Blog | Wednesday, June 11, 2014

Patients don't like the feeling of being pushed out the door


The focus on patient satisfaction and improving the hospital experience is stumping a lot of top-level hospital executives. What is the magic formula? Truth be told, there isn’t one. Most of the answers just boil down to practicing good medicine, simple common sense and basic communication skills. No matter how much anyone talks about the issue or how many “Directors of Patient Experience” an organization hires, forget these fundamentals and you will get nowhere.

And that’s the problem with our current approach. In the maze and complexities of health care, we sometimes lose the forest for the trees. A good example of one such contradictory approach in how we treat our patients is that at the same time we want them to rest and recuperate in a pleasant environment, we are also completely focused on pushing them out of the hospital ASAP!

Now, don’t get me wrong, in today’s world of increasing health care costs, concern about hospital acquired infections, and huge strains on our resources. Getting people out of hospital as soon as they are ready is always a good thing. It’s never better to stay in hospital if you are well enough to leave. That being said, it is also a really bad idea to give our patients the impression that all we want to do is kick them out of the door! Not to mention the fact that premature discharges are frequently blamed for a large number of readmissions; a problem that front line doctors see on an almost daily basis.

In my career, I’ve encountered hundreds, if not thousands of instances, where patients who are barely admitted to hospital, lying in bed at the sickest and scariest times of their lives, are almost mobbed by administrative staff and case management about when they should be ready to go home (allied to all the talk about their insurance coverage and admission status, it’s enough to make almost anyone feel worse). This often unfortunately happens while they are still very unwell, feeling vulnerable, and have lots of questions about their illness.

Then there’s the telephone calls made to worried relatives on the day after admission, where there’ll be a lot of talk about these things, before the doctor has even had the chance to address the actual medical illness. What are we thinking?! When I see this happen, I usually try to distance myself from it and stay focused on what the patient’s medical problems are, reassuring them and their family that we won’t discharge them until they are feeling a lot better. It may be part of the job of hospital administration in today’s health care environment to get the discharge plan set in motion, but during the emotional time of an illness, we have to exercise a bit of tact in how we do this.

Many doctors also now inadvertently give the same impression, that it’s all about making their patients leave (rather than maintaining a focus on them feeling better first). This can be especially anxiety provoking for vulnerable elderly people, where we must make sure we are striking the right balance between wanting them discharged and not letting them feel like we don’t want them under our care. Collectively, we have to realize that we bear this responsibility for making our patients feel welcome.

To draw a comparison for a moment with other service industries. Take hotels and restaurants. I accept that these are places where people “want to be” as opposed to hospitals where “nobody wants to be”. However the same rules of politeness and respect still apply. Imagine that the very second you entered a hotel or restaurant you felt pushed by the staff and constantly inundated with the feeling that they want you to leave. Would you expect any such place to have good customer service ratings? Or what about at home, if you invited some guests over and then constantly kept reminding them of when they needed to leave? They will likely never come back to your house!

I’ll finish with this perspective: Ask many of your parents or grandparents what hospital care was like 30, 40, 50, 60 years ago, well before we all wore the badge of “patient satisfaction”. They may have had less medical wizardry available, but most of them will tell you that their care was just fine. They were comfortable, usually knew their doctor well, and most of all were allowed to recuperate peacefully without being constantly reminded about needing to leave. Somewhere in the tumultuous journey health care has been on in the last couple of decades or so, we forget these basic rules of courtesy.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.