Patient perception is the only reality to the patient.  As medical professionals, we are in a service industry — and we are judged, whether it’s right or wrong, by the perception of the patient.  If a patient thinks you did a good job, well then you did a good job.  If they were unhappy with the service they purchased, then you didn’t do a good job. I understand this can open up room for argument, and there are times when patient expectation cannot be met. For example, maybe the patient has unrealistic expectations (“please cure my chronic abdominal pain”) or perhaps a patient feels that he or she needs something they really don’t need (antibiotics/narcotics.)  This patient is especially important at discharge.

Patient perception is key

Patient Perception
Patient perception can be shifted to cover our butts at discharge.  Let’s say a patient presents with an ankle injury, so we review the film and tell the patient that there is no fracture. The patient leaves, and in the small percentage of patients where the radiologist indeed sees a fracture and then calls the patient, the patient will be upset that a fracture was missed.  The stage was set – the patient believed that the ankle was fine — and when it turned out to not be the case, it is reasonable to think that a patient will be unhappy. To avoid this situation, it’s better to inform the patient at discharge that no fracture has initially been identified, but a radiologist will review the radiograph to be sure. If there is a fracture, we will call you.  For me personally, I always inform the patient that in the rare case a fracture is indeed identified, the ankle is stable enough to bear weight.  I call this the “razzle dazzle.”

Explaining the “razzle dazzle”

The “razzle dazzle” is a technique at discharge that sets the stage for what might happen in order to properly set patient expectations and prevent customer service issues.  For every patient that leaves with a laceration, I make sure they know that there is a very real chance of infection or internal injury that was not initially identified.  Or for every abdominal pain patient I send home, that patient knows that it is possible there is early appendicitis, and to return if symptoms increase or change. Taking a few sections to share the “razzle dazzle” with your patient covers your butt and it’s just good customer service. In the big picture of patient care, the customer service element is key.

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John Bielinski, Jr., MS PAC is a practicing emergency medicine clinician, and has been lecturing nationally for more than ten years, teaching the tactics that have proven invaluable in his career as a medical professional.