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The Q-Wave: You’ve Got to Play the Piano

By September 23, 2020No Comments
The Q-Wave Newsletter

I have a question for you – in your clinical practice, how important is bedside manner? When I ask that question, I want you to think about how important bedside manner is to you as a clinician.

Do you really value whether or not people like you? Are you doing anything to improve your bedside manner? Are there things you can work on, or is bedside manner just your personality? Are you just a likable person? Has any study really looked at key features of bedside manner?

I’ve taught lots of people medicine. I precepted lots of students. The strongest students I’ve ever precepted were waitresses before they became clinicians. They knew how to talk to people. We can teach medicine to anybody, but it’s the bedside manner that’s difficult. This is, really, emotional intelligence. I can’t recommend a book more strongly than Emotional Intelligence 2.0 by Jean Greaves and Travis Bradberry. It gives you a test and tools to improve yourself. It’s excellent.

What happens if you’re not well-liked? What does that even mean? Can we measure it? Well, that’s what Press Ganey scores are. Research has found that if you’re in the bottom third of the Press Ganey scores, you have two and a half times more complaints, two times as many risk management episodes, and medical malpractice claims go up 110%! Read that again; if you’re not well-liked, medical malpractice claims go up 110%!

Are there key behaviors shown in practitioners with high Press Ganey scores that really make a difference? There are. The question is, are you doing them?

At CME4Life, we’re mnemonic. I’m a mnemonics guy. When I teach board review, emergency medicine conferences, or our EKG course, I give you tools that you can immediately apply using words and phrases that are easy to remember. Also, if you have CME money left for 2020, we have CME packages in those areas that include a gift card, so you can purchase the needed hardware (computer/tablet) so you can learn on the go. It’s a wonderful win-win.

If you want good Press Ganey scores, you have to play the PIANO for patients.

Power opening: You walk into a room, and you’re on stage. Your patient drove all the way to your office, the hospital, or urgent care, and they waited for you. They want medical care. The show is on as soon as you walk into the room. Smile, make eye contact, and appropriately greet your clients. In past studies, they talked about shaking hands; in the era of COVID, maybe it’s an elbow bump.

Introduce yourself: Tell your patient who you are. Look them in the eye, give them your name nice and slow, and tell them your role in medicine. “My name is John Bielinski. I’m a physician assistant.”

Acknowledge, apologize & open (AAO): Acknowledge the time, saying, “I’m sorry for the delay. I apologize for that. I know you’ve waited for a little bit.” Whether they’ve waited a long time or not is irrelevant. Make this a part of what you do. Then, ask an open-ended question and allow them to speak with limited interruptions. “How can I help you? What’s going on today?”

Nonmedical gesture: Patients really like it if you can do something that’s not medically related. Bring them a blanket, a pillow, a cup of coffee. Just do something nice for them.

Overestimate time: We are in an era of instant gratification. We want things right now. Patients want things right now. If we overestimate time, we change expectations. The two biggest complaints related to Press Ganey scores are poor communication and time delays.

I’ve worked at hospitals where people say, “We’ve got to decrease time.” No. Decreasing time is very difficult. CATs can take so long. It’s a tough process to speed along. But you know what you can do? Change patients’ perception of time by overestimating it. If you’re going to do a pregnancy test and it takes 30 minutes to get back, just double it. When the test comes back in 35 minutes, they think you’re a genius.

Colleagues, if you want a better bedside manner, play the PIANO. Not only do your patients love it (and Press Ganey scores show that), but the nurses love it. The nurses see that behavior, and they know it’s what true leaders do.

Thank you for reading this month’s Q-Wave.

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