Is There Room for Patients on Your Bottom Line?

I’ve done my time as a senior executive. I get that the bottom line is what drives us. What I have to ask is: You do know customer service is part of that, right?

In any industry filled with opportunity in the form of big dollars, we often see numerous players. One only has to look on either side of any city street to see a variety of coffee vendors. Little wonder that if you don’t get your coffee as ordered and in a timely manner, you walk down the street to someone that understands you – the buyer – have the power. These guys get customer service.

The minute you walk into a bustling coffee shop, there is an energy that gives you a sense you are in the right place. Maybe it’s the music, the pleasant aromas, the smiles and chatter amongst people on both sides of the counter … whatever it is, that first impression has been made.

What’s the first impression in many healthcare organizations?

The minute you walk in, conversation stops. Your demeanor becomes more serious …. subdued. There is an absence of color, texture, and sound.

If it were only that, I think I’d accept it. Unfortunately, the atmosphere is off-putting and that includes the reception patients receive. It’s not rocket science people … smile, if nothing else.

We all have horror stories of bad receptions where the admin staff appears disdainful, unfeeling, and unprofessional in the initial exchange. Every now and then we get a good reception and what a difference it makes to the entire visit!

Case in point: A patient in front of me left the medical facility in tears because the staff member yelled that they didn’t know how long it was going to take and they were tired of being asked the question.

Rest assured, I didn’t ask the same question … but I wanted to.

Just last week, at the lab getting my blood work done, a technician assured the patient in front of me that they had a bed for her (for when she fainted giving blood), and that it wasn’t an uncommon request, and she shouldn’t feel bad about it in the slightest.

Maybe the different staff members were having bad and good days. Maybe some people just aren’t meant to be client-facing. And, maybe some organizations just don’t care about customer service. Because, if you care about your bottom line, you care about customer service, even if you aren’t getting it right.

One can’t help but posit: What can your healthcare organization do differently to better serve the patient?

As a patient, how do I get that experience of being served without being regarded as just a number? I realize we – the patients – aren’t in the same power position as coffee consumers, but wouldn’t it nice?

Patient Engagement and Other Mumbo-Jumbo

Say what you mean and mean what you say.

It sounds simple, but nothing could be further from reality in healthcare. That doesn’t mean we shouldn’t try, right? I have to wonder about the term “patient engagement”. I’ll be straight with you: it leaves me feeling confused at best, insulted at worst.

I’m confused about what you want from me, what I’m going to get out of this “engagement”, and where it will go. I’m insulted because it feels like whatever the goals and outcomes, they serve you, not me.

I’ve not been asked how I feel about the goals and outcomes my healthcare providers are looking to achieve through patient engagement.

I’ve not been asked what my goals are or what outcomes I want to see achieved. You do know my goals change regularly, right? What provisions have you made for that?

Let’s break it down …

First: We often see buzz words and phrases being tossed around because, well, they’re buzz words, which means they are the terms of the moment. Sure, they’re trendy and you sound cool and current, but if your end goal is a different response … you’ve missed your mark.

Second: When the association between words in a phrase is unclear, we tend to ignore it completely or at the very least be suspicious of the motives. I’m going to guess that neither is the goal … again, you’ve missed your mark.

Third: Patient engagement is a means to an end but not only do I not understand the end goal, we haven’t even had a conversation about what that end goal should or could be. Again … you’ve missed your mark.

Simply put, the word engagement is devoid of emotion. The words together don’t mean anything to me. I believe the intention is to engender feelings of warmth and caring, but they leave me confused, suspicious, and cold. Not a good start.

Engagement is a technical term to describe a relationship. It can be one-sided and if the two parties have not had a conversation about the end goal, then it is definitely one-sided in terms of decision making and power. And, because we have not had a conversation, and as a patient, I’m expected to be excited about this new “thing” that’s being presented, it is patronizing. It’s what we do to small children who are too young, too immature, and too inexperienced to know better.

Your language must be simple, clear, and honest in terms of the division of power and trust. This is not because we are incapable of understanding technical and academic language. Nor is it a matter of inadequate education. It is because the words we choose to outline our relationship matter.

To start, what do you know about the people you serve?

We may be patients, but we are so much more. Some of us are engineers, teachers, product managers, executives, technology gurus, software developers, and entrepreneurs. Many of us are also caregivers. We hold the hand of someone in need, we park the car at the doctor’s office, we wander the halls of the hospital looking for the correct department, and we listen to the instructions from the doctor or pharmacist.

