A Tale of Two Hospitals

A few months ago, before just about everything was shut down due to COVID-19, a good friend of mine was suffering with some horrible, and all too familiar pain. He knew he had a kidney stone and went to the nearby emergency department to get some relief.

After a few hours and several imaging tests, the news wasn’t good. The stones were too big to pass and he needed surgery to have them removed. The physician went ahead and admitted him, hoping the surgery could be done in the morning. 

Although it was located in the middle of nowhere, this hospital had recently been acquired by a larger health system, one with a wonderful reputation in the community, not only for clinical excellence, but for exceptional patient care. I felt relieved that he was in good hands.

We spoke about a week and a half later. As it turned out, he didn’t have the surgery at that hospital. He had been there for a few days, waiting, but was unexpectedly released. His daughter then brought him to the hospital near her.

“What on earth happened?” I asked him.

“I have no idea,” he answered. “The whole time I was there, I didn’t know what the hell was going on. There didn’t appear to be any coordination or communication between any of the staff, like nobody was running the ship, and plenty of conflicting information.” 

He continued. “They wouldn’t let me eat anything because I was waiting for an OR, which was understandable, but this went on for two days. I kept asking when I’d be going in to have these things removed, and no one had an answer. Then, finally, they took me down to surgery and the doctor came in and said I was getting a stent.” 

“A stent?” I asked. “Why not remove the stones?”

“That’s exactly what I asked,” he answered. “Something about them not having the equipment to be able to do it, but they were telling me this while I was lying on a gurney right outside the OR. The whole time I was on the unit, I kept hearing them talk about removal. No one said anything about a stent”

“Afterwards,” he continued, “they gave me a prescription for some pain pills and told me to make an appointment for a follow up visit in two weeks. That was it. I felt like I was getting the ‘bum’s rush’ out of there. My daughter was furious and took me directly to the hospital near her and that’s when everything changed.”

“What happened there?” I asked. I had a feeling I knew what he was going to say.

“The physician there was amazing. He was confident without being arrogant and at some point he put his hand on my shoulder and said, ‘It’s okay. Everything is going to be fine.’ That felt great. Very reassuring. It was like night and day between those two places.”

He went on to tell me that it felt like everything was running smoothly; everyone knew the plan of care, and he never felt like he was being a bother when he asked for help. He even noticed that behind everyone’s ID badge, there was a plastic card listing ‘Always Behaviors’, similar to AIDET, something he’d heard me talk about a lot.

As happy as I was for him that he got the care he needed and was just fine, I was a little disappointed. I was really hoping for something new, some magic nugget of information that would turn the patient experience movement on its ear. Something we never knew, never tried. Something revolutionary that would solve it all.

Alas, it all came down to the same old things: listen well, communicate clearly, convey kindness. All those things we’ve been talking about and training on for years. No new shiny bit of technology, nothing terribly complicated. 

It really can be that simple.

All It Takes is One

A few years ago, I was in charge of reviewing all of the social media posts about our hospital. I sifted through everything on Facebook, Yelp, Google +, and the like and added those comments to our tracking and trending forms of what was being said about us. That, along with our comments from the surveys, helped us determine which areas were doing great and which needed a little extra assistance.

One comment that stands out in my memory was a 5-star Yelp review from a woman who was over the moon about the great care she’d gotten in our Emergency Department. She’d written several paragraphs, each one more glowing than the last, about all the wonderful people who had cared for her, how quickly she’d been seen, and how this was her hospital of choice, despite living closer to our competitor. 

She had a list of nurses’ and physicians’ names and showered praise over each of them, likening them to gods and angels. It was quite a review.

I remember sending it to the team; the ED wasn’t accustomed to hearing good news. More often than not, when people post on social media it’s to complain and trash-talk (often anonymously). So I was happy in this case to send over something to brighten their day.

Not 72 hours later, she posted again, this time calling us THE WORST HOSPITAL EVER (emphasis hers) and warning people to never go there. EVER. She got my attention.

I took a walk over to the ED and asked what had happened at her last visit, why she had gone from our #1 fan to our biggest hater.

