What makes for a good patient experience? — In the Theater of Medicine
As a practicing physician, I started thinking more deeply about this only after I experienced it from the other side — that of a patient. ‘Patient experience’ as a topic, is not included in conventional medical school curricula, and while some residency programs are beginning to incorporate varying degrees of said training, they likely fall short of the ‘ideal’ state.
While watching a show about making movies, I could not help drawing parallels between elements of a great movie and that of an effective patient experience. For starters, movie-making and interacting with patients are both forms of art. The stage needs to be set, the script and story-telling should incorporate well-conceived and well-constructed narratives, the main characters should play their part well to bring the script to life, the assisting crew needs to make sure there is enough attention to detail, and the ending should be well-executed to wrap up the story well. In each of these elements — one can conceivably imagine parallel components in patient interactions that are critical for their success.
The patient encounter starts here. As the patient walks in to the clinic, or a hospital, it is important that he/she is greeted with warmth and a sense of familiarity. Patients are usually anxious at best, and dreadful at worst, for their visits with doctors, given a setting that demands that they share their vulnerabilities with a complete stranger. The least we can do, as physicians and health systems, is to make the setting as comfortable as possible. This may include greeting them with a smile, addressing them by their first name, offering them a glass of water, familiarizing them with the physical space and visit structure and making it known that we care.
I cannot emphasize this enough. Cinema is all about storytelling, and pretty much everything that goes into the film including dialog, props, lighting, a song, or even an edit, is intended to convey some message. Subtext, in particular, is all about the subtle messages that are conveyed implicitly without stating them. Not only is it crucial to have a well-conceived script, but it needs to be executed well also. A classic example that comes to mind is Groundhog Day — a film not particularly notable for its production design or cinematography — but a brilliant ‘BACK TO THE FUTURE’esque story, that draws you in, and holds you there. And it has made its way into our culture so indelibly — that the phrase” “Groundhog Day” is frequently understood as a metonym for re-living the same day over and over.
Coming back to our patients, it is so critical that we condense the assortment of medical jargon into digestible simple themes that draw them in, and hold them there — that they can take away with themselves — that they can explain to their near-and-dear ones. In particular, this concept lies at the heart of breaking bad news about life-threatening conditions like cancer or heart disease. Having a sufficiently rich vocabulary to support a language of patient care is, I believe, profoundly important. In that moment when the physician is essentially telling the patient that his/her life is about to change — the script, the subtext and the setting- are ever so important.
Characters bring the script to life. In the theater of medicine, while all personnel involved are essentially characters, I will focus, for now, on patients and providers. As a medical student, I learnt that two of the life-threatening conditions that have to be considered for a patient presenting with chest pain include heart attack and aortic dissection. While these might present very similarly, there are subtle clues that differentiate them. As a fellow training in cardiology, one of the first patients I cared for presented to the emergency room with chest pain. And while heart attack, being much more common, was highest on my list — it turned out that the patient played her role very well. She literally brought to life, the script of aortic dissection, that I had memorized and seen only in textbooks. She verbalized very well that her chest pain was radiating to her back and she had unequal blood pressure in both arms — clues to clinching the diagnosis of aortic dissection. And that saved her life.
Patients are often trying to communicate their pain, their frustration and their fears to their physicians. Some portrayals are straightforward, others less so, and it’s that uncertainty and ambiguity that makes them compelling. What is the patient trying to say? What is she hiding? What is he afraid of? And while, not all patients are able to articulate, or play out their scripts well, it is imperative that physicians and nurses play their part in eliciting their best performance — asking the right questions — and bringing their story to life.
While the cast includes actors who appear in front of the camera and give voice to the film, the crew works backstage to make it all possible. Most of us often dismiss the endless list of credits at the end of the movie, but it is the cinematographer who brings the look, feel and mood of the film to us, the electrical team that handles getting power on the set, the art department that realizes the creative vision, the gaffer responsible for the lighting plan, and the list goes on.
Along similar lines, several crew members working backstage in medicine have to play their part to bring the patient experience together — the social workers provide support and help our patients navigate the complex world of insurance and health services, physical therapists help patients regain strength, nutritionists help with healing with food, patient transport teams help patients maneuver the hospital maze, and the list goes on. The higher the quality of ancillary services, the better the patient experience.
Every plot thread and character that has been introduced needs some sort of resolution before the credits start rolling. The ending must be executed nicely; it must wrap the story well. Even great movies can have poorly executed endings. Take Lord of the Rings — The Return of the King for example. We understand that this ensemble cast had a lot of characters to say goodbye to, but the ending drags on and on. With a runtime already over three hours, this was beyond excessive.
The ending is the culmination of all that came before it. In the ideal patient encounter, this should incorporate a concise summary of what happened during the visit, clear articulation of instructions to follow after visit, comprehensive list of resources for their medical needs, contact details for communication with the doctor and nurses and above all — making sure that the patient understood all of this.
As I walk into the clinic to see my next patient, I will leave you all with food for thought. How can we tell our patients more effectively that we care? How can we communicate with them in a language that they understand? How can we partner with them and support them through their vulnerabilities? How can we make this movie better?
And with that, its time for — Lights… Camera… Action…
Originally published at blog.heartbeathealth.com on October 8, 2018.