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Top 10 Tips On How To Treat Your Patients

This is a guest post from Carolyn Thomas:

An Open Letter To All Hospital Staff

Dear hospital employees,

After a particularly bizarre experience undergoing a treadmill stress echocardiogram at your hospital recently, I decided to do something that I have never done before: I called the manager of the cardiology department to complain about her staff. (Incidentally, a recent opinion survey of international tourists found that Canadians were #1 in only one category: “Least likely to complain when things go wrong” — so you can appreciate that lodging an official complaint is a fairly big deal here!)

In my best PR fashion, I told the manager how distressing the appointment had been because of the behaviour of the two cardiac technicians in the room. It’s not so much that they were openly rude, but it was their insufferable lack of people skills that had pushed me over the edge. No introductions, no eye contact, no consideration of how awkward this test can be, no explanation of  the test procedures or even the flimsiest effort at polite conversation. To them, I was merely the 1:00 o’clock appointment, the obstacle between them and their next coffee break, just a piece of meat on a slab — but worse, an invisible piece of meat.

(And by the way, the next time I’m ordered to strip to the waist in front of a strange man, he’d better buy me dinner first.)

The department manager was very receptive to my phone call, particularly since mine was her second complaint in less than a week. She followed up immediately with her staff, returned my calls promptly, and even solicited my input about how patient care in her cardiac department might be further improved.

To this end I offered her the following tips, and if you substitute cardiology-speak for emergency, gynecology, oncology, radiology, renal, day surgery, or the hospital department where you work every day, I suspect these tips may be universally useful.

Carolyn’s Top 10 Tips on How to Treat Your Patients

1. Acknowledge the existence of arriving patients by saying something like: “Hello.  How are you? My name is ____ and I’ll be doing your ___ procedure today.”

2. Make eye contact when you are speaking to another human being.

3. Just because you do these same procedures day in and day out routinely, do not make assumptions that patients know anything at all about the procedure that’s about to be done to them.

4. These tests have been ordered because a cardiac event has already happened, is happening, or might happen in the very near future. This is extremely serious for most patients. There is no such thing as a “routine” cardiac test, especially once you’ve had a heart attack. Patients can feel nervous, worried, apprehensive, frightened, embarrassed, intimidated, vulnerable, highly sensitive, distressed or uncomfortable just thinking that there might be something (else) wrong with their hearts.

5. Say: “Today’s test will start with ____, and then we’ll do ____, and then finish up with _____.” (I had never undergone a stress echo before June 15, for example, but I knew about this test only because when I was at Mayo Clinic in October, the staff at their Cardiovascular Diagnostic Center toured us through the echocardiography labs and explained the stress echo procedure in detail). Even for patients who already know, it’s just common courtesy to review the information for them.  

6. Explain everything that is about to happen before you touch a patient’s body. 

7. Then ask your patient: “Do you have any questions about today’s procedure?” before beginning the test.

8. Stripping to the waist is not a big deal to most men, but it is a very big deal to women — especially with a man sitting in the same room (who has not even been introduced! Is he the tech? Is he the doc? Is he the janitor? )

9. Instead, immediately offer your female patients a private or curtained-off area to remove their clothing, a clean, folded hospital gown, and a surface to put their clothing on when ready, so they’re not standing there half naked in a big room, clutching their clothes and underwear in front of two strangers, and wondering what to do next.

10. For helpful hints about how to treat patients with respect and politeness even in the most awkwardly embarrassing clinical setting, ask the hospital docs and nurses who do sigmoidoscopies/colonoscopies to give you some pointers.  These people are amazing — unfailingly considerate, pleasant, friendly and understanding — all qualities that go a long way to improve  patient care.

Your patient,

Carolyn calligraphy

Carolyn Thomas lives on the West Coast of Canada. After a long career as an author, journalist, speaker, and PR professional, Carolyn survived a heart attack in 2008. She’s a graduate of the “WomenHeart Science & Leadership Symposium for Women With Heart Disease” at Mayo Clinic — the only Canadian ever invited to attend this training.  She was also named by “Our Bodies, Ourselves” in Boston as a “2009 Women’s Health Hero” — one of 20 inductees from seven countries honored for community activism in promoting women’s health. Carolyn maintains two popular websites: Heart Sisters and The Ethical Nag: Marketing Ethics for the Easily Swayed.

Disclosures: None

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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