As it turns out, there was one person with whom she’d interacted and it didn’t go well. It wasn’t so much a negative interaction as it was a just-not-quite-as-good-as-the-previous-ones kind of interaction. We’d done such an impressive job earlier, that we set the bar pretty high. This staff member wasn’t quite as attentive and it set us back. A lot. 

I thought long and hard about how to handle this. She’d left her name, so it wouldn’t have been inappropriate for us to contact her. Should I call her? Should the manager of the ED call her? Should the person she’d complained about call her? 

Ultimately, I did. I was used to these kind of conversations and it was certainly in my job description to follow up on reviews, positive or negative. I braced myself and dialed her number. 

She picked up on the first ring and, after I introduced myself, went into a tirade about how completely awful and disappointing we were. I listened, didn’t interrupt or try to apologize at first. Just let her talk. And talk she did.

“It sounds like this visit was very different from the others,” were my first words after she’d finished. “I’m so sorry. I can hear how disappointed you are.”

“You’re damn right I am,” she continued. I let her continue. She said mostly the same things she’d said before, but it clearly mattered to her that I heard them. 

“Gloria (not her real name), I’m so sorry we let you down. You came to expect a certain level of care and service from us and we didn’t deliver this time. I’m sorry we missed the mark the other day. What can we do moving forward?”

After a few seconds of silence she said, “Nothing. It’s in the past. But I’m glad you called.” 

“Gloria, I hope it’s not any time soon, but if you ever need to go to an emergency department again, whether it’s here or another hospital, I hope you receive the level of care you expected from us.”

“Well, I know you guys can do it. You did it before, you can do it again.” She paused. “I love your hospital. I don’t want to go anywhere else. But you have to do better, okay? I know you can do better. Promise me you’ll do better.”

I thanked her for talking with me and she thanked me for calling her. I was glad I did. Until that call, I don’t think I realized that people really do form relationships with their hospitals. This was her hospital. It was familiar. She felt safe there. We needed to reassure her that this one bad experience was not going to be the new normal.

All it takes is one bad interaction. It can completely undo all the goodwill you’ve built up with your community. If you’re lucky enough to get the opportunity to apologize, don’t pass it up.

Clear is Kind, part 2

Last time, I wrote about Brene Brown and how she stresses that clear is kind. I related it to my own experiences surrounding death and dying and, while using language like passed on to a better place may feel more comfortable, it isn’t clear. And it isn’t kind.

Thinking about all that reminded me of another incident in which being clear would have been much kinder.

I was working at a smaller community hospital, not a large trauma or academic medical center, when a patient who’d had multiple cardiac arrests on the floor was moved to the Intensive Care Unit with a significant decrease in brain function. The family was understandably upset and wanted answers about how this happened. 

We needed to have a family conference but there were no conference rooms available at that moment. We did the next best thing and gathered in the empty patient room next to his while the team of physicians and nurses spoke with the family about what had happened and what the plan was, moving forward.  

In hindsight, it’s easy now to see where we went wrong. We allowed to family to remain in that empty patient room after the conference. We thought we were being sensitive and accommodating, but over the next several days, they had multiple family members round the clock, sleeping in sleeping bags on the floor of that room. They brought in coolers filled with water and juice and even plugged in a crock pot for pulled pork sandwiches. 

We thought that by not setting any boundaries, we were being nice but it was the worst thing we could have done. By not telling them at 9pm that it was time to go home, we gave them the message that they shouldn’t leave. They stayed and didn’t get the rest they needed. They even asked if they could use the patient showers so they could clean up. 

It also put an undue burden on the staff. There was a window between the two rooms so anytime a nurse went into his room to provide care, the family was watching. It was very hard for the nurses to focus  and concentrate, knowing that there were people looking at them. People who, quite frankly, didn’t really know what they were looking at. 

This went on for over a week before the patient was transferred to a hospital that could offer a higher level of care. That place, I knew, had very clear boundaries about how many visitors could be there at any given time, very clear visiting hours, and a very strict no crock pot policy. 

