Do providers feel threatened by patients?

Barbara Balik, RN; IHI Senior Faculty, Common Fire Healthcare Consulting

Providers, I think, are threatened by patients on different levels. One is threatened in thinking that, “If I take the time to ask and listen, I don’t have that time,” so the threat is complete loss of control of my daily schedule. That production pressure is so huge that the threat is not a negative as far as, “I don’t want to listen to patients,” but, “My fear is if I do, what does that mean to all the other patients I’m committed to see?”

The threat is also, “I’m not sure I know how to listen really well.” Often, we as providers, physicians, and nurses, especially, no one observes us. Our interactions are very private, so many great organizations are now doing direct observation. I’ve done a number of those just in the last four or five months, where you shadow a physician in the exam room. At first I ask the patient’s permission, and people are concerned. Are they going to feel odd about this? And most often within seconds the patients ignore that you’re there. You’re standing off in the corner. So you have some direct observation of the physician in saying, “Here’s what you did incredibly well. Here’s where you missed it just a little bit, and if you just do this, you would have a much better connection.” To a person, these physicians were greatly appreciative. No one, no one had ever told them what they were doing well, and if they had, it had been way back in med school. Secondly, they didn’t know where they were just missing the mark slightly.

It’s reducing that threat of, “What do I need to do, and do I have to change my entire practice?” Usually, it’s not. We all know as humans that to have somebody tell us we shouldn’t feel threatened and not feeling threatened are two different things. It’s back to those small tests of change. Try it once. Try it once.

In working again with physicians and nurses about, first, sit down. Just equalizing that and that experience that we’re on the same level. Secondly, asking, “What are you most concerned about today? What’s most important today? What are you most worried about?” Asking one of those questions and then pausing — kind of zipping the lips and letting the patient talk.

Try it once, then you’re not blowing an entire schedule. You’re not blowing an entire day. Maybe do it at the end of your day with one patient. Getting past that fear of what might happen diminishes the threat. As those practitioners have more and more experience with it then they see that they can take a deep breath and say, “This can work.”