Communication as a key component of patient experience
How we got from ‘I’ve got a kidney stone’ to ‘We’re going to take out your gall bladder immediately.’ Patients need discussions, not dictums.
Patient experience is gaining more attention from healthcare professionals. Because the industry is drenched in complexity, adopting an improvement strategy can become a convoluted, intricate exercise.
But strategic approaches that are complex are often difficult to implement on a consistent and ongoing basis. To get such strategies to sing, they often need to be simple, repeatable and no-doubt-about-it common sense.
I’ve been doing some thinking about this lately. I’ve been writing about or editing healthcare stories for nearly 40 years, and I’ve deeply imbibed the complexity Kool-Aid. So how would I completely simplify an effort to give patients warm, fuzzy feelings about their encounters with healthcare organizations, so that they are empowered to make the best decisions and really take charge of their post-encounter health?
I think it comes down to communication that level-sets expectations and ensures there are as few surprises as possible, mixing in a heaping helping of compassion and relationship. When it comes to treating challenging conditions, there are curve balls and unexpected issues, but ameliorating those again falls back to a good back-and-forth discussion with patients and their families – building a relationship, not just consummating a transactional event.
When communication gets truncated, that’s when patients feel out of control and confused. They’ve been acculturated to increasing levels of communication everywhere else in their lives – they can track the progress of their packages from Amazon and other merchandisers, but those expectations of precision still face a learning curve in healthcare organizations. And patients and their families – working their ways through a health crisis – can easily feel talked to, not part of a critical discussion.
Surprise, surprise
That whole enchilada – the surprise, that lack of discussion, that feeling of being a widget and not a person – was something I experienced about five years ago. It was scary, didn’t make sense and left me wondering if anyone was hearing me.
I’ve been fortunate to have good health, so this particular incident was all the more jarring. One night in August 2019, I woke up in the early morning hours with incredible back pain and nausea. After a quick stop at our primary care doctor’s office, I walked in like a bent paper clip to the emergency department of a local community hospital.
The diagnosis, after imaging studies, was a kidney stone. Given what I had been through for hours, I was expecting the size to be something close to a bowling ball; instead, imaging revealed it to be one millimeter. That amount of pain from a tiny stone was pretty humbling.
Most of the emergency treatment went pretty well. Medication effectively dissolved the stone as I lay in a bay in the department. After a sleepless night, I kept dozing off – only to be consistently re-awakened after my low pulse rate set off the alarm on the heart rate monitor. In the middle of marathon training, my heart rate dropped into the low 40s, and below, when I slept. Thankfully, we finally convinced them to turn off the warning alarm.
But then an ER doctor dropped the bomb. They were going to admit me and set up surgery to remove my gall bladder, which appeared slightly inflamed on the imaging study. So, their call was to take it out ASAP.
Suddenly, I was really awake. While I had been bent in half by the tiny kidney stone in the previous 12 hours, I had no discomfort or signs of illness in the previous months. Not that anyone asked me – the gall bladder decision just seemed to come from above with no queries about my history, current health status, physical activities or family history, and no sharing of the imaging studies that set off the decision.
Besides being worried about a potentially needless surgery (there was no explanation why it was urgent to remove the organ, by the way), I was concerned about how soon I’d be able to resume marathon training, or even run the Chicago Marathon in six weeks. I received no information on the type of procedure, potential risks, education on gall bladder removal – perhaps that would have come later when I was asked to sign permission documentation. Just get this guy into a room and into surgery.
Finally, someone talks with me
But before we were going headfirst into the surgical suite, the ER clinicians wanted to get a better look, so they scheduled a more precise imaging procedure. They wheeled me into the imaging department again for a 15-minute session, where I was warned to not move for the duration and stay awake. No worries on that – you’ve got my full attention, and my heart rate was no longer slowing down.
So, I gazed at the ceiling of a dimly lit room, pondering everything I didn’t know about what was going on, sleep-deprived, hungry and completely confused. It was a long 15 minutes.
Finally, imaging procedure over, the surgeon walked in to talk to me while I was still flat on my back on the ER gurney.
He was looking at the report and looked confused. “So, what did you come in today for?” he asked.
I explained the effects of the kidney stone, and how the pain had resolved within a couple hours of treatment in the ER.
“So, you didn’t have any indications of problems or abdominal pain before this morning?” he asked, looking confused. No, I replied, no problems beforehand.
“So, no tests in previous months have indicated any problems?” Nope.
“Have you had any dietary issues or abdominal pain? What’s your general health like?” I said no, explaining that I had been training for a fall marathon for the last few months and that my health had been excellent.
Now he really looked confused. “Any history related to the gall bladder? Any family history?” None.
“So do you want to do this?” Finally, someone sought MY input. I indicated that I was hesitant because I had no other concerns other than the kidney stone, little other information was provided as to why this was urgent and worries that it would impact my marathon training.
After taking in this information and looking at the report one last time, he said, “OK, we’re not doing this,” with a mix of befuddlement and consternation.
After I was wheeled back to the ER, the specialist announced that I would be discharged and to self-monitor for any changes in my condition. My wife recalled that the ER doctor looked concerned that his determination had been overruled, but he acquiesced. We left the hospital that afternoon after a long and tumultuous day.
(Well, at least marathon training continued without incident, and I was able to run a 3:51 in Chicago and qualified for the 2021 Boston Marathon.) And since that August, there have been no other indications that my gall bladder was acting up.
Two different experiences
I hope this event illustrates the importance of communication in determining patient experience. Healthcare encounters are emotional, high-stakes events that deeply affect patients who need information and time to process what they are hearing from clinicians.
I would expect ER clinicians are likely to be more direct in making clinical decisions because they deal with patients who need emergency care of a time-sensitive nature. Still, there’s a need to differentiate between urgent, emergency care and “next steps” care, which can allow time for discussion, patient education and processing out of a high-stress environment.
While many factors may have played into what happened on this day in 2019, there’s validity in understanding the impact of communication on patient perceptions and their overall experience. And when my next kidney stone rolls around, I’ll be less sleepy and have more of an inquiring mind, ready for a good discussion about what’s going to happen next.