It’s important to remember that the things we say or do when we try to be sensitive or accommodating aren’t always the kindest. Families need to know it’s okay to go home. To sleep in their own bed. To shower in their own bathroom. Or if they live out of town, at least at a hotel. Somewhere that isn’t the hospital so they can recharge, refresh, and be ready to support the patient and each other. 

This is where being a patient experience professional can get a little tricky. For those of us who have a hard time saying no, saying yes to every request seems like the kind thing to do. It isn’t. Not always. We have to stress the importance of downtime, of rest, and we have to be sure we’ve earned their trust, so they know they can leave the room and their loved one will still be safe. 
I wish we’d done things differently for that family. I wish I’d known of Brene Brown and her clear is kind message at that point in my career. It would have been a much kinder situation for everyone.

Clear is Kind

I read a lot of Brene Brown’s work. Her book, The Gifts of Imperfection, made a huge impact on me and I’ve been a fan of hers ever since it came out in 2010. I’ve started reading her most recent work, Dare to Lead, and in it, she talks about how being clear is kind.

It made me think back to when I was working in organ donation and transplantation. I was not on the recipient side, where the person who has been sick for so long finally gets that life-saving transplant. I was on the donor side, where a family who has just suffered a sudden tragedy is asked to make the ultimate selfless decision and donate their loved one’s organs. 

Since most Americans hate to think of death, we tend to use phrases like ‘passed on,’ ‘is no longer with us,’ or ‘is in a better place.’ They told us on day one of orientation NOT to use euphemisms. Say ‘dead’ or ‘died.’ It may be uncomfortable for you as the bearer of bad news, but it’s the kindest thing you can do. Families will appreciate it.

I said it a lot. I got used to saying it and I got used to hearing it.

Fast-forward a few years to when my husband and I were throwing a party at my house around the 4th of July. All of our friends and family were there, including my very best friend. It was well into the evening and many of us had had a few too many drinks, so when her phone rang and I saw all the color drain from her face, I didn’t know what had happened. 

I’d heard her say her brother’s name. I’d heard hospital. I thought I’d heard accident, but I wasn’t sure. I looked to my other friend in the room. “Wait… what happened? Is he okay?”

“He’s fine now,” she said. 

“Oh, thank God,” I answered. “Something happened but he’s okay?”

“He’s much better now. He’s out of pain.”

“Wait. Is he okay or is he not okay?” I struggled to read her face and make some sense of the situation. My friend had run out of the room crying and saying she had to get to the hospital, but my other friend was calmly telling me he was better. I had no idea what to think and those moments of uncertainty were horrible.

Finally, my husband who thankfully doesn’t drink, said, “He died, Kate. We have to get her to the hospital so she can be with the rest of her family. Let’s go. I’m driving.”

And at that moment, I understood. As horrible and unthinkable as that news was, I was almost relieved to know what we were dealing with. The next few days were a terrible blur for all of us, but I kept going back to those first moments when everything was so confusing.

I suppose it’s easier to deal with being mad at the one being unclear than it is to deal with your feelings about a friend dying. But when you’re faced with a sudden, unexpected, and tragic loss, what you need is information. Clarity. 

I know when Brene Brown says “clear is kind” she’s talking about instructions, feedback, expectations, generally between co-workers or bosses and employees. But it’s also true in painful situations like death. While we may want to soften the blow and use those phrases we think are helpful, it really only makes things worse. 

When I’m talking to an angry patient and trying to do some service recovery, the very best thing I can do besides apologize is be very clear about what happened and what we’re going to do about it. Patients want answers and as uncomfortable as it can be for me, it doesn’t pay to use fluffy language to try and soften things up.

Clear is kind. 

The Family Conference

I hadn’t been involved in the case. I didn’t know anything about why the family was upset, only that their father had died and they had questions about what had happened.

I met the patient’s two adult daughters in the hospital lobby and escorted them back to our conference room where several staff members, including the hospitalist physician who had cared for him, were waiting. After we’d gone around the table and introduced ourselves, I asked the daughters to tell us about their concerns.

As they told their story, I looked around the table and took note of how we were sitting, where our hands were, what kinds of expressions were on our faces. Most of us were sitting forward in our chairs, hands together, eyes on the sisters, while periodically nodding our heads or pursing our lips as they spoke. One of us sat back in his chair, arms folded across his chest, looking mostly at the table. The sisters noticed.

