Tips for Hospitalists on Solving Difficult Situations

Physician Communication Often Abysmal, Patient Advocate Says

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Hospitalists, no doubt, encounter many challenging patient situations that have a lot to do with inappropriate behavior on the part of patients.

But from patient advocate Jackie O’Doherty’s point of view, many tough situations involving the patient-physician dynamic evolve from hospitalists who seem almost incapable of communicating well.

“I’m not saying they’re bad; their communication is not as great as it should be,” she says. “It has to be just giving the information. People get really frustrated when they’re in the hospital and they don’t know what’s going on.”

O’Doherty, a private patient advocate who represents patients in their efforts to get good healthcare at hospitals in New York and New Jersey, says sometimes the communication gaps are staggering.

For example, she represents a patient who had a heart attack and was transferred to a larger center to have open-heart surgery. The surgery went well, but when a Swan catheter was pulled, a plaque was hit and the man had a stroke. Suddenly, his care became a lot more complicated.

A series of specialists came in to see him. One told him that he would be sitting at home at the dinner table and watching football on Thanksgiving. Others gave him a far less rosy outlook. Some told him to drink water; others said not to.

The patient became frustrated, and O’Doherty demanded a meeting to sort out the mess. Eventually, all five of the patient’s doctors, a social worker, and the director of nursing met.

If the hospitalist is supposed to be a unifying force, that hadn’t happened in that case, O’Doherty says. Such cases, while not the norm, are frequent enough to cause concern.

“They’re the quarterbacks, supposedly, of the whole hospital experience, and I haven’t really seen that happen,” she says.

In another case, a patient getting suspect care—O’Doherty had pictures of the patient with a tracheostomy almost falling out of the bed—got a good response.

“They want to do whatever they can to make this work, and that’s a great response,” she says. “The question is, would that have been the response had I not been there?”

She understands the pressures that hospitalists can feel. And she says the system in which the hospitalist is working can matter as much as the hospitalist’s own communication skills.

“If you have a hospital that’s crazy busy, understaffed, and there’s not time,” she says, “that’s what goes first is the communication.”

How to Handle Tough Cases

Here are tips from experienced hospitalists, administrators, and patient advocates on how to handle, and avoid, tense patient-hospitalist encounters.

1. Go back to the room.

Physicians should almost always go back into the room to try to resolve a situation if patients demand they be fired and apologize if that’s appropriate.

“Say, ‘Look, we’re taking ownership of your concern, and I’m back in the room because I want to give you great care,’” says John Vazquez, MD, associate director for the Emory University School of Medicine’s Division of Hospital Medicine.

2. Put yourself in the patient’s shoes.

Patients are in a vulnerable position, and sometimes that requires a tender touch.

“We need to reassure people—that’s part of our job,” Dr. Vazquez says.

3. For leaders of a group, set expectations for doctors.

“If the leaders in the group are constantly having temper tantrums, it’s not going to look good to the other doctors,” says Martin Austin, MD, SFHM, medical director at the Gwinnett Medical Center Inpatient Medical Group.

4. Don’t guarantee a new doctor.

According to Dr. Austin, it’s OK to say only, “We’ll assist with calling another doctor and see if they will agree to take on your case.” Often, the patient no longer wants the original physician fired.

5. Have self-awareness.

A good way with patients—helping to avoid tense and awkward moments—is something that can be learned.

“But you also have to want to learn it,” says John Bulger, DO, MBA, FACP, SFHM, chief medical officer at Geisinger Health Plan. “Some of the issue is realizing you have a problem and understanding it’s a learned thing.”

6. Know the policies

This includes knowing the obligations of the next hospitalist in line before a patient demands a physician be fired.

“The best thing is just to talk about these things before they happen,” says Robin Dequaine, director of medical staff services at Bay Area Medical Center in Wisconsin. “Know what your legal protection is. If you have a contract with the hospital, know what that says. Know what your bylaws say.”

—Thomas R. Collins