What are you doing to tap into all that?

Answer that question and maybe we’ll get somewhere.

Here is the story I tell about the time the healthcare system got it right:

I was woken from surgery last year and although the procedure had gone satisfactorily, I had not reacted well to the anesthesia. There was the anticipated pain from surgery to deal with, but also overwhelming dizziness, nausea, and disorientation. I couldn’t speak. I could barely hear, let alone process what was being said to me.

But, I could see clearly.

What I saw was a nurse seeing me just as clearly. She made the decision to keep me overnight in order to monitor my condition. In my single lucid moment, she asked me if I was in pain. My words were slow, but I assured her it wasn’t too bad. I didn’t want to be a problem. I didn’t expect anything but to be left alone. Her response was I didn’t need to be in pain on her watch.

I have not felt so precious, so taken care of, since I was a child with my mother.

What that nurse did was validate my experience, my pain, my person. We both knew she could do nothing about why I was there or anything after I left. But, while I was in her care, I would be comfortable.

Not only had I no pain … I was safe in her care.

It is unfortunate this doesn’t happen more often.

You want patients engaged? Give them a reason. Hear what they are saying and instead of giving them all the reasons why it can’t be the way patients want it, ask yourself why it can’t be that way.

You want patients to be committed to their own health? Give them an experience like I had, because that nurse had a significant influence on my speaking up about patient engagement.

I believe you need to start with a conversation. And, to start that conversation, look at the patient like my nurse did. Do not be swayed by what you want for the patient, because in doing so you do not live up to the covenant of trust extended to you in your role as healthcare provider.

Does that mean we’ll get all the answers to solve all the problems with healthcare? Are you crazy? The problems are too big to take on all at once. All I’m talking about it changing the way in which we tackle the problems.

The solution is not patient engagement: It’s having real conversations.

So, watch your language.

Illusion of Choice

I was reminded of the illusion of choice the other day. My father-in-law was deciding on dinner from the “soft foods” available on the hospital menu. I was surprised at how many tasty sounding options he had, even if he was restricted to soft foods. While he agreed he had more options than you might think, what he really craved was a salad.

It brought to mind getting my then six-year old daughter dressed for school in the morning in a timely manner because it also involved the illusion of choice. The night before we would select two outfits and the next morning she could choose one of them. It was simple, straightforward and it worked, until … the day she refused to accept that there were only two choices available.

See, the illusion of choice only works when we accept that we will choose from the options presented. In my father-in-law’s case, he felt he had no choice so he will stick to the soft foods for another couple days. The alternative would be detrimental to his health and he accepts that reality. The day my daughter realized she had an entire closet of options, she demanded to know why she had to limit herself. And, really, that is the question: why do we impose limits, when should we simply accept this is good for us, and when do we push back?

Let’s apply this to a treatment plan or more specifically to medication that has been prescribed to treat an illness. While we may be presented with more than one option, generally physicians have a “go-to” drug to treat a particular ailment (when medication is warranted). As patients, we are often so relieved to be diagnosed and know we can be treated with medication, we go along with it and wait eagerly for relief from the symptoms of our disease.

Here’s a question: how many people read the warning labels on their medication? I’m not talking about just on the bottle, but the multiple pages pharmacists hand out. As I’m sure most of us have, suffice it to say these scare the beejeepers out of me and that’s saying something considering the medications I take regularly.

I know, I know. The drug companies have to list all the possible side-effects even if the odds we experience them are minsicule. Ignore for a moment the risk of stroke, paralysis, or other nasty side-effects and consider the ones that sound innocuous enough like dry mouth, headache, and upset stomach.

From experience, I can tell you that after months of not having a flare-up (of inflammation), I desperately want to get rid of these “minor” side-effects because I will have forgotten how bad it was before. And that’s when we begin to run into compliance issues.

I started with a discussion about illusion of choice so let me get back to it with this: when a patient feels the side-effects are at least as bad as the original ailment, they begin to waver in their commitment to comply with doctor’s orders. Let’s not forget that taking medications are also inconvenient and expensive (especially for those without a drug plan).

Not saying it’s right, just saying it happens. We begin to wonder if there are other options. Sometimes, instead of asking our doctor, we take it upon ourselves to determine what options are available and that is when we run into trouble. Whereas my daughter was checking out her entire closet for options, patients have google.