“Why can’t you look at me?” one of them demanded. “I’ve been asking questions about what happened and all you can do is stare down at the papers in front of you.”

He looked startled. “I just want to be sure I’m answering your questions accurately. I printed parts of his record so I don’t say anything incorrect.”

I could appreciate where he was coming from; he came to the family conference prepared to answer medical questions about what had happened. He didn’t come prepared to address their feelings about what had happened.

The woman continued, “All of you at this table have offered an apology and I believe everyone here feels genuinely sorry. Except you.” I shifted uncomfortably in my chair as she pointed at him.

“Maybe you do feel bad. Maybe you do have some empathy for me and my sister but you need to learn how to make people see that. I don’t believe for one second that you care at all and I really hope I’m wrong. If you really do care, then don’t just say you’re sorry. Show it.”

I was starting to feel really bad for him. Here he was in a room with several staff members, including the Chief Medical Officer, getting raked over the coals for a death that really wasn’t his fault. And that’s where he was stuck – it wasn’t my fault.

I’ve said before that patients and their families don’t care whose fault something is. They just want to know you heard them, you’re sorry, and you’ll do your best to be sure it doesn’t happen again. In this case, the patient’s daughters wanted medical answers, yes, but they also wanted all of us to understand how difficult things had been and to take steps to improve. This poor guy was stuck.

As uncomfortable as this family conference was at times, I’m very glad we had it. It gave all of us at the table a chance to hear directly from the family how scary, confusing, and frustrating it can be when loved ones are in our care. We forget sometimes that treating a patient also means caring for a family, and showing genuine empathy involves more than simply saying you’re sorry.

It’s the Perfect Day for a Grilled Cheese

He was angry. He was so angry, he got out of his hospital bed, grabbed his crutches, and walked down to administration to find the president to complain.

From his perspective, everything that could go wrong in a hospital stay had. Nothing was right. Everything was poor. He couldn’t imagine how we stayed in business if this was how we treated people. A few different staff members had tried to talk with him, explain things to him, tell him that he was wrong about us, that we really are a good hospital. Nothing helped.

“Somebody call Kate.”

I’ve been doing patient experience work for a long time so I’m used to going in and talking with people who are really upset. More often than not, I’m able to break through and resolve the situation. That day, I wasn’t so sure.

When they called me, he was refusing to eat, saying that he didn’t trust anything from our cafeteria. He said he had gotten so many trays of food that were wrong, he didn’t think any of them would be right. And he’d complained about it so much, he thought the kitchen staff might “mess with it.” Instead of trying to convince him that our staff would never do anything like that, I started by listening to him.

He told me about everything that had happened to him since he came to us, all the ways the communication had broken down, all the things that didn’t go the way he thought they would. I apologized. I told him I couldn’t imagine how frustrating it must be to feel like everything is going wrong. I apologized for letting him down. I didn’t offer one single explanation or excuse just then, even though I could have. There were plenty of things he wasn’t factually correct about but at that moment, it didn’t matter. What mattered was his perception. And his perception was we let him down.

I asked him a few questions about his life outside of our hospital, what his life was like before he came here and learned quite a bit about him. We kept on talking about things that had nothing to do with why he was here and eventually he asked if we could step outside for a moment so he could get some fresh air. We walked outside to a very cold and rainy day, typical for the Midwest. After just a bit, it was clear that we were both getting cold so I said, “You know what I think? I think this is the perfect day for a grilled cheese sandwich. I used to love coming inside on a day like this and having a nice, hot, gooey grilled cheese sandwich. Does that sound good?”

He stared at me for a second, suspiciously. “You’re thinking about it, aren’t you?” I smiled.

“You know I don’t trust this food here,” he answered.

I said, “What if I went down there and got it so the staff thinks they’re making it for me? Would that help?”

Again, he waited a moment before answering, “A grilled cheese sandwich sounds really good.”

