Because hospitalists may have only an initial, brief, single encounter with many patients they care for, there is not much time in which to establish rapport and gain trust and confidence. I suggest 10 easy-to-apply actions that generate “thank yous” and give immense professional satisfaction even in the face of a poor patient outcome.
- 1. Always introduce yourself and your role in the patient's care. If you have an unusual or difficult-to-pronounce name, enunciate clearly. Provide a nickname or other means to make you easily identifiable to the patient. For example, most people know what a piranha is. When I am asked, “Doctor, what is your name again?” I answer “Peraino, like piranha the fish” and make the hand motion of a biting fish. Write your name down or provide a business card. My hospitalist group has started using business cards with a photo.
- 2. Address the patient formally—Mr., Mrs., Ms.—unless invited to use a first or nickname. This shows patients respect for their individuality and lets them know that they are not just another Tom, Dick, or Harry.
- 3. Shake the patient's hand at each visit. I cannot emphasize enough that touch is very reassuring and shows patients that you are there for them, that you really care. Shake hands with every person in the room and ask his or her relationship to the patient. Thank them all for being there to support the patient's recovery and comfort.
- 4. Move a chair close to the bed or patient and sit down. Lean toward the patient when conversing. This prevents you from unconsciously sitting back with arms folded and legs crossed—a posture of indifference, disinterest, and skepticism. Always address patients directly, even if they are comatose or suffering from dementia, before addressing the significant others present. This gets you in the habit of not ignoring the patient while conveying important information and getting decisions from others present. If patients sense you are talking about them, treating them as a child, or assuming they are incapable of understanding, you will have irreparably damaged your rapport and their confidence in you.
- 5. Address the patient's comfort before beginning your interview. “Are you in pain, thirsty, nauseated, warm enough?” If you can relieve these issues before attending to the disease process, do so. If not, then tell the patient you will take care of the discomfort as soon as you have formulated a plan of care. If I can get the patient an extra blanket or a beverage, I do so personally. I do not ask and wait for the nurse to provide these. It doesn't add much time to rounds, but it adds immensely to our relationship.
- 6. Review test results and what they mean with the patient, as well as those present, if appropriate. Solicit questions and provide frank answers. Saying “I don't know” is not a sign of incompetence but an invitation to learn.
- 7. Review the plan of care to date and what the patient can expect from the treatment. For example, you may comment that it's “too soon to see an improvement” or “may take a few more hours/days to see a beneficial result” or “breathing is better; appetite is returning.” Saying something like “the antibiotic is killing the germs in your blood” may be true, but how does that relate to how patients feel or their chief symptoms? It's better to say “As the treatment takes hold, you will feel less fatigued, stronger, your appetite will return, and the fever will end,” if the main problems were fever, fatigue, and loss of appetite.
- 8. Review that day's plan of care with the patient. For example, let the patient know that hydration and antibiotics will be continued and that mobilization will be started. Tell the patient about any planned blood and diagnostic tests and why they have been ordered.
- 9. Before leaving the patient, summarize your visit. Repeat the diagnosis if known (and, if not known, what is to be done to make the diagnosis), the plan of care to date, and changes to be made. Repeat a third time. Limit important information, as much as possible, to 3 items, such as “Treat your pain, continue fluid by vein, continue antibiotic.” Otherwise the patient and others get information overload and can become confused or inaccurate about what they heard. Ask for questions. After each answer you give, do not assume that there are no more questions. Instead, repeatedly ask for more questions until there are none.
- 10. Tell the patient and others when you will return and until what time you are available in house. Remind patients to ask the nurse to call you if they want to ask more questions or express a forgotten concern. Ask who should be notified about the hospitalization and the patients' condition. Let patients know you have contacted their spouse, daughter, or friend.
Once all 10 items become habit, the total time required to complete them will be less than 10 minutes. Because of your bedside manner, the patient and any significant others will feel like he or she is your only patient.