Do I Really Need to Have This Conversation?

“I have an angry patient who wants to talk to ‘The Administrator,’” he says as he leans into my office, the smallest hint of a smirk on his face. 

“What’s he angry about?,” I’ll ask. 

“I don’t know, but he’s really, really angry, and he’s scaring the staff and he demands to talk to you,” is the reply.

Ugh.  Of all the fun stuff that hospital administrators get to do, talking to disgruntled patients, aka “customers”, is one of my least favorite.  My wife says its because I don’t like conflict…but I deal with conflicted situations all day long elsewhere in the hospital, so maybe that’s not it.  My dad says its because I want everyone to like me…but my mentor, CEO Bill Morrison, said if “everybody likes you, you’re not doing your job” and I believe that to be true.  Maybe I don’t like feeling like we’ve let the patient down, failed to meet our customers expectations. 

But at the same time, I’m always curious as to what the complain might be, and maybe just alittle incredulous that anyone would complain about our fine operation.
 

So, off I go to find the patient.  I used to say “off I go to find the patient and resolve this issue” but over time I’ve discovered that sometimes people don’t want the issue resolved, matter of fact, sometimes I make it worse when I try.  What’s that Terri Clark country western song?  “I Just Wanna Be Mad for Awhile.”  My wife tells me the same thing, “Sometimes I just want you to listen and not try to solve my problem for me.”  So, I’ve learned to:

1.     Be Quiet:  Introduce myself, say “I hear you have something you want to share with me.” And then be quiet. 

I then follow with four additional steps that I’ve found help effective deal   with conflicted situations:

2.     Listen:  Duh. “Listen”?  Thank you, Dr. Obvious!  But what I mean is “actively listen.”  Active listening includes:  Maintain eye contact.  Nod to show I’m listening.  Don’t interrupt.  When the patient pauses, as if to say “now YOU say something”, I’ll simply say “What else is going on?” or “Can you elaborate?” Most of all, I resist the temptation to interrupt, argue, or otherwise say “You’re WRONG!”

3.     Evaluate:  While I’m listening, I’m evaluating what’s being said, how its being said, what’s motivating the conversation.  First, try to see the issue from the patient’s point of view…someone told me once “If its true for the patient, its true…their perception IS they’re reality.”  Second, evaluate the content.  My good friend and psychiatrist Dr John Parkinson told me that “every conversation takes place simultaneously on two levels:  The manifest content or what’s actually being said, and the latent content or what the patient is trying to communicate.  For example, the manifest content of  “I haven’t seen my nurse in over 8 hours!!!” doesn’t mean “and I’m worried about her”, it more likely means something like “And I’m scared for my safety.”  So I put myself in their shoes and figure out what’s being said and, more importantly, what it means.

4.     Reflect:  In order to make sure I’m receiving what the patient is sending,  I use one of those standard psychologist techniques:  reflect the patient’s comment by repeating their comment back to them in the form of a question:  “So, you’re saying that it was so noisy last night that you couldn’t sleep?”  “So, you thought the tech was too rough moving you to your wheelchair this morning?”

5.     Ask what their expectations are.  “How would you like me to resolve this?” or “What would you like me to do?”  or “What can I do for you today to improve your stay with us?” 

Interestingly, I’ve found that if I allow the patient (or staff member, for that matter) vent, show that I’m listening and interested, and reflect their concerns to show my understanding, more often than not when I ask what I can do, they say something like “I don’t need you to do anything, I just wanted to make sure you knew about it.”

What comes next is one of the lessons I learned from my father, who told me he learned it in the military:

“Tell people what you’re going to do.  Do it.  Then go back and tell them it’s been done.”

…and I’ll try to remember all this the next time someone knocks on my door and says “I have a very angry patient on 3-North who demands to talk to you…”!