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

~ Carolyn Thomas

hospital

by Carolyn Thomas  ♥   @HeartSisters

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 Cardiology Department manager to file a report about her staff.  (Incidentally, a recent opinion survey of international travellers 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 friendliest PR voice, I explained to the manager how distressing the appointment had been for me because of the behaviour of the two cardiac technicians in the room. 

For example, when I entered the echocardiography lab, one of the two men in the room sat at a corner desk. He did not look up at me when I walked in, did not say hello, did not introduce himself. Was he the tech? Was he the doc? Was he the janitor? Who knows?

It’s not so much that he and his equally disinterested colleague were openly rude. It was their insufferable lack of people skills that pushed me right over the edge:

  • no introductions
  • no eye contact
  • no consideration of how awkward this test can be
  • no explanation of  the test procedures
  • not even the flimsiest effort at common courtesy

To them, I was merely the 1 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.

The department manager was very receptive to my phone call, particularly since mine was her second staff complaint in less than a week.

She followed up immediately with the two techs, 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. (And by the way, I learned later from friends who work at this hospital that copies of my “list” ended up posted on bulletin boards in staff rooms throughout the building).

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.”  (For more on the importance of introducing yourself to patients, visit #HelloMyNameIs, a U.K. campaign launched by physician-turned-terminally ill cancer patient Dr. Kate Granger. And read Dr. Kate’s comment in response to my blog post, The Lost Art of Common Courtesy in Medicine).*

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/procedures 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 or procedure, especially once you’ve had a heart attack.  Patients can feel nervous, apprehensive, embarrassed, intimidated, vulnerable, distressed or frightened just thinking that there might be something (else) wrong with their hearts.

5.       Say: “Today’s test/procedure will start with ____, and then we’ll do ____, and then finish up with _____.”  (This was my first stress echo, for example, but I knew about this test only because during my first trip to Mayo Clinic, the staff at their Cardiovascular Diagnostic Center toured us through the echocardiography labs and explained the stress echo procedure in detail).  But even for patients who already know, it’s just common courtesy to review the basics 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.

8.       Stripping to the waist is not a big deal to most men, but it is a very big deal to women – especially with men sitting in the same room (who have not bothered to introduce themselves!) And by the way, next time I’m ordered to strip to the waist in front of a strange man who hasn’t even introduced himself, he’d better buy me dinner first.

9.       Instead, immediately offer your patients a separate 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 – as I had to do in front of those echo techs – half naked in a big room, clutching sweater, purse and underwear in front of two strange men, and wondering what to do next. And by the way, why do I even have to be telling educated, intelligent people this in the first place?

10.   For helpful hints about how to treat patients with respect and politeness even in the most awkwardly embarrassing clinical setting, just ask your colleagues who do sigmoidoscopies/colonoscopies to give you some pointers.  These people are generally amazing – unfailingly considerate, kind and understanding, all qualities that go a long way to reduce patient discomfort.

Your patient,

Carolyn calligraphy

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*  Dr. Kate Granger died on July 23, 2016 at the age of 31.  The oncologist who told her that her cancer had spread did not introduce himself, and did not make eye contact with her, and immediately “fled the room” after he spoke.  She was so disturbed by this experience that she launched her #HelloMyNameIs global campaign to encourage all healthcare staff to introduce themselves to their patients.  RIP, Dr. Kate.

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Q:  Are there any tips that YOU would like to see added to this list?

♥

NOTE FROM CAROLYN:  I wrote more about the importance of common courtesy in medicine in my book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University Press). You can ask for this book at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon  – or order it directly from Johns Hopkins University Press (use their code HTWN to save 30% off the list price when you order).

♥

See also:

A perfectly ordinary workday. Unless you’re the patient…

Would it kill you to treat your patients with respect?

The lost art of common courtesy in medicine

Patient privacy, modesty, and staff burnout

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Published by Carolyn Thomas

25 thoughts on “Carolyn’s Top 10 Tips on How to Treat Your Patients”

  1. Pingback: Market Mad House

  2. If the equipment isn’t functioning properly, reschedule the appointment.

    Yes. This happened to me. The technician and the physician murmured that it was not working correctly. They should have discontinued. But I should have left the room immediately. Instead, they proceeded with the testing saying it was “good enough.”

