Our nurses will soon have “scripting” guidelines for their interactions with patients. This is apparently widespread in many industries. The idea being, patients will be more satisfied with their care if certain key phrases are repeated to them; phrases which might, possibly, just maybe find their way onto satisfaction surveys. Wink, wink!
Whether I will have to engage in this tawdry bit of theater remains to be seen. But bless the nurses and clerical staff! Here are the early scripts, printed on yet another laminated card to go with the other assorted cards all the staff wear with their ID badges (predicted to weigh at least 5 pounds in total policy reminders before long):
“Hello, I’m (name, occupation)”
“I’m here to (Meds, Procedures, Clean)”
“Is there anything else I can do for your?”
Key words: Safety, Privacy, Care
Our nurses and secretaries are wonderful people, and might have had careers in Hollywood if things had gone differently. But one of the last things they really want to do is act. Nevertheless, I know the game.
Someone will read this and think that I’m a Luddite, a curmudgeon, a stick in the mud of progress. Others will say, as they do about every new customer service initiative, federal ruling, Joint Commission rule or state nursing board policy: ‘It’s only a little thing, so stop being a baby and get with the times. Sheesh!’
Indeed. It may be the case. Only today I was reminded, in a meeting about STEMI, that my group is tragically, woefully lax. We are failing to use a key phrase that explains why thrombolytics might be given instead of percutaneous intervention. In order to meet quality indicators (and get paid appropriately), we must write, in the chart, the following magical incantation: ‘The patient received thrombolytics because his time to cath lab would exceed 90 minutes.’
Silly, lazy doctors, trying valiantly to reach the bedside and touch a patient, make a good decision and save a life when we could be populating data fields! Bad, bad doctors! To quote Monty Python and the Holy Grail: “You must spank us! Yes, spank us all!” I digress.
Let me bring it round again. Scripts are about patient satisfaction scores, which remain quite the rage despite some rather damning suggestions that they might not be good for doctors or patients. Scripts come to us from firms hired, using hospital budgets, to teach us how to increase satisfaction scores in order to put more money in the budget … and on and on it goes. How much we lose on consultants in order to make enough increased money to pay for consultants is a bit of a mystery to me.
Still, progress marches forward. So let me suggest how I might find scripts useful:
“Hello, I’m Dr. Leap. I’m here to take care of you while you’re sick, not do data entry. Is that OK with you?” Key words: care, sick, data.
“Hello, I’m Dr. Leap. I’m here to preserve your airway and rescue you from your own alcohol toxicity. Is that OK? Is there anything else I can do for you? Sorry, I can’t understand when you vomit.” Key words: airway, sick, alcohol, toxicity, data, scores … vomit.
“Hello, I’m Dr. Leap. I’m here to decide if your pain score is really a ten, since you look uninjured. Is there anyone I can go ahead and call to take you home?” Key words: ten, uninjured, call, home.
“Hello, I’m Dr. Leap. The last time you were here you stole an entire drawer of dressings and a dirty needle box. I’m here to report that. Is there a parole officer I can call for you?” Key words: stole, drawer, needle, parole.
“Hello, I’m Dr. Leap, I’m here to commit you to a psychiatric hospital to help you obtain disability at 30. Is there anything else I can give you besides my time and my tax dollars to help perpetuate your life of inactivity?” Key words: commit, psychiatric, disability, 30, tax, inactivity.
“Hello, I’m Dr. Leap. I’m here to ease your suffering, my dear, stoic little lady. Whatever you need is fine. Is there anyone bothering you because I will shut them down!” Key words: suffering, dear, stoic.
“Hello, I’m Dr. Leap, I’m here to find out why you’re smoking in the emergency department, and ask you to leave. Is there any way I can make that happen faster?” Key words: smoking, leave.
“Hello, I’m Dr. Leap. I’m here to explain to you that you can’t speak to our nurses that way. Is there a bar of soap I can shove in your gullet, you nasty man?” Key words: nurses, speak, soap, gullet, nasty.
“Hello, I’m Dr. Leap. I’m here to explain to you that you will not be receiving Valium, Ativan, Klonopin or Xanax for your panic attack. Just like the last four times. Can I get you a cup of coffee with caffeine?” Key words: Valium, Ativan, Klonopin, Xanax … not.
“Hello, I’m Dr. Leap. I’m here to protect you from your neglectful parents, little one. Would you like a coloring book? Look! Your parents are too busy texting to hear us talk! Funny, funny parents in orange jump-suits!” Key words: neglect, parents, little one, texting, orange jump-suit.
“HELLO, I’M DOCTOR LEAP! I DON’T SPEAK YOUR LANGUAGE. I’LL FIND SOMEONE WHO DOES, OR A TELEPHONE! IS THAT OK? IS THERE ANYTHING YOU NEED?” Key words: LANGUAGE LINE!
“Hello, I’m Dr. Leap. I’m here to talk to you, not to text you. Let me know when you put it down. Is there any other means of communication I can get for you? Until then, I’ll ignore you.” Key words: text, communication, ignore.
“Hello, I’m Dr. Leap. I’m a health-care professional who does great job. I won’t always follow the script, but then, you won’t always follow the text-book. I’ll do my best. If you’re unhappy, tell me and we’ll work it out. But let’s not play word silly games. Let’s make you better, shall we?” Key words: professional, better, best.
Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test.