So what’s the point to all this?

There’s a natural progression that patients go through in their treatment plan. If you recall, my father-in-law decided the soft foods restriction was worth following and it wasn’t going to last forever. Not only that, this treatment was not ambiguous or subject to the individual’s case: you have abdominal surgery, you have restricted diet. Period.

It’s when a patient has a chronic treatment plan that things get a little messy. There is no end to the treatment. There is no single way forward because everyone reacts a little differently to medications. Just like my daughter who wouldn’t accept a two option restriction – take it or leave it – patients in a treatment plan for the long haul will push back and that can be viewed as a problem or an opportunity for greater compliance.

Remember: the underlying premise is that we all want a patient to get better, but what “better” means for one party may be different for the other. We all reach a point when we can’t just tell a person the way it has to be “for their own good”. The illusion of choice works well for a long time, but when a patient starts pushing back, you have to be prepared to change the options to ones that the patient accepts for themselves … and then support them in those choices.

The alternative will always be non-compliance.


While We Wait

It started with my hands.

There wasn’t a moment of the day or night without pain. My life was reduced to transitioning from angry, hostile monster to sobbing, incoherent mess.

It was clearly no way to live and I was 42 years old.

In my case, the very last thing my physician tried was a test to see if I had rheumatoid arthritis. That is, after months of negative and inconclusive testing and, always, that uncertainty and pain. When I was finally referred to a rheumatologist I remember the intense relief: finally … I had some answer as to what was wrong with me.

That was before I realized it would be another 29 weeks – or more than 200 days – before I would see the rheumatologist and another couple weeks waiting on the additional blood test to confirm the diagnosis.

I waited because what else was I to do?

It would be another three weeks after formal diagnosis by my rheumatologist before the inflammation, and therefore the pain, would be reduced enough that I could think straight again.

I’m one of the lucky ones – wait time to see a rheumatologist is now at over 2 years.

So maybe you can understand why all the hullabaloo about wait times always makes me smile. It’s not a happy one by any means. On the contrary, it is my acknowledgment and understanding as to how brutal waiting is on every facet of our lives, because, believe me, I get it.

From the person anxiously watching the clock wondering if their parking will run out before they are seen to the person wondering if their co-workers and boss will understand that they are late; from the person juggling three active children in an overfilled waiting room to the person wondering if they will have time to make dinner when they get home before soccer, ballet and piano lessons; from the person wondering if this test will finally determine what is wrong with them to the person wondering if they are going to catch anything from the clearly sick people around them.

These are all legitimate factors when we have to wait. But, from my perspective, dealing with long wait times is only part of the solution. What happens while we are waiting is just as important.

Case in point: One of the waiting rooms I was in recently had a screen that not only posted a patient’s first name and the number of minutes until they would be seen, but was updated so if there was a change, a patient would be informed immediately.

What a simple solution to the “how much longer?” situation that not only addresses patients’ queries and concerns, but it has to affect the bottom line in terms of reducing the time of staff answering this question!

Let’s be honest, we all check before we resign ourselves to participating in the line that goes on for who knows how long. It’s one of the reasons why Appletree’s online app showing available doctors, locations, and wait times is so successful.

It’s also one of the reasons why booking online for our appointments makes sense: we don’t have to wait for staff to be available to take our call. Conversely, that same staff member’s time is reserved for some other task.

So where am I going with all this talk about waiting? I’ll sum it up with three points.

First, we need a discussion about necessary versus unnecessary waiting; between what we can and will accept versus what is bordering on immoral or inhuman.

Second, it makes sense that all stakeholders be involved in figuring out how to deal with waiting. This includes objective and critical evaluation as to the success of any program or process put into place.

Which brings me to my third point: I think I speak for many people when I say I don’t mind waiting for something if at the end it is worth the wait. Taking a look at my journey of being diagnosed I have to say I have mixed feelings. Knowing what was wrong with me gave me intense relief, especially when I had to work hard at getting taken seriously all those months. However, I don’t believe I was ever really heard.

If I had to give a single piece of advice based on my experience it would be this: listen. I mean, really, listen to the patient and don’t assume you heard unless the patient tells you that you got it right. I didn’t care what was wrong with me so much as I wanted and needed the pain to stop. Not only would the wait have been far less of an ordeal had I been heard, I likely would have been able to hear what was being said to me. I don’t believe I was being obstinate … I simply couldn’t hear past the pain.

