Don’t take patients’ patience for granted

When I was a resident one of my attendings said, “You know why patients are called ‘patients’? It’s because they have a lot of patience. For us.”

Patients in hospitals do a lot of waiting. They wait for physicians. They wait for nurses. They wait to use the bathroom. They wait to undergo procedures. They wait for their IVs to stop beeping. They wait for the person next door to stop vomiting up what sounds like all of their internal organs. They wait for the person down the hall to stop screaming. They wait to eat. (Doctors: Reverse those NPO orders as soon as you can! Food is at the base of Maslow’s hierarchy of needs! Food is more important than safety and security of health!) They wait for the nursing assistants to finish taking their blood pressures so they can sleep. They wait for the unit clerk to answer the phone so a nurse can help them get out of bed without the bed alarms screeching throughout the unit.

They wait to feel better. They wait for good news.

No one has any idea how much patients wait in the hospital until you become a patient in the hospital.

Sometimes it’s not even clear what patients are waiting for. Hospital staff arrive and they have no idea why they are there:

  • “Hi, I’m the physical therapist.”
  • “Hi, I’m here to take you down for an ultrasound.”
  • “Hi, I’m the dietician.”
  • “Hi, I’m the consulting psychiatrist.”*

Because of the nature of acute care in hospitals, rarely do things run on a consistent, predictable schedule. This lack of punctuality is not intentional; things change. Hospital staff triage patients all the time and, unfortunately, patients and patient care are shuffled around in order of acuity.

Thus, if you’re in a hospital and someone tells you that so-and-so will see you at 2pm, don’t believe it. Yes, so-and-so might actually see you at 2pm, but it takes extraordinary planetary alignment for that to happen. So-and-so might show up at noon … or at 4:30pm.

Yes, doctors wait, too. The waiting doctors do, though, is informed by the knowledge they have about why they’re waiting. Doctors wait for patients to come out of the bathroom. They wait for patients to go for a study or imaging test. They wait for family members to arrive to get more history. They wait for the pathology or study results to clarify diagnosis and treatment. They wait for information that affects what happens next.

Patients often wait without knowing what will happen next.

If you work in a hospital, remember that most patients have an extraordinary amount of patience, given the circumstances. Yes, there is a minuscule minority who have the frustration tolerance and impulse control of toddlers, but that is not a common means of coping in adults. (Physicians tend to call psychiatry when this happens. This is not a common consult.)

Do what you can to orient patients to what is going on. Give them approximate times for your visits and if you are running late, send a message to them to let them know. (Technology could help here: What if we could send text messages to patients through the television? or if the text message could become a voice message on their in-room telephones?) If patients are not around when you come by to see them, leave a note to let them know that you’ll try again later. (Technology could help with this, too.) Tell them why you don’t want them to eat after midnight. Tell them why you want them to work with physical therapy. Tell them the purpose of the bed alarm.

Help them understand what they are waiting for. Don’t take their patience for granted.

* Hospitalists: If you call a psychiatry consult for your patient, tell your patient. Most people, with or without psychiatric issues, do not appreciate an unexpected visit from a psychiatrist. “I’m not crazy! Get out of my room! No one asked you to come here!”

Maria Yang is a psychiatrist who blogs at her self-titled site, Maria Yang, MD.

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  • Suzi Q 38

    “….* Hospitalists: If you call a psychiatry consult for your patient, tell your patient. Most people, with or without psychiatric issues, do not appreciate an unexpected visit from a psychiatrist. “I’m not crazy! Get out of my room! No one asked you to come here!….”.

    So true.
    I would have refused your visit,, and made sure I wasn’t charged for it.
    Sometimes, there are too many consults. Not all are necessary.
    My assigned hospitalist and PCP knows not to send in a consult without my approval.
    I like to know who is visiting and treating me, and why.

    I also like to rest while I am in the hospital.

    With so many interruptions, I am better off at home with my daughter, who is a nurse.

    Also, with all the cutbacks, the last hospital I was in was visibly filthy.
    I knew that I needed to get out of there ASAP.

    • guest

      Given the severe shortage of psychiatrists, your typical psychiatric consultant has more consultation requests than he or she can handle anyway. I promise that they are not out looking for business.

      In any case, hospitalists and surgeons do not just ask for psych consults on patients who are schizophrenic, depressed, suicidal or agitated. They also ask for consults in situations where the patient appears to have emotional needs that the doctor cannot meet in a reasonable length visit. Such situations include cases where the patient is so emotional during the visit that they cannot communicate effectively, cases where the patient appears unusually hostile, and cases where the patient is obsessively preoccupied with past negative experiences with medical care. In such cases, the hope is that the psychiatrist will be able to spend enough time with the patient to help her process her issues and work more effectively with the treatment team.

      Having said that, I completely agree that it is not at all a good idea to order a psychiatric consult without discussing it with the patient first.

      • Suzi Q 38

        Thank you for your explanation.

    • rbthe4th2

      Oh yes, had a doc do this too. I got a call from this psych doc and didn’t return the call. I raised crap with the insurance. They then raised crap with the doctor who did the call in the first place.
      Randy

  • rbthe4th2

    I see a lot of that: doctors complaining once they are treated like us cattle call patients are.