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How to manage patient expectations

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You’re the nurse. Not the butler. Not the waitress. Not the servant. But when unhappy patients treat you like one, it may be time to put the stress of dealing with them into perspective.

We ask Dr. Brady Pregerson (“MD”) and Nurse Rebekah Child (“RN”) for their points of view.

MD: We’re all painfully aware of the challenges of meeting patient expectations, and fortunately many of our patients are, too. There are a multitude of reasons we can “let our patients down.”

  • Sometimes we forget things when we’re juggling multiple tasks.
  • Every part of our job takes time, which always seems to be a commodity in short supply
  • When we’re in a hurry, doing the right thing usually takes precedence over explaining it.
  • Maintaining patient privacy can be difficult when your patient is hard of hearing and only a thin curtain separates him from the bed in the adjacent treatment area.
  • The inevitable delays that we can’t always predict: a hemolyzed blood specimen, a long wait for CT, a family doctor who takes two hours to return a phone call.

Each time I apologize to a patient for the wait and they answer, “I completely understand—everyone looks very busy and I know things take time,” I feel a weight has been lifted from my shoulders. The understanding patient is truly a blessing, and luckily there are many of them. But how should one handle the unhappy patient, the one who doesn’t seem to get it—get how busy we are—or doesn’t seem to care?

RN: One way is to put ourselves in the patient’s shoes. Imagine you have a stomachache and you think it’s cancer (doesn’t everyone always think it’s cancer?), and no one explains anything to you, or the wait times. Or what if you’re in pain or you’re cold? The list goes on and on. I think we need to try to remember that this is our area of expertise and a very foreign land for many people. In certain situations, empathy is king.

It’s never a pleasant process dealing with someone who is rude or can’t be pleased, but that’s just one of the challenges we face on a daily basis. If you have a strategy, maybe you can win both the battle and the war.

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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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One Response to How to manage patient expectations

  1. Sherry

    Where O work we deal a lot with these types of patients because they have been sick for so long. I usually can understand their frustration and shrug off their behavior. But today its all about PR and those evaluations.If we do not get perfect scores, our administration comes down on us. I do not feel we can get perfect scores because when a person is sick for so long, their other personal issues surface and they can become very unhappy and difficult to please. I would hope to see above average score to know that the care provided was the best they can have.Then we have done our jobs as nurses.

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