Quote from KatieMI
While I cannot deny that education is a good thing, I feel that health care providers should also start to speak the language their patients speak and deliver information the way it would be clearly understood. The current "professional" and "politically correct" medical language just doesn't do the job. All those "might help", "you may want" and "you've got little bit of problems" give lay people impression that 1) their problems are not serious enough, and 2) that they have wiggle room while they don't.
I heard many times that direct and honest communications are not what most people expect and "it is important to tell them what they want to hear". It was one of my breaking points between medicine and nursing because I just refuse to lie to my patients. So I tried to speak with my patients about, well, undeniable facts of life after I establish trust and good contact with them, and I can tell that most of them appreciate it.
I can add that during my long way as a nano-premee's mom, there were only 3 (three) providers who spoke with me with complete honesty and openness, and two of them were neonatal NPs.
This is good to think about. One of the things I've actually seen a huge improvement in (while everything else seems to be going down the toilet) is the way ED providers are interacting with patients these days. They sit down and talk to patients a good amount of the time, especially in situations where follow-up is important.
We don't send anyone out without follow-up instructions, regardless how minor their condition.
I think it helps to have conversations about the ED's role - but those can't be undertaken willy-nilly. They have to be respectful and informative, not based upon chastising people. Patients truly don't understand our convoluted healthcare system, and honestly common sense is not helping too much of the time, either. If you have chest pain and have a work-up and are told to schedule an outpatient stress test but instead of doing that you come back 2 weeks later saying that "the pain is back" and then get mad that the previous ED course is going to be repeated, that is a failure of both understanding and common sense (how would we know whether you're having an MI today based on studies that were done two weeks ago??) - - but, patients don't know that. I try to preempt their anger all the time by telling them, "Well, I know you had these things done two weeks ago but now you're having new symptoms, so the tests that we did when you were here last time can't be relied upon to tell us what's going on today..." - - it usually works (as far as having them not get angry), but doesn't fail to surprise me that they didn't know that until someone tells them.
When discharging patients I sometimes have conversations about the role/capability of the ED - it helps if I have confidence in the rapport I've established with them. I say something along the lines of, "I'm sorry, I am sure it is very frustrating to have put up with this for so long and then when you come to the ED we are not able to tell you exactly what is causing it. Unfortunately sometimes the role of the emergency department doesn't work that way - - our primary task is to look for emergent or urgent serious conditions that might be associated with ______ (abdominal pain). We have checked out those things out today, and your normal CT scan gives us some confidence that you don't have a condition that needs emergency surgery, for example. But it's very important that you take the next step and see [GS, GI] because they may have suggestions for additional studies that can't be done in the emergency department, like a colonoscopy......Here is the phone number for Dr. X - and our recommendation is that you call the office in the morning and an set up an appointment.
I also talk to them about how they are encouraged to return to the ED if anything changes and I review the information about that, but I ususally do reiterate that we have done what we can do to evaluate the kind of symptoms you're having today, and if these continue, our only options really would be to repeat what has been done already (if appropriate) so it's VERY important that you take the next step and meet Dr. X.