Here’s the thing: fixing wait times is a good thing and we should do it, but it’s too big for one person to solve … but hearing what a patient needs at that very moment is doable. In doing so, we change the conversation to be about the waiting experience instead of wait times.

It would have made the wait worthwhile to me.

Playing with the D-Rings of Life

So maybe it was the thrill of being in a foreign place that a sense of adventure commandeered my better judgement. It could have been because my husband really wanted to go and this was a couples’ vacation. More likely, I was exhausted from life, hence the need for this vacation away, and he got me when I was vulnerable.

Regardless, I found myself strapped into a harness, watching the waves crashing against our tiny boat. I realized there was a lot of water around us. I started to get second thoughts. As if our local guides sensed my concern, they began to let the line out and I bounced on the bottom of the boat. It distracted me, and moments later, the lines on our sails were let out and that boat got further and further away.

There is no other way to describe it: we were being flown like a kite.

I’m not crazy about heights so I decided it was best not to look down. I didn’t like the way the clouds were gathering (yes, there was a storm approaching), so I decided to look into the distance. Again, land was a long way off, but it didn’t look so scary. And then it happened … my husband told me to stop playing with the d-rings.

I had no clue what he was talking about until he calmly explained.

Annoyed, I told him I had to do something to keep myself from being anxious up there. I mean, what was the big deal? He’s an avid fiddler with anything and he was telling me not to do so?

He assured me that if I wanted to go down in a hurry I should just keep doing what I was doing. Alright, what he really said was the only thing keeping me attached to the sail was the d-rings. That I was fiddling with.

Now, I’m not one to panic, but I sure did that day. Thankfully, it took the form of freezing in place. He had to pry my fingers from the d-rings.

That was almost 20 years ago and I have never been flown like a kite since…

But, it did get me to think about how there are times in our lives when we find our situation precarious, much like my kite-flying adventure was to me. It also made me think of what I learnt from such an experience … besides never doing that again.

First of all, we should live life to the fullest. That means be watching for opportunities and when one presents itself, we should recognize it as such and take advantage of it.

Second, accept the fact that by taking advantage of opportunities, we are sometimes going to find ourselves in a less than optimal, even downright bad, situation. Gotta take the good with the bad, right?

Third, cultivate the types of friends and colleagues that will not only notice when we’re heading for trouble, they’re invested in you enough to warn and even, when called for, take steps to prevent serious harm: especially the stuff you don’t see coming.

Life isn’t without its dangers, but when you have people willing to be flown like a kite alongside you and keep your fingers off the d-rings, well, then you’re set for whatever opportunities come your way.

Personally, I’d stay away from anything with a d-ring…

All You Need is 60 Seconds

If you have a chronic illness, you need an elevator pitch.

You know what I’m talking about: the less than 60 second sound bite that explains you with your illness and how the world should deal with that knowledge. I didn’t think it was so difficult to come up with one.

The Pitch: I have rheumatoid arthritis, an autoimmune disease, involving inflammation of my joints, including those that keep my organs functioning, as well as chronic fatigue and pain. Essentially, my immune system is attacking itself and the only way to treat it is with medication aimed to reduce my immune system; the result being increased susceptibility to infection.

Pleased with myself, I shared this with my twenty-six year old daughter. She has fantastic neutral face. I wanted genuine feedback. I got it.

I may have explained my condition, but I left out the most important aspects of the perfect elevator pitch: what it means for others … in other words, why they should care and how they should relate to me.

Not to be dissuaded, I tried again. And, again. We were at it all afternoon. Turns out there’s a reason this isn’t as easy as it looks: it’s about seeing it from the other person’s perspective and we can all relate to how difficult that can be at times!

So here’s what I did: I got the clinical explanation out of the way as quickly as possible. It’s true, almost everyone has heard of arthritis. For the sake of a 60 second explanation, it really doesn’t matter that rheumatoid arthritis is like no other arthritis. I have to save that educational moment for another time.

Instead, I focused on what a person would see and what they would not see about my illness. Then, I worked out scripts people can use to interact with me.

For instance, I get tired easily, but at the same time I don’t want to miss anything (or let anyone down). If there is an understanding that I will do everything I can to avoid cancelling a get-together, appointment, deadline, or other scheduled event, and that I don’t want people to stop counting on me or start making allowances for me, then we have a starting point.

