Being the patient is always an eye-opening experience. I’m able to see some of the best and worst there is in the industry. This past week was no exception. After being placed on a new medication for migraine headaches, I began to have heart palpitations that were concerning enough for the neurologist and PCP that they agreed a stress test was in order. With my travel schedule, the most stressful part of the situation was trying to find time to have the test while in Wisconsin. I was able to schedule it, but it would require some travel to another city, 25 miles away.
The test was scheduled and I arrived the 15 minutes early, as requested. There was no paperwork needed so the 15 minute lead time was most likely to ensure that I didn’t keep the busy doctor waiting. After sitting for 30 minutes past my start time, a tech came to tell me there would be another 30 minute delay as the doctor was busy. Okay, that means a total of 45 minutes of waiting for the busy doctor. I’d left my laptop in the car thinking I’d be in and out. At 1:30 pm (now 75 minutes after my scheduled time and 90 minutes after my ordered arrival time) I am brought to the stress lab.
The tech did the typical set up with vital signs and connecting me to the 12 leads for the monitor. It’s been years since I worked in ICU but feeling the palpitations and seeing them on the monitor is disconcerting. There they were, popping up at will on the monitor when the doctor burst (I’m not exaggerating) through the door. He looks at me, the tech, and his cell phone and says, “Another stress test? I didn’t know we had a stress test. Who ordered this?” I explained it was my PCP, Dr. X.” Then, for the first time, he makes eye contact, shakes my hand, and introduces himself. He asks, “Do you happen to know where Dr. X is today? He’s not returning my calls.”
This man doesn’t know me from Adam and he’s asking me for the whereabouts of my PCP who is in another city altogether. At that point I wasn’t sure whether I was more irritated, concerned, or just intrigued at this guy’s behavior. He’s becoming a case study.
He finally glances at the monitor and says, “Huh. You’re skipping beats. You shouldn’t do that. Why do you think that’s happening?” Seriously? Is the doctor really asking the patient this and even worse, while he’s looking at his cell phone? So I explained about the new medication. He nodded while scrolling through his emails.
While I’m on the treadmill he inquires what I do for a living. My short answer is, “Consulting,” I say. “What kind of consulting?” he asks. “Helping healthcare organizations improve patient satisfaction,” I explain. “Oh that’s easy. Give them a comfortable bed, decent food, and keep it quiet enough for them to rest and they will be thrilled,” he tells me while looking at his cell phone without so much as glancing at the monitor where I can see that in spite of the increased heart rate, I am still having irregular beats.
At this point I’m tempted to leap off the treadmill, grab his cell phone from him, and demand that he at least pretend to be interested in what my heart is doing. But instead I say, “Well, you are right that patients want and need those things, but they also want to be listened to and treated with respect.” Hint, hint, nudge, nudge. He agrees by saying in his condescending tone, “Well that goes without saying.” Well doctor, you are right about that; but let’s review how you might at least pretend to listen and show respect.
When we teach our physician shadow/coaching course, we teach four best practice categories including engagement, empathy, communication, and gestures of respect. This doctor failed miserably in each. Here are just a few pointers that he could have used:
- Engagement – Address the patient immediately upon entering the room. They are the reason for this encounter. Make eye contact, introduce yourself and smile.
- Empathy – Put yourself in the patients’ shoes. They may be frightened and vulnerable or even irritated. In my case, I would have liked an apology for the delay and didn’t want to feel like an imposition. It’s not appropriate to say “Another stress test!” What I heard was, “Who is this person and why are they here. I’ve got better things to do.” There were many things he could have said and did, but I won’t get into all the detail here.
- Communication – Use your words and body language to raise patient trust that you know about them and that they are in good hands. In my case, the attention to his cell phone spoke volumes. He wasn’t interested in me or my condition. If I didn’t code on the spot, he didn’t want to be bothered. His words were just as bad. Don’t make flip remarks or tell the patient insignificant information that erodes trust. I.e. Who ordered this? Or, your PCP isn’t returning my calls. Do you know where he is?
- Gestures of respect – Let the patient know through words and actions that they are important. Giving your undivided attention is a great start. In this case, there was no respect for my time, my concerns, or my relationship with my PCP.
His final parting remarks were consistent with my previous assessment. He said, “Well, you’re having skipped beats because your heart has slowed down from the medication. Tell your neurologist to put you on a different medication. There are others that he could prescribe.” And then he left. There was no reassurance that he’d communicate with my PCP and neurologist so this one was on me, the patient.
Message received? I need to figure this out and I’m just not that important to him.