms. You cannot diagnose something that you failed to consider because you had already formulated a tentative diagnosis in your brain and on your chart and the input from your patient was not fully considered. This type of behavior in a licensed professional is like mindlessly prancing through a minefield in a warzone. These are the most common reasons for failing to make a diagnosis (or not ordering special studies, labs, or a specialist consultation) which could have identified the problem with certainty.
These actions or their absence, demand malpractice insurance which is current, paid up-to-date and identifies YOU as the policy holder. You would be surprised how many employers conveniently forget to pay for a policy for their employees, PAs, or NPs. One reason for such “lapses” is that most employees rarely ask to see a copy of their paid policy as they near their annual end of year. Such slothfulness could become a financial and personal disaster. Now is the time to consider a personal liability insurance policy, or to ask your employer to pay for or share the cost. No one has a crystal ball or can guess when a patient might engage an attorney. The cost of such an episode could be catastrophic and well beyond your savings or future earnings. And when you choose, look for a company with specialized malpractice expertise and a proven track record of stability with top-rated insurance underwriting. For three decades, my choice has remained CM&F Group, Inc. I have found their products, prices, and customer service to be unrivaled!