14 Dec Insights From A Negative Patient Experience: Lessons Learned From A Caregiver Turned Patient
Communication at Heart of Patient-Centered Experience
By Laura Bennett, ARNP, CNM
Institute for Healthcare Excellence Faculty
As a patient caregiver for nearly 20 years, I recently had a role reversal. I entered a hospital for a gynecologic procedure and experienced firsthand a feeling of vulnerability as I entrusted myself to the medical team. Although the outcome of the procedure was satisfactory, I experienced avoidable concern about my care. I was discouraged and frustrated by the lack of respect for me and my input.
My concerns about my care stemmed from the attitude of the anesthesiologist and nurse anesthetist.
A Missed Opportunity for Respectful Listening
My first confrontation involved my preference to have IV sedation rather than general anesthesia, something my surgeon had agreed to at a pre-op appointment.
On the day of the procedure, the anesthesiologist (I’ll call him Dr. A) said he would be using general anesthesia. I explained my medical background as a nurse-midwife and my reasons for not wanting the additional risks of general anesthesia and a breathing tube.
Rather than exhibiting openness to my point of view or stating risks and benefits of each of the options, he said only, “That’s what I’d do for my wife or my daughter.”
Dr. A then shared from a previous case that day, “Your doctor doesn’t like squirmy patients who are moving around.”
I imagine he intended to strengthen the case for general anesthesia, but the impact of his words was to make me worry that the previous patient wasn’t comfortable. I also became concerned about the surgeon not being in a good frame of mind for my surgery.
I repeated my request to discuss IV sedation rather than general anesthesia with my surgeon.
This initial encounter could have been handled quite differently. I teach a Communication in Healthcare course to hospital personnel across the country, which focuses on meaningful communication to achieve patient-centered care.
Active listening, seeking to understand the patient’s point of view, and actively engaging the patient in decision making all are at the heart of patient-centered care. As a patient, I would have greatly appreciated a doctor who involved me in the decision-making and educated me about the risks and benefits of the anesthesia options. I also highly recommend that we, as caregivers, not raise concerns to patients about other providers’ behavior.
Patient Trust on a Downward Spiral
My procedure was scheduled for early afternoon, and I hadn’t had anything to eat or drink since the previous night. I asked the nurse if she could give me something for an upset stomach. She conferred with the anesthesiologist, and he came back to my curtained enclosure in the preoperative holding bay.
I was perplexed by his next comment: “You’re not a mom who has read the Internet, are you?” He said it jokingly, but I wondered if he objected to a woman (or anyone) doing research, asking questions or being assertive about her own care?
When I asked why patients couldn’t drink even a little clear liquid on the morning before an afternoon surgery, his answer boiled down to “patients can’t follow directions.”
At this point, I felt defensive and under attack. If the doctor’s concern was for patient safety, he could have phrased this in a much more positive light. As healthcare providers, we owe it to our patients to speak to them respectfully and to always consider their wishes and try to allay their fears.
The Pitfalls of Personal Biases in Patient-Centered Care
Following these negative remarks, Dr. A began a commentary about women coming into the hospital with their own birth plans. As the nurse anesthetist assigned to my case came to give me medicine for my stomach, he joined the conversation, as well. He said, “If women have all of these demands, they should deliver at home.”
Even as I verbalized my support of women who speak up about their own hospital birth plans, I wondered why we were having the conversation at all. It had nothing to do with why I was at the hospital, but made me feel disrespected.
As healthcare providers, we need to be aware of our biases. Beliefs such as “This is the way we’ve always done it” or “I know what’s best for the patient” or “People who read the Internet just get in the way of the important work I’m trying to do” put the patient at a disadvantage rather than at the center of care.
Put the Patient First
Although I received IV sedation and my procedure went well, I felt disappointed in my overall experience. I didn’t feel honored or respected by the anesthesiologist and nurse anesthetist. Yet, even with their biases, good communication skills might have saved the day.
It’s so important to convey respect for all patients through every word and action. We need to be aware of our biases and approach each patient with curiosity and openness. Rather than judge their questions or view them as a challenge to our authority, we need to be flexible and try to fill knowledge gaps.
When we put patients at the center of care, we pave the way for an excellent patient experience.About the Institute for Healthcare Excellence
Laura Bennett, ARNP, CNM, an advanced registered nurse practitioner and certified nurse midwife for more than 12 years, provides women’s healthcare in an obstetrics and gynecology practice in Florida. She also is a faculty member at the Institute for Healthcare Excellence, providing communication training for healthcare personnel nationwide.