Nikki, a weathered ED nurse, took me aside during my internship. "Just because that was your eighth patient with an ankle sprain this evening doesn’t mean it was her eighth ankle sprain.” My ears burned with indignation. How could people praise me for moving patients through the system and at the same time criticize me for not spending enough time with them? Now I salute Nikki and other nurses for believing that I was trainable.
The next step in my inadvertent journey to improve the patient experience came two years later when a lump in my neck proved to be a non-Hodgkin’s lymphoma. "It’s not fair,” one of my colleagues said. "You are a sensitive doctor. Why couldn’t this happen to some of the residents you work with who need to learn what it is like on the other side?” I felt that being a patient transforms a sensitive person into a sensitized person. I likened it to being a white male college professor who does research in race relations suddenly waking up and seeing that his skin has changed color. After that experience, it became easier for me to be in a room with an angry patient and family and say sincerely, "I can only imagine how upsetting this is for you,” and ask, "How can we work together to make your situation better?”
I witnessed the power of apology when I was asked to see a 20 year-old college student whose parents drove him from his college to the hospital where I was working after an ER doctor at an academic medical center dismissed his abdominal pain as alcoholic gastritis. After I went into the room, introduced myself, and said, "I’m sorry this has been such an ordeal for you,” I watched his parents’ shoulders drop several inches from the level of their ears. I operated on their son for appendicitis.
It wasn’t till I did a fellowship in surgical oncology that I learned that there is a time-tested framework for delivering bad news to patients. The SPIKES protocol consists of six steps, including:
- Setting: respect privacy, involve others, be seated, look attentive and calm, listen actively, be available; let patient know of any time constraints ahead of time
- Perception: ask patient’s and family’s viewpoint and concerns
- Invitation: ask how much information patient wants to know
- Knowledge: warn of upcoming news; give information in small chunks and clarify understanding at each step
- Empathy: acknowledge the patient’s and family’s emotion with phrases like, "I can only imagine how you must feel.”
- Strategy: summarize events, check understanding, and plan for the future
That a surgeon like myself can learn from inadvertent experiences suggests to me that all physicians can benefit from training. I salute programs like the one where I trained (Columbia College of Physicians and Surgeons) that use actors to give medical students feedback about body language, tone of voice, and word choice. In general, physicians have done everything that we have asked of them. We:
- Studied hard in college to get into medical school
- Memorized and regurgitated facts the first two years of medical school
- Worked 80-100 hours during residency and fellowship training
A physician CEO once told me, "We dismiss communication, negotiation, and conflict resolution as the soft skills, but they should be called the hard skills since they are so hard to do consistently and so hard to do well.” Physicians enjoy learning from fellow physicians. It can inspire all of us to be better role models in our daily practice.
Ken is a general surgeon/ MBA and CEO of Healthcare Collaboration, who works with healthcare organizations to engage doctors to improve the patient experience and organizational performance. To learn more about what he does, please visit Healthcare Collaboration.