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Angry patient damage control

In part two of a three-part Scrubs exclusive series on caring for unhappy patients, our favorite sassy nurse, Rebekah Child, RN, and our favorite ER doc, Dr. Brady Pregerson, offer some rational suggestions on what to do when the visit has gone sour.

MD: Dealing with an unhappy patient is always somewhat stressful to me, but there are a number of techniques that I try to reconcile the relationship.

Here’s a partial list; if you have your own suggestions, please write them in the comments section!

  • Ask your patient directly what he’s unhappy about and what you could do to fix or improve the situation. Maybe the patient wants a specific test done that you didn’t offer. If you don’t ask, you won’t know. While I wouldn’t order an unnecessary CT or MRI just because someone is upset, if it’s a simple x-ray or lab test, I usually answer with “No problem.” It’s not worth sacrificing a professional relationship. And every once in a while, I pick up on something I would have otherwise missed.
  • Prioritize their care. Yes, I know, they probably don’t deserve it, but it will make it easier for everyone involved—doctor, nurse and patient. There’s a reason why the squeaky wheel gets the grease. Apply grease, polish, red carpets or whatever you can to expedite their care (and their departure from the department).
  • Spend a little extra time with them. Again, they often don’t deserve it, but you’re stuck, and if you spend a little extra time, everyone may end up more at peace. Also, a little extra time spent now may save you from a long time spent later in a meeting with your supervisor to discuss a complaint letter. If it never gets written, there’s no meeting.

And remember that although you may not think they “deserve” extra attention and care, you also may not know that amount of stress they are under. A hospitalization can become a very stressful occurrence if there are children involved that need childcare, if finances are an issue, and most importantly if it is a new diagnosis that will impact their life. Try to have empathy with every patient you encounter, whether they be difficult or not.

RN: To understand why patients become unhappy, think back on the last time you were in a hectic environment (hello, Home Depot!).

One time, my beloved was putting sprinklers in our new backyard. He needed a different kind of sprinkler head, so he asked me to run to the home improvement store and buy it. I didn’t think it would be such a hard task (even though I’d rather go to the dentist than any kind of home improvement store)—until, of course, I got there. First, I had to find someone in the appropriate orange jacket to help me. This alone took three tries to get to the appropriate sprinkler guru. Then, when I finally found this man, he was highly irritated with me and my lack of irrigation knowledge. Long story short, this was his area of expertise, not mine.

If we take a couple of extra minutes as healthcare professionals to explain to our patients, in a common language, what seems so intuitive to us, we can avoid exacerbating their frustration and might even have some happier campers on board! What a utopia we would have! We could all sit around the nurses’ station making s’mores and waiting for our CT scans!

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Brady Pregerson, MD

Brady Pregerson, MD, a returned Peace Corps volunteer and winner of the 1995 Wise Preventive Medicine Scholarship, completed his medical school at the University of California, San Diego, and his residency at Los Angeles County General Hospital. He has authored three medical pocket books for nurses and doctors, as well as the educational web sites erpocketbooks.com and gotsafety.org. Dr. Pregerson currently works as an emergency physician in Southern California. He writes, "Although the ED environment may be quite different from working on the hospital floor or in an office setting, I am hopeful that you can take these tips and apply them to your own specific work situation." You can buy his books on lessons from the ER, including Don't Try This At Home: Lessons from the Emergency Department and Think Twice: More Lessons from the ER, at amazon.com.
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