Good patient communication by managing expectations

My father suffered a mild heart attack last year. In his 80+ years, he has never had any indication he had a problem with his heart!  A variety of other health issues have arisen over time, but Dad’s heart was always thought to be as strong as could be.

In fact, despite protestations (“I don’t really think these chest pains are a big deal… let me just make an appointment to see my primary….”) emergency personnel arrived and whisked him off to Sarasota Memorial Hospital (Florida) where he spent the better part of the next three days.

Some rigorous testing, a heart catheterization and an angioplasty of a small artery later, Dad later went home.

I happened to be visiting him when it struck – amazing timing, don’t you think?  I’ll be here for a few more days to make sure he’s on his feet and feeling more confident, as we review what led him to a heart attack and what adjustments he’ll need to make from here.

Of course, little did those who helped Dad know that a critique would be forthcoming once we were past the initial shock and care. I’ve been making observations throughout that might help all of us get the care we need.

I can’t say enough good about Sarasota Memorial Hospital.  I’ve been admitted to, and visited, many hospitals, but by far, SMH is the best I’ve experienced.  Here’s why I say that.

The personnel were very helpful. No one was ever too busy to answer a question or explain what we needed to know.  When we had questions about the meaning of the various numbers appearing on the monitor he was attached to, each section was patiently explained to us.  When they moved Dad to a room, I was able to get easy directions to find him. When Dad was admitted, he mentioned he hadn’t eaten any breakfast or lunch, and a turkey sandwich appeared.

The hospital is immaculately clean, from the facilities to the people.  A great deal of emphasis is placed on washing and sanitizing hands and surfaces.  I watched the cleaning people use great care in cleaning up behind the patient in the next bed, wiping off every surface including the phone, the bed controls, the TV remote.  The personnel that actually touch patients (nurses, others) were diligent about washing their hands and sanitizing.  The only time either Dad or I asked them to wash their hands was in the emergency room, and then the nurse told us she had sanitized before she came in the room (although I didn’t see any dispensers outside the room.)  But she was happy to comply when Dad asked. Of course, the entire point is to avoid infections.

Dad’s nurses, in particular a young man named Eyves who was available the entire day of his procedure, and the night nurse, Bren, were particularly helpful.  Dad had a rough time of it — a lot of pain and nausea.  Both were right there for him and did everything they could to keep him comfortable.

The check-out process was excellent.  All instructions were explained to us carefully. Dad, foggy from so much painkiller, had some trouble processing instructions, but the discharge nurse was very patient, taking it very slowly so it could sink in.

Even the food in the restaurant is good!  Add that to the free parking, great signage (very easy to find my way around) and the fact that we could use cell phones, had free internet access and no restricted visiting hours.

The only fly in the hospital ointment was communication from the doctors — a problem that was a much larger minus than it needed to be.  The problem was this: we were told that both the proceduralist who performed the heart cath/angioplasty and another doctor would visit us a few hours afterwards to explain the findings and next steps.  It never happened. In fact, the proceduralist never visited, and Dad’s new “assigned” cardiologist (the recommendation from his primary) didn’t visit until the next day.  Both he and the primary get a few points for phoning me (it was 7:30 AM, and I hadn’t gone in to the hospital yet).

This problem was not about the actual communications; rather, it was about managing our expectations.  If we had been told we wouldn’t be contacted by either doctor until the next morning, we would not have expected it, nor would I have been upset when we didn’t.

And this is where Dad’s nurse, Eyves, gets more brownie points. When I made it clear how peeved I was many hours after we expected the proceduralist to arrive, he tracked down another doctor in that same practice who then called me and explained in a very detailed manner exactly what the findings were during Dad’s procedure.

This won’t be our last experience with Sarasota Memorial Hospital. My parents are both older and both have health issues. I expect I’ll get to know much more about this facility. I’m very thankful to know there is so much emphasis on the important aspects of care.

One more point to make:  as mentioned, Dad was “assigned” his new cardiologist.  I helped him understand that he is under no obligation to accept that assignment.

The same is always true for you.  Referrals can work out well, or they may not.  Just because you are referred to a specific doctor does not mean you are obligated to stay with that doctor.  You may always choose your own doctor, as may Dad.

Trisha Torrey blogs at Every Patient’s Advocate and is the author of You Bet Your Life! The 10 Mistakes Every Patient Makes (How to Fix Them to Get the Healthcare You Deserve).

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  • Jonathan

    Unless the physician himself told you that he would come by and visit, then it is unfair to blame the doctor for the “miscommunication.”

    I do not know the protocols of the hospital but we only see post-operative patients after a major procedure or a minor procedure with complications.

    Although the angioplasty is a significant procedure for your family, it is a simple procedure that rarely requires a post-op consultation.

  • Tricia

    Medicine today is a team sport. Perhaps in some other world besides this one, direct physician-patient communication would occur instantaneously and on command, and there would be no one else involved. But this is not our reality. There are many players involved in the health care experience, including the primary care doctor, specialist, nurse, and patient/family. If one member of that team is told to expect something from another member of that team and it doesn’t happen, that is a communication lapse that needs to be addressed as a team, by all members of the team.

    • pcp

      Your father receives excellent care in an emergency situation, and yet, because one “someone” told you somthing incorrect, you expect the entire “team” (i.e., the dozens of people involved in your father’s care) to conduct an analysis of the “communication lapse”?

      I’m sorry, but I think that is unreasonable.

  • Carolyn Thomas

    I completely agree with Jonathan’s comment in this particular case.

    As a heart attack survivor, I’ve had a couple catheterization procedures and the interventionalist in both cases tells the patient right on the spot in the cath lab what’s going on inside the heart via the screen overhead.

    Skilled CCU nurses – who by the way, in my experience as a ‘frequent flyer’ heart patient, are far more expert in post-op patient care than that interventionalist could ever be – are perfectly appropriate for the management of overnight care and home discharge instructions unless there is a severe complication following the procedure.

    It sounds like by all accounts your Dad actually received exemplary care throughout!

    The only issue here seems to lie with whoever told you to expect the visit of not one but two physicians for a chat. If any follow-up is warranted, rather than recounting the story here, you might consider tracking down the specific person who made that completely unrealistic promise to you.

    Personally, if two physicians phoned MY family at 7:30 a.m. to discuss my previous day’s cardiac procedures, I would be pretty darned impressed! You are absolutely correct: managing expections – realistic or otherwise – is the key in all successful health care.

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