He went back up to his room and I went down to get the sandwich. I had the head of our nutrition services bring it up with me so he could see that she was on our side. We then got to talking about the problems he’d encountered and I had a chance to explain what had happened. It wasn’t so much that things had gone wrong but we hadn’t done as good a job as we should have in explaining those things. I tried to make it clear I wasn’t making excuses, just trying to reassure him that he was safe, no one had messed up, but we needed to be better about communicating. He smiled and not only ate the sandwich, but ordered dinner and breakfast for the next morning. Success.

The next day, he was cleared for discharge and before he left, he asked to see me. I went up to his room to make sure everything was in order and to ensure he knew what to do once he got home. He thanked me, took my hands and brought his head down so his forehead was on them, stayed there a moment, and kissed my hand. “This place needs you,” he said. “I appreciate you and everything you did for me. Thank you.”

It was the perfect day for a grilled cheese.

“These Parents Aren’t Right…”

Child abuse. We all hated those cases.

Years ago, when I was working in the organ donation and transplantation industry, I was called out to a case involving child abuse. As you might imagine, it was incredibly difficult to see a small child injured to such an extent as to cause brain death, but the added layer of knowing the death was caused by a parent or caregiver was often too much to take. Most of us required a lot of de-briefing and assistance as we processed our emotions after a case.

In this particular instance, the mother of the child was the one suspected of perpetrating the abuse. Because there was no definitive proof yet, she and her husband were the ones I had to approach to obtain consent for organ and tissue donation.  

I walked onto the pediatric intensive care unit and found the RN who was caring for the little girl. She was visibly upset. She had been caring for this child for several days and watched her neurologic decline until a declaration of brain death had been made. She pulled me aside and told me the parents weren’t right.

“What do you mean ‘not right’?”

“Mom is not behaving like a normal grieving mother,” she answered. “And dad has some cognitive deficits, like he’s developmentally delayed. The whole thing is a mess.” Her voice broke and she looked like she was fighting back tears. She walked away before I could ask her anything more.

I went and took the parents to a small conference room and began as I always did. “What have the doctors told you about your daughter’s condition?”

“They said she’s dead.” Mom’s response had an alarmingly flat affect. I had talked to many parents who had lost their children and I’ve seen several who were trying to be very matter-of-fact and hold themselves together but you could hear the pain behind their voices. They were devastated but trying to get through what they knew they needed to get through at the hospital.

This one was different. There was no emotion behind her eyes.

As we talked about the option of organ donation, I felt a tingle running up and down my spine. “Something’s wrong,” I thought. “This isn’t shock or a delayed response. What is this?”

She asked a lot of questions about the surgery and what organs and tissues could be donated. I took my time and answered as thoroughly and compassionately as I could. She told me that the staff at the hospital hadn’t been very nice to her; they were convinced she had hurt her daughter and she said she trusted me. I told her she could trust me. We would take excellent care of her daughter’s body during the donation process and would let her know all about the recipients of  her life-saving gift.

She hugged me. And that’s when my blood ran cold. I actually felt a chill when she put her arms around me.

“This woman doesn’t feel anything.” The voice inside my head felt she had, in fact, done horrible, unspeakable things to her daughter. That I had positioned myself as someone she could trust was more than I could take.

We got the paperwork signed and I called the procurement team in to get started on the process. The mother’s sister came up to me and thanked me for showing her sister such compassion and respect.

“We’ve always known there was something different about my sister,” she began. “She didn’t express or exhibit emotions like other people. Growing up, I remember her always looking around and then doing what everyone else was doing, especially when it came to feelings. Thank you for not judging her, but treating her kindly. She never would have agreed to donate organs if you had been anything but kind to her.”

I was speechless, overwhelmed with all that had happened, sad to see this three-year-old’s life come to an end, and feeling like I had betrayed her somehow by being nice to her mother, the person who I suspected killed her.

I made my way to the staff break room and couldn’t hold back my emotions anymore. I cried. I’d never done that on a case before. They train us to keep our emotions in check and not get consumed by the tragedy that often accompanies a brain death diagnosis. But I couldn’t contain myself. I felt horrible. One of the nurses came in and I tried to pull myself together, not wanting to look vulnerable or unprofessional in front of her.

