Communication is the Best Medicine
As ER doctors and mid-levels, we live in the emergency room. It is our home away from home. And each room can present a new and exciting challenge. But for a patient, each room can present a new and frightening uncertainty: Will this hurt? Am I having a heart attack? Am I going to die? As clinicians – and caregivers – it is our job to help ease the worries of our patients. Our tone of voice, our facial expression, every part of our presence in the examination room will have an effect–positive or negative– on the patient’s experience. If that effect is positive, it can lead to better patient outcomes, decreased medico-legal risks—and a better shift for you. And if you keep stringing better shifts together, sooner or later it adds up to a better career.
Don’t keep secrets from your patients
Let patients know, within reason, what you are thinking at every point in the encounter. It is a real privilege to give this insight and it will be appreciated. For example, express your findings while examining the patient. “Your lungs are nice and clear” or “you seem a little tender right here,” engages and reassures patients and lets them know both that you are paying attention to the exam and that you are making an effort to communicate with them. Telling patients what you think the problem may be or your preliminary diagnosis BEFORE ordering tests might even avoid some tests if the patient has been given a good rationale and you have earned his or her trust. You may well be able to confidently reassure them that the problem they were most concerned about–or even terrified of—is in fact not present. You will have a very relieved and very grateful patient.
Honesty is the best policy
We hold ourselves to extremely high professional standards and expect even more of ourselves than our patients do. At times, however, we may encounter a difficult or uncommon problem that we haven’t previously encountered. It is best to be honest with patients if you are uncertain about their diagnoses. A good example of this is with rashes – often tricky to definitively diagnose in the emergency department. It is best to explain the possibilities, discuss treatment options, and give appropriate referral advice. Patients appreciate honesty. And even if we can’t identify the rash, we may be able to make the critical determination: “I’m not entirely certain what this represents, but I’m confident it’s not the rash of …” [shingles/Lyme disease/smallpox/Ebola/etc.]
The emergency department is our second home, so it is best to treat our patients like guests. Worried guests.
Marc A. Milano, MD, FACEP, is an emergency physician at Somerset Medical Center in Somerville, N.J. He serves as physician head coach of the Patient Satisfaction Coaching Program at Emergency Medical Associates, an emergency medicine practice headquartered in Parsippany, N.J. He is the medical director of emergency medical services (EMS) at Somerset Medical Center. Dr. Milano received his undergraduate degree from Rutgers University, his medical degree from St. George’s University in Grenada, and completed his emergency medicine residency at Newark Beth Israel Medical Center.
**Catch Dr. Marc Milano on WMTR 1250 AM on Sunday, March 24 at 9:30. He will be a guest on the “Answers Live” call-in radio show**