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    1. Yikes. In what other industry would procedures that were “not working correctly” continue as if nothing’s wrong? My mechanic wouldn’t keep on checking tire pressure with a faulty gauge, my grocer wouldn’t keep using a cash register that wasn’t adding correctly, my hairdresser wouldn’t keep cutting my hair if her scissors broke. But you’re right – in each of those scenarios, I would not hesitate to leave the premises, returning only when everything was operating dependably again. Why should we tolerate less from medicine?

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  3. Hi Carolyn,
    These are fabulous tips. You’d think they would be a matter of common courtesy and/or common sense, but…

    It’s all about treating patients with respect during stressful times/procedures when they are afraid and feeling vulnerable. I think you covered things nicely. Thank you.

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    1. You have hit upon a critical lesson, Nancy: tolerating disrespectful or inconsiderate treatment in a non-healthcare setting (two retail clerks ignoring you while they stand around chatting with each other, for example) is bad enough when we are feeling just fine, but lack of respect is 1,000 times worse when we’re feeling afraid or vulnerable while we’re patients! Thanks for that reminder…

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  4. What a great blog. I recently went through radiation for breast surgery. On the very first day of radiation, the simulation day, there were about 10 people in the room! I entered the room, my emotions already raw from having breast cancer and having to have radiation in the first place, and was told to strip down to the waist, with all these people, including men standing there.

    I felt they were gawking at me! The head technician introduced everyone and their titles and then asked if I minded that they stay for “training purposes”. My head was swimming, I couldn’t even get out a NO! I have experience working in the healthcare field and reminded myself that they are professionals.

    However, I felt totally violated and called the nurse advocate. She said she would talk with the head doctor confidentially to remind the techs to be more thoughtful and compassionate. She vowed to follow up with me, but I never heard from her again.

    I had my radiation during the summer and vacation time. There were times when I just had male techs and that also felt awkward. In a perfect world, women would have only women techs.

    After 7 weeks of radiation, I became very close with my radiation team, both male and female and would never want to get them in “trouble” and am composing a letter to the VP to re-address and re-train them regarding modesty for female patients.

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    1. “I was told to strip down to the waist, with all these people including men standing there.” OH, GOOD GRIEF!!! And this was during your very first day of radiation therapy??!

      What were these brainiacs thinking?!? Earth to that head technician: the first radiation appointment is NOT the place to trot out a parade of trainees. Utter disregard for even the basic essentials of consideration and modesty…

      Some staff attempt to reassure uncomfortable or embarrassed patients by saying something like “don’t worry, honey, I see this every day” – but the flaw in this response is the failure to appreciate that this is NOT about them and their comfort level, but about YOU and your discomfort level.

      Good luck to you in getting that letter acknowledged and acted upon!

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  5. Brava, Carolyn!! How utterly appalling though. The last time I had a stress echo (which was necessitated by a combination of a shellfish allergy attack and late-term side effects of radiation), it was actually a pleasant, even fun experience, because the tech & the nurse were kind and considerate. Oy. Good on you that you followed up this way, with special congrats given your Canadian-ness. 😉

    I had several miserable experiences early on after my cancer diagnosis dealing with a so-called breast health center that was supposed to ‘coordinate’ my care. After getting nowhere with trying to contact anyone who would listen to me (after I refused to continue with them), about a year later, I accidentally found a post about the place on the Facebook page of the hospital that sponsored the center. I complained there, and got a call back the next day from the new administrator of the center. I was impressed at the follow-up. The new admin was pitch-perfect and explained what had been going wrong there at the time I was visiting, and that they were working hard to improve their service. I’m glad I persisted. And I’m glad you persisted.

    Sometimes you do wonder how certain people end up working in healthcare at all.

    Great post.

    Kathi

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    1. That’s an encouraging story of good follow-up, Kathi after what must have been a maddeningly frustrating experience during such a traumatic and vulnerable time in your life. That new admin made all the difference, and I hope that your feedback actually trickled down to front-line staff as well so that “working hard to improve service” becomes more than just a marketing tagline.

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  6. In case this one wasn’t already covered, I suggest:

    For prolonged procedures requiring more than one health care worker, refrain from extended discussions not involving the patient or unrelated to the test being conducted.

