In the hospital system alone, mistakes are commonplace due to all of the specific orders that need to be followed by so many different people at different times. On the outpatient side, fewer errors occur - there are usually less people in the order chain and the errors tend to be less serious.
We are all familiar with ordering a product from an online store only to have the order arrive incomplete, incorrect, and/ or way different than we originally ordered. The same is true when we make purchases in the physical store.
We expect the items we spend our money on to be correct every time. I mean, how difficult is it to put items x, y, and z into a box and mail them? It becomes inconceivable to us that someone somewhere messed this up causing us the hassle of having to call, complain, and possibly argue about the mistake that occurred.
In medicine we do not think about shipping anything. Instead our mistakes tend to occur with “idiosyncratic drug” reactions or prescribing two medicines that should not be taken together. As doctors, we generally shake those mistakes off as individual reactions that were not predictable in the first place. How did we know that she was going to get a rash with HCTZ? Why didn’t the pharmacist alert her that she should not take the Biaxin with her Prozac?
We practice in a medical world filled with mistakes that occur every day. In the hospital system alone, mistakes are commonplace due to all of the specific orders that need to be followed by so many different people at different times. On the outpatient side, fewer errors occur - there are usually less people in the order chain and the errors tend to be less serious.
But these errors do occur and they occur a lot. It is not just the wrong medicine, either. Using the “ship product model” from the retail world, the errors in medicine occur on a much larger scale. Why? Because our product is not just the medicine we prescribe or the radiology exam we order or the abdominal surgery we perform. No, our product that we ship is the interaction and relationship that we engage in with the patient in the exam room every day. We ship multiple products a day.
The simplest way to get your shipping process right every time is to have a game plan. For most of us doctors, we do not plan on what we are going to do in the exam room, right? We certainly review the patient’s chart and note to ourselves what is going on with the patient before entering the exam room, but we usually leave it at that before going into the exam room.
For most doctors, the process is blunted and shortened by the pressure to see so many patients and as a result they end up shipping by listening for a minute, talking for a few minutes, and providing prescriptions (new and refills) for the remaining minutes. There, of course, is a physical exam, thrown in there at some point.
Does that sound familiar to you? Whether you are a patient or a doctor, this is how most exam room experiences turn out to be. As doctors we tend to view the exam room as an unpredictable arena - I think this is why it is difficult for us to schedule well all the time. We understand that patients are unpredictable and so that 10-minute allotted sore throat can easily turn into a 30-minute crying session due to the loss of a family member or pet.
So here are a few simple ideas to help you get your shipping right every time. Remember, you have to practice these for them to feel natural.
1. Let the patient talk, uninterrupted for at least five minutes. No pointed questions. Just let them go.
2. When talking with the patient (listening counts as well), mirror their actions - if they are using their hands a lot, use your hands a lot. If they are completely still, be as still as you can. People feel more comfortable when they are talking with someone who resembles how they communicate.
3. Choose positive words to express your message.
4. Look them in the left eye when you are telling them anything important (the left eye is the receiving eye).
5. Use body language that conveys your care and concern - a touch on the elbow, shoulder, or hand can go a long way
If you complete these five steps every single time you are in the exam room, you will be shipping right every time. Yes, there of course will be prescription medicines and the scheduling of surgeries in this mix. There will still be drug reactions, incorrect prescriptions prescribed together, and errors that occur. The point is, the product we, as doctors, ship, is the exam room experience. When we take the time to ship this way, those other errors lose their meaning in this context. So go ahead, try and ship your product this way and see how it good it feels for both you and your patients!
For more on Craig Koniver and our other Practice Notes bloggers, click here.