#80 Can Leaders Improve Difficult Clinician-Patient Interactions?
Yes, there is a way forward.
The physicians who take on leadership roles in our multifaceted healthcare system face numerous challenges. Hiring and retaining the members of the healthcare professional team is paramount among them. From Becker’s Hospital Review: The cost of nurse turnover by the numbers (beckershospitalreview.com)
“In 2020, the turnover rate for staff RNs was at 18.7 percent, a 2.8 percentage point increase from 2019. The average cost of turnover for a bedside RN is $40,038 and ranges from $28,400 to $51,700, causing a hospital to lose $3.6 million to $6.5 million per year. Each percent change in RN turnover costs or saves the average hospital $270,800 per year.
The cost of replacing a staff physician is estimated at over $1 Million. Clearly, anything leaders can do to address the issues concerning staff members is compassionate, practical, and financially wise.”
Photo by Sawyer Bengtson
Some studies place the rate of difficult interactions between the medical staff and their patients to be at 15-20%. For every shift logged for a busy nurse or physician, those incidences add up quickly. Even though most of our interactions with our patients are satisfying and mutually beneficial, those bad ones drag down morale and make us feel terrible. When nurses and physicians feel terrible at the end of every shift, they start updating their resumes and looking for easier or non-clinical work.
In Changing How We Think About Difficult Patients, published by the American Association for Physician Leadership, I address this problem. In my humble opinion, the lions’ share of the problem comes from the nearly impossible definition that physicians, nurses, physical therapists, and paramedics have adopted for what makes a “good” patient. We expect them to follow our plan, keep appointments, get better, and to give us a warm handshake of gratitude at the end of every encounter. Wouldn’t that be lovely?
Image from American Association for Physician Leadership
I review the fears and challenges that are faced by patients who are ill and injured. The typical patient responses are discussed as well as some of the classic literature on challenging patient types. Then, I review the typical thoughts that healthcare professionals adopt towards their “difficult” patients. A tool to change our thoughts borrowed from cognitive behavioral therapy is discussed. With practice, our nurses and doctors can change those thoughts that are not useful.
“Difficult” patients don’t have to change for the interactions to get better. The challenging behaviors can be accepted and placed into context. There are no difficult patients. There are just people who clinicians judge to be “not doing it right.” Our competent patients have the autonomy to do things their way. Sometimes we feel bad because we think that we can no longer help a patient. Our thoughts about how others are doing it wrong cause us frustration, feeling of inadequacy, and cynicism. We are human clinicians who entered our fields with the highest hopes and ideals.
The emotions of the good people on the clinical staff matter. Feeling of satisfaction and fulfillment keep the staff coming back and doing some very hard work. They must witness some of the saddest and most heart-breaking situations that their patients and their families go through. Feeling grief and loss with our patients connects us and cannot be deleted from the human experience. We can hold their hands, hug them, and cry with them. These emotions experienced by the clinical staff are personal and beautiful. They reveal a piece of vulnerability and compassion that cannot be replicated by an AI driven algorithm.
The AAPL invited me (in March of 2022) to discuss how clinicians can change their thoughts about difficult patients on their podcast SoundPractice. Their publisher took a chance and agreed to publish my book (Now available in Audio format!). Now, I am being given the chance to present the ideas at the Annual Leadership Conference being held in Chicago from June 9-11th, 2023. I am speaking to the conference attendees on Friday June 9, at 2:15 pm. I will also hang around the book market to meet folks and to sign books.
The attendees are physicians who have chosen to go into staff and administrative leadership positions. Some physicians still have clinical duties and seek to lead by example. My wish is that the physician leaders will hear the message of my talk and get inspired. Then they can figure out a way to share the message with the staff back home at their hospitals. My talk introduces the lessons of my book, Changing How we Think about Difficult Patients: A Guide for Physicians and Healthcare Professionals.
Leaders can arrange for me to speak directly to their people. I have spoken to a California PACE program physician workshop day. I have spoken to a large group of staff nurses at Jefferson Health in Philadelphia during their Patient Experience Week. I can travel or zoom into a book club. The book is now available as an audiobook through Audible at a very nice price. With an accompanying work book (in the planning stages) encouraging case discussion and group interaction, leaders can hold monthly meetings to re-enforce the lessons of the book.
Photo by Alexis Brown
A lot of physicians, nurses, and other clinical staff members are suffering more than they need to over difficult interactions with patients and their families. Most clinicians do not even realize the callous and judgmental practices of labelling people occurring in their offices and hospitals. Patients are called frequent fliers, non-compliant, drug-seeking, and difficult every day. The clinicians heard it during their training and everyone speaks that way in the break rooms and work stations.
They don’t need another learning module assigned to them. They need to pay attention to their emotional responses and to work on changing the thoughts that lead them into frustration, disapproval and cynicism. Clinicians need to be heard and validated. They are having normal, human responses.
Physician leaders can blaze the trail here with an approach to changing their negative thoughts to believable and useful considerations of their patients. Kinder thoughts will naturally lead clinicians to more curious and compassionate care. Our patients will get improved results and feel more satisfied. Clinicians will feel better about their patients and their jobs. They might just come into work with a smile on their faces.
