Turning the scripting around for our benefit.

I had a "Eureka!" moment recently with a patient. We are scripted minimally (just use "excellent") at my hospital, but I've read enough here to know about the full scripts that some of you are required to use. One line is, "How can I exceed your expectations today?"

I've always found that line to be cloying, robot-like, and disingenuous. However, I think I've finally figured out how to use it with chronically malcontented patients to our benefit.

In report, I got the low-down on the important stuff, then the report ended with the behavioral stuff, as is the normal flow of report on difficult patients. I steeled myself for the onslaught of negativity as I walked in the door of the patient's room. Yep, the nurses sucked, the doctors sucked, everyone lies, no one answers the call bell fast enough, the food is awful, and "I want out!"

Step one: Don't say a word. Just listen, or at least pretend to listen. (I pretended to listen as a coping mechanism. Every once in a while, consciously hear the words, evaluate importance, slip back out into my happy place. It works for me!) Insert head nods and make sure my face is set into a concerned expression.

Step two: Ask the question. "I hear what you are saying, and I would like to know what I can do specifically to meet your expectations."

Step three: Sit back and wait a while. And wait. And wait. 'Cause a malcontented, almost-ready-for-discharge patient has difficulty coming up with exactly what they want.

Step four: After his ranting for a little while longer, I got two actionable items. Repeat them back, and set parameters for meeting them. "From what I'm hearing, you want your needs met quickly, and you want better food. If you need something, you call me. I may not be able to get to you in two seconds, but I will tell you how long it will take me to get to you. It may be five minutes; it may be 15 minutes. I will meet the timeframe. As for the food, I'm sorry that it is not to your liking. We are a hospital--not a hotel restaurant--after all!" Make sure you laugh and dial down the sarcastic tone with that last statement. Make it sound like you're on his side and not being condescending.

The actionable items and repeating them back seemed to make all the difference. My day with the patient wasn't all that bad. Oh, sure, there were a couple bumpy spots, but nothing awful. Hopefully, my passing on what worked to the noc nurse helped her night go more smoothly too.

Please share your tips and tricks for chronically malcontented patients.