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Trisha Torrey

How Tone and Approach Can Improve Your Care

By May 3, 2010

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So many of us patients are getting on the empowerment bandwagon. We're asking questions, we're sticking up for ourselves... it's all good... until....

Two articles to share with you have crossed my monitor in the past few days. And both are less about the facts of the situation, and more about how we approach them.

First, colleague Ilene Corina, a patient safety advocate who often spends time at a patients' hospital bedside, tells about asking a nurse to wash her hands before touching the patient. The nurse took offense. Later Ilene had to ask the same of the doctor, but she changed her approach a bit, and didn't meet with the same resistance.

Then, this article from US News and World Report about how advocates can best help their patients in the hospital. It's all about (pardon the french) backside-kissing.... but it does seem to work.

I've sounded warning bells before about getting overly aggressive when you are trying to get a certain form of care, or even when you're trying to get your hospital bills fixed. At the least, this too-in-your-face behavior can mean you put your doctors and other providers on the defensive. At the very worst, they will bounce you from their offices, or even blackball you all together.

Our grandmothers told us we could catch more flies with honey -- and they were right. It seems from these two stories that we can advocate for our loved ones more effectively with tone-of-voice and approach "honey", too.

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May 4, 2010 at 10:05 am
(1) Sara says:

(1) Why do we talk favorably about catching flies with honey. Who wants flies? The point of catching flies with honey is to rid yourself of them, not to work with them.

(2) I would appreciate more specific advice on this topic, and also information about how to find out what grievance policy the hospital has when you run into a truly miserable nurse or doctor or other health professional who is an obstructionist when it comes to respecting and working with patient advocates.

Due to my father’s ill health of the past 14 years, I and my mother and sisters have received our own master’s-level education in being a caregiver and hospital patient advocate. Many doctors and nurses “get it,” particularly in ICU’s and when dealing with specialists, and I can’t tell you how appreciative I am of them — my father’s care has been made immeasurably easier by their wonderful work, and we don’t all go home stewing and frustrated and scared after a hospital stay when we’ve had good care.

But there are also a lot of old-school nurses and doctors who don’t follow appropriate cleanliness measures, or who really resent polite questions and requests about medication and meals and exercise and hand cleaning.

Hospitals need to have a timely and fair grievance and mediation process so that patient advocates aren’t jerked around. My own feeling is that everybody involved wants the patient to get better and be comfortable and therefore get released from the hospital as expediently as possible and in the best position to continue mending or stay stable once home or in a nursing home.

And yet I recognize that that is often poorly expressed, by both sides. Sometimes as a patient advocate I know it’s tough to keep track of what’s going on, and if you can’t be by the patient’s side 24/7 and you can’t get information about what’s been going on in your absence, it can quickly escalate to anger even when there’s no true issue. At the same time, when you witness a lapse in care that will jeopardize the patient’s ability to heal or even will harm the patient, it’s important that your concerns not be met with stonewalling or accusations.

Nurses and doctors, as the day-in/day-out professionals here, have a real opportunity to construct and engage in a good dialogue and team-building with patients and their advocates towards clearly-articulated goals for the patient’s care and recovery. Hospitals have a clear financial interest in getting people out of the hospital quickly and in protecting and improving their health while in the hospital, so that they hopefully don’t return. Many insurers, both government and private, are contemplating penalizing hospitals that have a large percentage of repeat patients in certain categories where it’s deemed that better hospital treatment the first time and better follow-up care, should not be resulting in re-admission.

What are hospitals doing to help mediate these tensions and disagreements between hospital caregivers, and the families and patients? If I’m at the hospital and am having a problem with a nurse who won’t wash her hands before putting in a catheter or who cannot or will not resolve problems with timely medication or food delivery, what’s my recourse?

May 4, 2010 at 10:34 am
(2) bennett says:

This is precisely the approach I teach for Docs in patient-centered care. In response to the first comment, this is why some Docs are so rude. they reason “why should I ask a patient what her feelings and concerns are? She still needs to take the med so I’m just going to tell her to do it.” they don’t realize that by doing this they actually lower the odds of their plan getting carried out.

in the same way, if you want THEM to carry out your “plan” you’ll get more with a carrot than a stick. It’s a feature of human nature. There are plenty of times I wanted to scream at a parent that they’re being unreasonable or stupid, but I don’t because it’s firstly unprofessional and secondly will only make things worse.

I will let Trisha answer the second part…except to say that emailing the President of the hospital as one parent of a patient I met recently did really isn’t a good idea to foster team spirit…


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