My daughter encouraged me to remember that there is limited mobility and strength which translates into asking for help opening water bottles on a regular basis. What is important is that I would prefer to ask for the help, as opposed to people pushing the assistance on me. If I promise to ask when I need it, we have a script we can all respect.

So, armed with these (and many more) examples, I tried my pitch again.

Pitch Take 2: I have rheumatoid arthritis. It’s an autoimmune disease affecting joints, including organs, and involves chronic fatigue, pain, and inflammation. I may have to ask for assistance opening a bottle, but I’m not afraid to do so. I may have to ask for your understanding if I cannot meet a deadline, but I’m not afraid to do so. I may have to ask for alone time when I’m overwhelmed with pain or lack of sleep, but I’m not afraid to do so. I’m more susceptible to infections because of the medication used to treat my disease, so do as you would with anyone else: don’t cough on me and please wash your hands regularly.

I want to live to the full extent that I am able to do so and that includes letting me try and fail things. What I want from you is not to do everything for me, nor to feel sorry for me. If I need help, I’ll ask, and if you can give it, all’s great.

If you have a question, definitely ask. When a person asks a question it’s a win-win: you get the information (hopefully) you’re looking for and the other person gets to give it to you. Such a simple exchange can mean more for developing understanding and fostering trust and respect than any one thing can do.

Just under 50 seconds.

It’s a work in progress, but I’m more convinced than ever that creating an elevator pitch and accompanying scripts for my chronic disease is an exercise that will pay off and then some.

Lies We Tell

We used to tell our children that an act of omission is as bad as an act of commission. That is, leaving out salient details is still not telling the truth, especially when we’re asking the questions…

I find myself committing acts of omission every day.

I had to cut short a get-together with a friend not too long ago, explaining that I hadn’t slept well the night before. It was absolutely true: I had slept fitfully and maybe 2 hours. What I left out was the reason: I’d had a flare-up of my rheumatoid arthritis.

Now, that doesn’t sound so bad what I left out does it? Let me tell you why I think it matters.

There are days, weeks even, when I am able to do less than usual, certainly far less than I would like, either directly or indirectly because of my chronic disease. It’s difficult enough to admit this to myself, let alone someone else. Add in that I may inconvenience or let someone down and I think you’re getting a glimpse of what I’m getting at here.

On the surface, people can be extremely gracious (we are Canadians, after all), and accommodating, given the reason of insufficient sleep for less than par performance or participation. I don’t need people to be polite. I want them to tell me when I’ve put them in a difficult position and then brain-storm together how to handle it.

Consider if I had a broken leg and that’s why I had trouble sleeping. I share this with people and they immediately get where I’m coming from. In fact, we’re likely to exchange stories of people we know that have been in similar situations. If I slip, I’m clumsy and we share a laugh. If I attempt an ambitious snowboard stunt and almost make it, I may get an approving nod and again we share a laugh.

However, I explain that I couldn’t sleep because I was in pain and … instant silence.

People aren’t sure what to say. Maybe we say “sorry” (we are Canadians), suggest ways in which I could “deal with” the pain … and the list of polite, yet distant, responses continues. I don’t want people to feel awkward about asking me or talking to me about my health. I want them to ask me straight out if I feel it’s under control, or being managed, just as they would ask who the surgeon was that set my broken leg.

I don’t know if it’s because one is a physical and temporary condition and the other is a physical / mental and chronic condition, or what, but it does make you stop and think, which brings us back to what else is going on in our heads.

For me, I’m wondering if the person I’m speaking with will think I’m unreliable, weak, fabricating or embellishing my condition, or worse, wonder why I didn’t just tough it out. I want a world in which it is not mutually exclusive that I have a chronic disease and am reliable.

There’s a reason people are reluctant to discuss a chronic condition: we don’t know how to manage the conversation. We have no script.

I can hear the argument: You don’t have to tell people everything. It’s absolutely true. I don’t have to tell them that I am less reliable due to a health condition because I don’t know when there will be a flare-up. I can do what I’ve done for years and manage my health as best as I can and give acceptable reasons for when I am unavailable. But is that really the best we can do?

I want people to see me as capable of managing my health and my life as anyone with a physical and temporary injury: because I am. And, if someone calls me out on something that they believe I’m not managing, I’ll just call them a true friend. I don’t want people to “fix” me, but just like the person with a broken leg, I want to be able to ask for a little help now and then.

Either way, what we leave out of a conversation can be more important than what we include and that’s something we should talk about.