It’s important to give patients an idea of what to expect


The familiarity that health care professionals develop with complex medical procedures and topics is the result of years upon years of hard work, and over time we become accustomed to the jargon. We use phrases like “lap chole” and “appy” without much thought when talking to each other and (if we have a momentary lapse) with patients. We take the fantastic array of medical specialties, procedures, and knowledge in our world for granted. The extraordinary becomes mundane.

For patients, medicine is very different. The situations they encounter are, for the most part, totally novel. They don’t go through two gallbladder removals or appendectomies. They often walk into our offices without a clear picture of what will happen. The experiences that patients have can be overwhelming, bizarre, and frightening.

That’s why, when we refer patients to others or put them through a new experience, it’s so important to help give patients an idea of what to expect. Not just the broad-level overview, but specific, concrete details. It’s critical to make sure a patient understands what test or treatment they need and why, and informed consent is the bedrock of modern medicine. But it’s also valuable to give patients a touchstone about what the experience will look and feel like for them.

When a patient is going to see a specialist, their primary care provider can give them a roadmap of how the encounter may go. The specialist’s schedule may be complicated; the patient may need to wait longer than they would expect, and allow more time for traffic, if it’s in an area they’re not familiar with. The visit itself can include discussions of surgery, medications, and other options for treatment, if there are any. The primary care provider can tell the patient roughly what they expect the specialist’s discussion to include, with the caveat that they are referring out specifically because the specialist will likely have better perspective on and insight into the issue.

You may have heard the word “schema” before, or you may not, depending on what subjects sparked your interest in undergraduate or graduate school. A schema — from the same root as schematic — is, in essence, a blueprint. It’s a mental map of how something is going to go. People have schemas for just about everything, from events they’ve experienced a hundred times to events they’ve never experienced. Schemas give us comfort. If we know what to expect, we feel more confident, less frightened.

As health care providers, we can use this to help our patients and our colleagues. Patients who are prepared for a visit with a specialist can have time to think about their questions and to make sure that their biggest concerns are addressed. Many of the specialists I’ve worked with have had moments of frustration when patients had totally unrealistic expectations for their visits, whether it was about a medication prescription, an easy answer for a complex problem, or just how the day would go.

Health care providers are familiar with the concept of a “warm hand-off,” which is less exciting than it might sound to a layperson. This is most often when an outpatient provider has a patient who is being hospitalized, and reaches out to the inpatient provider to give a personalized, less formal picture of the patient’s clinical situation and psychosocial background than the inpatient provider would get from notes alone. It helps make sure that the inpatient provider is up to speed on the patient and their wishes, and improves the likelihood that the patient’s care will be congruent with their goals. This is the flip side of giving the patient a schema. Providers benefit from schemas, too.

Knowing what to expect is helpful. It’s what we as humans spend a lot of our lives looking for, whether it’s Yelp reviews for restaurants, getting physician recommendations from friends and family, or Googling a new diagnosis. Many patients have had bad experiences with the medical establishment. Patient empowerment is a buzzword, but it’s a cliché for a reason. It matters.

Providers should think about what the situation looks like to their patients, and try to help them anticipate what’s coming and what they can do, rather than asking them to blindly trust an imperfect system.

Kristin Puhl is a medical student and can be reached on Twitter @kristinpuhl.

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