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The First FIVE seconds.....

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Well after spending the day in the ER and having a family member admitted I noticed one thing....

 

The first 5 seconds of your visit are the most important for raport building.... and to put someone at ease.  

 

Lots of people coming in and out of the room, only one actually stopped, fully introduced themselves and explained their roll in the delivery of care.  That one was received the best by the patient and myself (I was there as family, no name tag, keeping quiet in the corner so no one knew my position/education/title)

 

 

Those first 5 seconds are critical and so many people waste them by just jumping into history, or even worse exam (way to fast!)

 

So stop outside the door

take a deep breath

knock, ask if okay to come in

walk in slowly, close the door behind you - hospitals are noisy places

introduce yourself, your title, and your role ie I am the hospitalist provider

Shake a hand or make and effort to touch the patient is a gentle introductory way - if received well indeed shake the hand, if not received well just stop looking for contact

Pause briefly and let the patient and family absorb who you are, what you are, and what you are likely doing there....

 

Max 5-10 seconds and yet it sets the stage for a successful interaction...

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So... acknowledge the patient as a person?  Talk to them?  Make...eye contact?

Human sacrifice, dogs and cats living together... mass hysteria!

Just kidding.  One last thing: turn away from the computer.  It's not your lover.  

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Interestingly enough, I've evolved into this "script":

Me: Mr/Miss Lastname, I'm Ohiovolffemtp, the night PA.  I'll be taking care of you.  (shaking hands in the meantime)

Patient: Hi, how are you? (their typical polite response)

Me: Fine, but I'm supposed to be asking you that question (said with a smile)

Seems to work great.

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Being primary care, I don't often state my role, I always thought that was evident given I'm the only person not wearing a lab coat, plus I've seen these people many times.

I usually bring them back from the waiting room; "Mr Smith, there he is! how are you. Mr Smith?".  Sometimes I pretend to review his vitals and meds sheet, which I already know, because I reviewed the chart beforehand, but I save this for patients who are bent on making the world around them miserable.

The dance continues on the way back to the exam room; "Who is this young lady you brought with you today?" (Usually the wife, if it's a daughter, I use "oh, you brought your sister today!" Usually breaks the ice and makes them smile, and gets me introductions.

At this point I can see them and get an initial assessment; they don't necessarily know it, so no exaggerating going on; sometimes extreme like a 35 yo walking like a 90 yo 

In the room, down to business, but I still like to let them set the stage; (if I've never seen them before) "Hello Mr so-and-so, I'm Thinkertdm, I'm a physician assistant"; but then: "what brings you in today?"

I usually sit and face them; if it's an acute, serious sounding concern, I'll start looking again at previous vitals, labs if they are back yet; I'll periodically look at them to engage.

If it's a routine follow up, sit and talk, they'll tell me everything, sometimes without me having to ask.  You can make an Ros without sounding like an interogation.

I avoid PA because it sounds like "MA", but I suppose "assistant" sounds like "assistant".

 

 

 

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1 hour ago, thinkertdm said:

 

I avoid PA because it sounds like "MA", but I suppose "assistant" sounds like "assistant".

I never say assistant. it is not on anything associated with me. everything says PA, including name tags, CV, scripts, etc

Hi I'm Emedpa, one of the PAs here. what can I do for you today Mr Smith?

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"Evening Mr. Smith, my name is MediMike, one of the PAs with the pulmonary critical care team "

*Ventilator sounds/gurgles/screams*

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Yup, all above, "my name is Lov2xlr8, one of the Internal Medicine PAs, I'll be working with the Orthopedics team to manage your existing medical problems (I cover sick Ortho stepdown Pt's that Ortho doesnt want to manage). Additionally, I sat in an ER with a buddy last week and confirmed another big one I've always thought (and always try to do). Sit down with the Pt! Eye level. This isn't always possible but sure enough, my friend commented the provider he most trusted was the PA who took a chair and sat down with us.

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I go get the patient from my nurse's check in room.

Knock knock

Hi Mr Jones, can't believe it has been a year since your last physical. How is life treating you? Come on with me - we are moving next door to my room.  (as shaking hands)

Chat along the way, catch up.

If a new person. Shake hands, introduce myself. Glad to have you on our team. Let's get to know about you. Come on with me - we are moving next door.....

Always eye contact and greet the patient. I can usually remember something personal about them - or where is your Mrs today, etc.

We are people, they are people. No pretense or hierarchy - just say hello and be there.

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It's helpful to write something personal and non-medical related about a patient in your note. Gives an easy talking point for next time. Something like, "Likes golf, headed to Florida in March." 

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3 hours ago, HanSolo said:

It's helpful to write something personal and non-medical related about a patient in your note. Gives an easy talking point for next time. Something like, "Likes golf, headed to Florida in March." 

Dogs name is one of my go-to's

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I offer shake hands with all my sick patients, even if they conscientiously defer.  I then go wash my hands before conducting the rest of the exam, and note that while hygiene is important, so is respect and human connection.

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Yep, that's new way ER is now done and unlikely ever to get better. The ERs are overcrowded and the staff are burnt out. We need to change the whole dynamic and that wont happen until people stop coming to the ER for opiates, simple crap wasting peoples time, and mental illness. We need to get back to ERs treating emergencies. It sucks when there is a waiting room full of chest painters losing beds to custody patients and drunk people.

Sent from my SM-N950U using Tapatalk

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