Better Explanations and Setting Expectations at the Bedside

By Marc Belcastro, DO, chief medical officer, Southern Region

I am the Southern Region Chief Medical Officer (MVH/MVHS/Atrium). Every day I am thankful to serve you. I hope you continue reading this series on patient experience. Thank you for your time and consideration of my challenge to you.

While this article concerns the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey, it is more about physician satisfaction and personal fulfillment. For your information, below are the questions patients are asked when evaluating their physician interactions. Truly, would you not want your patients to answer “always” to these questions?

• During this hospital stay, how often did doctors treat you with courtesy and respect?
• During this hospital stay, how often did doctors listen carefully to you?
• During this hospital stay, how often did doctors explain things in a way you could understand?

Recall the simple tool represented by the acronym AIDET: Acknowledge, Introduction, Duration, Explanation, and Thank you. A tool is simply something to facilitate what we desire to accomplish. The tool, or “script” as some argue, is not the point of this discussion. Our passion to care and serve is what must drive us. In May, I wrote about the introduction with a powerful addition called “manage up.” In this article, I will discuss Duration and Explanation.

Finding a way to inform your patient of “durations” will provide some measure of calm regarding their fears and anxieties. This might be how long you will spend with them talking or performing a procedure, how long until you return to talk with them, or how the time of a scheduled procedure may easily change to accommodate emergencies. Admittedly, we all feel better when we know how long something might last, how long we might have to wait, or when to expect an answer to a test that is life-changing. It is also true, particularly in medicine, that wait times are subject to many variables we cannot control. After three decades of practicing, I came to realize that the families I cared for understood that my predictions of their “waiting times” were not precise, especially when advised of the unexpected events that can alter a physician’s day or cause delays in procedures and tests. For certain, an attempt to provide a time frame is far better than saying, “I just can’t say, it’s too variable.” Even more powerful were the expressions by some families knowing that their wait was allowing me to care for another family in distress.

Most – if not all – physicians provide “explanations” for their families and patients. The two keys to an explanation that is understood are speed and our choice of words. We must truly “slow” down a bit for our patients and families to keep up with our discussions. Our days are truly fast paced. This requires an intentionality to our slowing down. In addition, try to pay attention to how often you use even the simplest of medical verbiage that may not be understood. Combine this with an explanation at even a normal pace, and most patients will not comprehend us.

Finally, complete your explanation with only open-ended questions. “What questions do you have?” or “What would you like me to repeat?” are very effective.

These two steps do not take more time; in fact, they will save you time in the long run throughout your day. Most importantly, your patients will find more peace in their journey. 

Back to the November 2017 issue of Premier Pulse