You don’t have a second chance to make a great first impression.
If twenty random numbers were read aloud, most people would remember the first few numbers and the last few numbers. We tend to remember beginnings and endings. It is the same with patients; they tend to recall what they hear at the beginning and the end. This is how our brains are wired; it is called the recency primacy effect (or serial position effect).
I am sure most of us have been to a concert or musical theater event. The production always starts with a big opening to set the tone, gain attention and capture interest. They want to show us that this will be a great experience. They want to let us know this will be worth our time. That is what we need to do at the beginning of a patient meeting: create an excellent impression. There are many ways to achieve this goal, which will be the focus of this article.
This article is designed to highlight effective elements of an appropriate opening, and is certainly not designed to cover every aspect. The article moves from the preparation stage to the opening line. Time constraints and large patient volumes are the norms in health care. All of the suggestions provided in the article can be done in little time.
Before you see the patient
In addition to learning about the patient’s medical issues and reason for visiting, there are additional items to consider before you open the door or move the curtain.
Recharge yourself. A few years ago, at a medical conference, I was sitting next to a physician who was involved in resident education. He told me he instructs all his residents to take a deep breath between patient visits. He said the exhale should be longer; he suggests an inhale on the count of four and exhale on the count of six. A great quick tool to relax and recharge.
Many of you have heard this analogy, but for those of you who have not heard it, it is worth mentioning. Prior to an airplane taking off, there is a safety demonstration. What, you don’t pay attention to this information? Next time, listen carefully. Passengers are instructed that during an emergency to put their mask on first and then help the person next to them. In other words, we need to take care of ourselves first before we take care of someone else. This does not mean being selfish; it means taking care of ourselves so we can adequately help other people. You are busy telling patients to take care of themselves; you need to follow your own advice. “We teach what we need to learn.” (The quote has been attributed to many people, however most sources cite Gloria Steinem.)
Pleasant breath. This is quite personal, yet very significant. Check your breath! The sandwich you had at lunch smothered with onions and garlic may have tasted great, but you don’t want all your patients to immediately know what you ate! Over the years, I have had to discretely remind many health care professionals to pop a mint.
Cultural factors. If possible, find out if there are any cultural issues you need to be aware of before seeing a patient. For example, in some cultures, when addressing a family, it is appropriate to address the oldest member of the family first. Also, in our culture, we emphasize the importance of direct eye contact with other people. However, in some cultures, direct eye contact is frowned upon. In some cultures, there are taboos regarding men and women touching. If you are a female health care professional and your patient’s guest is male, a simple handshake may be an issue. Know your patient population.
Put phone on vibrate mode. Of course, emergencies happen where people may need to reach you ASAP. This can be done discretely via vibrate mode as opposed to a ringing sound.
Knock on the door. After a tap on the door announcing your presence, wait for the patient’s response. Do not just immediately open the door. Some health care professionals knock and walk in simultaneously; however it is best to knock and wait until you hear a response and then enter. This act of courtesy only takes a few seconds. In a hospital setting, this knock at the door scenario may not always work since people may be sedated or sleeping. However, always tap at the door as a courtesy. If the patient is behind a curtain, state the patient’s name and give them a moment to respond. Suddenly opening the curtain could startle people. Also, be sure to close the door or curtain after entering.
Shake their hands, if appropriate. Rely on your instinct to determine if this would be appropriate for the particular patient. A study found that nearly 80 percent of patient survey respondents reported that they wanted the physician to shake their hand.
In addition to cultural factors, there are patient safety issues regarding hand shaking. The handshake, while a societal pleasantry, can also serve as a vector for disease transmission. Assuming you are washing your hands between patient visits, a handshake should be considered safe. Keep in mind, according to a recent New England Journal of Medicine article, on any given day, 1 in 25 hospitalized patients has at least one infection they got from being in a health care setting. Many of these infections are due to poor handwashing compliance. Also, many patient advocates are telling patients to insist that members of their health care team wash their hands in front of them before touching. However, many professionals wash their hands before entering the room. One option is to walk into the room rubbing your hands, so you are giving a nonverbal cue to the patient that you just washed your hands.
Patient’s name. Most textbooks and articles discussing patient names always suggest going formal (e.g., Mr. / Mrs.). This is certainly a safe move. However, what if the patient prefers a more informal approach? How do you know what the patient prefers to be called? Ask them! Early on, have an administrative professional ask the patient, “How do you prefer to be addressed?” or “What would you like us to call you?” This information should be documented so when any professional walks into the room they know exactly what name to use when greeting the patient.
Your name. If you are meeting a patient for the first time, state your name and role. For example, state, “Hello Mrs. Smith. I am Dr. Steven Jones, a family doctor.” If you are going to be accompanied by colleagues, state their names and roles or have them introduce themselves. This may seem like an obvious point, but I have seen countless professionals walk into a patient’s room with an incomplete or nonexistent introduction.
Meet the family. Acknowledge others in the room, such as a family member. Be sure to get their name. Shake their hands, if appropriate. This acknowledgment is very important since you want to create a positive impression with the family members as they will play key roles in the patient’s compliance. Keep in mind; it may be a family member who is filling out the patient satisfaction survey! Also, the family member is going back to the community to share their experiences. For some patients, it is helpful to have them introduce their guests. During the introduction, they will state the guests preferred name and relationship. (e.g., “This is my daughter, Kathy.”)
Biosketch card. Many health care organizations have their physicians and some other health care professionals provide a photo card, with information about their role, area of expertise and education. On the card include some personal details, such as family information and hobbies; this creates a well-rounded picture of you. If you use these cards, give them to the patient at the beginning of the meeting. Providing the card at the start of the meeting will help avoid some patients from awkwardly asking in the middle of the meeting, “So what kind of doc are you?” Recent research has found these biosketch cards improve patient satisfaction.
Personal discussions. Some health care books and articles suggest always starting the meeting with a brief chat of personal topics, such as a quick discussion about the weather or a patient’s family, hobbies, work, etc. There are many variables that dictate when these types of discussions are appropriate. If a patient is in significant pain, the opening line should not be, “So how’s your dog?” If it is a wellness check or routine testing, then starting with a brief personal chat is certainly fine. If the patient has a symptomatic medical issue, then it is a case by case basis. Another important variable is how well you know the patient.
Patient advocates always emphasize knowing the patient as more than a diseased body part. This personal talk is helpful in establishing the relationship and making connections, but it also must be authentic and natural. The personal chat could be blended as the meeting progresses. If the patient stated they starting feeling ill while gardening – a question or two about their garden would be acceptable.
In the unlikely event that the patient seems to go on endlessly about a personal subject, gently and politely redirect. For example you can say, “Planning for your daughter’s wedding sounds very exciting. I wish you all the best. I want you to feel your best too. Let’s discuss the pain you are having …”
Opening line for a non-wellness, non-routine visit with a patient experiencing a medical issue. Do not say, “How are you?” According to John Tongue, MD, chair, American Academy of Orthopaedic Surgeons Communications Skills Project Team, “In the U.S., this is a greeting, not a question, that can put the ill or injured person in the awkward position of saying they are ‘fine,’ just before telling you their story or problem(s).” Start with an open-ended statement or question, such as, “Tell me what is going on …” or “How can I help you today?” Be cautious with the following opening line, “What brings you here today?” Yes, I have heard patients respond to this question by saying, “The bus.”
A great opening leads to a productive meeting. The tips listed in this article will help you create effective and powerful patient meetings.
Edward Leigh is founder and director, Center for Healthcare Communication.
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