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  7. Great article Carolyn! I, unfortunately, had a horrible experience with the cardiology department, so similar to yours. It can be a scary & embarrassing experience and you want to feel as safe and comfortable as possible. I’ve never looked back since switching to my private heart specialist and the doctor who I see is an absolute dream!

    This is a great article Carolyn and the dinner comment did make me laugh.

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  8. Excellent Carolyn! Thank you for speaking up! The only thing I would add is the clinician could explain when and how we may receive the results of the test.

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  9. Ay yi yiiiiiiiiii – talk about adding insult to injury! Those tech people should be mandated to take training not only in people skills but in MANNERS. Luckily I’ve never had that kind of experience and hopefully never will.

    I did love your comment about the next time you’re asked to strip you better get dinner first . . . and I might add – you should get paid big bucks.

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  10. Nice list, Carolyn. And it is great the hospital staff was able to hear your opinion. Fortunately, I’ve seen only few hospital worker or doctors who behaved the way you describe (and even worse). But I agree with you: this is really insulting to feel such attitude, even if this happens not often.

    I’d add to this list my own observations and thoughts, if you don’t mind.

    Well, dear hospital workers/doctors:

    1) Please do not turn your back to your patient. Even if this is your 50th one this day, please respect the patient, like he/she respects you, by trusting your expertise. (Why not respect? Just a little effort: do. not. turn. your. back. This isa really offensive way to speak to the patient through your back).

    2) Please do not interrupt your patient. Do not raise your voice at them. Do not insult them by giving them names like “challenging patient”. All these are appropriate for a street fight, not for the doctor’s office.

    3) Learn from your nurses. Seriously. Most nurses are real professionals with expertise in establishing patient-care provider relationship. Nurses often (surprisingly) treat their patients like human beings, not cases or procedures. They understand somehow that patients suffer, face possible tragic outcomes, are scared, anxious about their conditions. And even in the situations when the nurse cannot adjust your medication list, he/she adjusts your soul instead. By a single warm word sometimes. Additionally, there are many real experts in their fields among them. I was fortunate to meet a nurse for example, who had a built-in talent to read ECGs better than any of his specialist co-workers.

    The message here is: respect, please. In my opinion, there is no lack of expertise among doctors, there is a lack of respect and trust. And, in the opposite direction, patients do not trust their doctors, as they do not like to be dictated, interrupted, dismissed. We still have a paternalistic medical care model, where the doctor is a God, and the patient has a passive role of listening and having as few questions as possible.

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    1. Great additions, MioMyo. I especially liked your comment about the nurses. I worked with nurses for several years and was continually impressed by the skills and caring of SO many of them…

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  11. 11. Continue to talk to the patient during the procedure, calmly explaining what is happening and asking if they understand and if they are alright.

    12. Give the patient his/her privacy to dress again and let them know who will be following up with them with the results. Thank them for coming in and direct them to the exit.

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  12. Oh, yes! That sounds like my first experience with a stress test. And then, when I had to stop prematurely because of severe pain and an inability to breathe, did they think to ask if I needed an inhaler? Oxygen? A cardiologist? Of course not!

    Thankfully, last week’s stress-echo was overseen by a WOMAN PA, with a WOMAN echo tech. The lone man left the room while I got ready behind a curtained partition. When he did have to approach me to administer meds, the echo tech ensured that my modesty was preserved. The Oklahoma City VA Medical Center is learning, though some of the surgical residents who come over from the University could use your list.

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  13. Thank you for this Carolyn. I live in the UK and find that most often the NHS staff is very personable here and they seem to have integrated most of what you recommend…before I came here to live I had never had a doctor look me straight in the eyes and ask me in an appointment ‘how are you within yourself’ after I had told them about the specific reason I made the appointment.

    I experienced this as a deep regard for my heart self, a beyond polite note of caring that inspired me to care more for myself (as you write – it is scary to go to the doctor or hospital when your body ‘is not working’ the way you want it to or expect it to is how it USED to). I have made note of Kate Granger’s work now in the UK. Thank you to your 2009 self for writing this and your 2015 self for including it again. Good luck on your new writing project. You inspire me to get on with my half finished ones!

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