Do-overs in the same barn

In, Blink, Malcolm Gladwell explains that we often make decisions in the blink of an eye. In fact, Gladwell shows us, we frequently form an opinion of people we meet within the first few seconds. This makes it important for us to prepare before walking into an exam room– we want to know our patient’s name (and how to pronounce it), why they have come to see us, and what we hope to accomplish. Acknowledging that we are about to make a difference in the life of another person (we have that opportunity each time we interact with a patient) gives us a sense of purpose that our patient will pick up on immediately.

But sometimes we aren’t at our best. We may be distracted, irritable, or overcome with an emotion that we just can’t shake at the moment.

So if we fail to make our best impression, do we get another chance?

Yes! But it helps to employ a few simple skills.

First, we can acknowledge that we got off to a less-than-optimal start. The next time we see our patient, we can explain what was going on at the time (if appropriate) and state what we want instead: to have a strong partnership, to provide the best care, to listen – whatever we feel we missed the first time around. Years ago, I was practicing Internal Medicine in an HMO setting with 15 minute appointments, frequently running behind schedule. I didn’t know how to care for patients in such a short time when their medical conditions were complicated or they were emotional. The clinic I worked in asked new patients to arrive one hour before their appointment to fill out paperwork that usually took 10-15 minutes. On one particular day I was running an hour late, so my new patient, a busy executive, waited 2 hours to see me before I walked into the room. After apologizing to her for keeping her waiting, I was hit with an angry tirade that centered on the concept that her time was just as important as mine. Since I had been working hard and without a break all day, I felt unjustly accused. Pointing that out, however, would have gotten us nowhere. So I repeated my apology and explained that if I could have prevented this situation I would have, but that now that we were together I would like to spend our time on the concern that brought her in rather than have her continue to yell at me. She instantly dropped her anger and we used our time to discuss her concern, ending the visit with a solid relationship and a plan that we both felt good about.

Another great skill for building relationship after a rocky start is to use a fact that Gladwell alludes to – our tendency to make quick associations between current situations and past experiences. Yesterday I saw a 50-year-old professional who came in with his wife. It quickly became apparent through her many questions that she was a very detail-oriented person. My patient obviously valued this and deferred to her assessment many times. Coincidentally, I happened to mention that I was a very detail-oriented physician and we shared a laugh that, “being ‘a bit OCD’ is a good thing for a doctor,” as my patient put it. His sense of comfort on making this association was palpable, as he seemed to feel more comfortable with the idea that his physician was like his wife, also someone he could trust and rely on. While we never want to misrepresent ourselves, when we point out shared values or perspectives we help our patients feel more secure being cared for by us.

Years ago, a horse trainer explained to me that when you move a horse to a new barn, you get a “do-over.” The horse perceives that he is now in a new place and easily accepts any change in routine or rules. Although our patients do make an immediate judgment about us based on their first visit, even in the same “barn” we can often create a “do-over” with these simple yet effective steps.

About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
This entry was posted in building relationship with patients, effective communication in healthcare, first impressions, physician coach, physician coaching, physician communication and tagged , , , . Bookmark the permalink.

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