Managing Expectations – Part 1

Don’t shoot yourself and everyone you work with in the foot!

If you’re a doc, then you shoot others in the foot when you tell patients in the hospital that you’re going to order a certain medicine or a certain test – without telling them that it’s going to take some time.

If you’re a nurse, you’re shooting the doctor in the foot when you say, “I paged the doctor, but they never called back.”

The fact is that both may be true… but you need to give more information. Think about it from the patient’s point of view…

“The doctor just now told me that pain medicine is ordered. Why doesn’t the nurse get it right when I ask for it?”

“Why isn’t my doctor calling back? I’m sick enough to be in the hospital, you’d think they’d call back. He comes in for 5 minutes a day, at least call back when the nurse has a concern!”

It takes less than twenty seconds to change the way you say things, and in the process you can save the patient, other nurses, other doctors, patients’ family members, etc a lot of grief.

It’s all about managing expectations…

Many patients have never been in the hospital before. Many family members have never had someone so close to them in the hospital. Listen to what you say with their ears. See what they see.

They see the doctor in their room for 5 minutes a day… They don’t see the doc

  1. Checking labs
  2. Discussing things with consultants
  3. Reviewing old records
  4. Discussing the dispo with the case managers and social workers
  5. Arguing Advocating for the patients with the insurance companies
  6. Writing progress notes
  7. Dictating consults
  8. etc.

If you’re a nurse, you can change all of that if you just say something like, “Behind the scenes, we’ve all put our heads together and the doctor has reviewed your labs. Although she’ll be by a little later, she’s up to date on everything that’s been going on. She has some pretty sick patients on another floor.”

Likewise, the patients don’t know that when the you (Doc) write an order that…

  1. The secretary has to take that order off
  2. The secretary faxes it to the pharmacy or enters it into the computer
  3. The secretary alerts the nurse or flags the chart
  4. The nurse reviews the order
  5. The pharmacy checks for duplicate orders, drug interactions, therapeutic substitutions, etc
  6. The pharmacy sends the med up
  7. And, finally the nurse brings the med to the patient

All it takes is saying something like, “I’m going to order a stronger pain medicine for you. But, I apologize, it’s going to take a little while for it to come up from the pharmacy.”