“It’s okay,” she said. “It’s actually good to see this. We kinda think of you donation guys as being uncaring vultures. It’s good to know you feel things like we do.”

The donation process began and this little girl was able to save a number of people’s lives. I don’t know what came of the mother, whether criminal charges were filed, or if she was convicted. What I do know was that it took me a very long time to process my feelings. I had never come face to face with what appeared to be a real-life antisocial personality disorder. It’s something I’d seen in movies and heard about on the news. I lived in Chicago, after all, the land of John Wayne Gacy who had committed the most atrocious acts imaginable on young boys. But I’d never spoken to or been hugged by a person who was completely void of emotion. It was bone-chilling.

Over time, I’ve come to realize that this was a person with a disease. Just like someone with diabetes or multiple sclerosis, she didn’t choose to be this way. She deserved my compassion and mercy just as anyone else with a disease would.

It’s a lot more difficult to remember that when a person has committed unspeakable acts of violence on a child, but that’s really what’s at the heart of healthcare, isn’t it? People come to us needing our help and it’s not our job to pass judgement; it’s our job to serve. We need to leave judgement to law enforcement and the courts. Our job is to care, to minister, to serve, to show compassion and mercy. Remember that the next time you’re faced with a difficult or even unspeakable case. And if you’re struggling, you can reach out to me to talk.

Do We Really Know What’s Best for Our Patients?

Back in the mid 1990’s – early 2000’s, I worked for the organization that coordinated the organ donation and transplant process in Illinois. I met with families who had a loved one in the ICU, often due to an unexpected trauma like a car accident or gunshot wound, and asked them to consider donating that loved one’s organs to save someone else’s life. A tough job, to be sure, but one I found truly rewarding.

While I learned a lot about the medical side of donation- the Glasgow Coma Scale, the importance of vasopressors, and how to do an apnea test- I learned a lot more about human nature; how quickly we form opinions about people and how they’re often completely wrong.

It was a Saturday night in the summer, our busiest time. My pager (yes, pager, it was a long time ago) went off just before midnight and I was sent to Cook County Hospital. The old Cook County Hospital, before the much-prettier Stroger building.  There was a 21-year-old man there who had just been transferred from the Cook County jail. The other inmates had quite literally beaten the life out of him.

Now at this point, I’ll tell you that he was African-American and that’s actually relevant because it was our practice to send an African-American staff person to approach African-American families. However, that night, they were either post-call or on another case and I was the next one up. I hadn’t had very many opportunities to work with families who were of a different race and I just wasn’t sure how this was going to go.

I got to the hospital and there in the dimly lit room was his family- about 20 women who were praying and crying and waiting for some definitive news from the doctors. The neurosurgery resident was about to go in and tell the family that despite their best efforts, he was brain dead. He wanted me to go in with him and ask the family about donating his organs. We never like to have those conversations together; it’s best to let people come to terms with what brain dead means and later present donation as a next step, once they’re ready. But that wasn’t going to happen that night.

The resident gathered everyone together at the bedside (another thing we don’t generally like) and broke the news: the young man had died. Immediately, the mother fell to the floor, crying, screaming. The others circled around her, fanning her face, giving her juice, praying. When she came to her feet she said, “I need to go home. Get me out of this hospital. My baby’s dead. I need to get out of here!” Her family was helping her to the door, when the chaplain said, “Wait a moment, this lady has something she wants to ask you.” She looked at me and said, “Go ahead, ask.”

I shot that chaplain a look like I was trying to burn a hole into her, eyes wide and subtly trying to shake my head no. This was clearly not the time. The mother looked at me with unimaginable pain on her face and said, “What? What could you possibly have to ask me? I just need to go home!”

With all the courage I could muster, certain that these women were going to start swinging, I squeaked out the words, “Organ donation. Unique position. Help someone. Maybe?”

I braced myself, ready to hear a stream of obscenities, and started to look for another way out of that room, when the mother got on her feet, looked me right in the face and said, “You’re telling me my boy could save someone’s life?” “Yes, ma’am,” I answered, still not sure what she was going to do.

Suddenly everything changed. The room erupted in cries of, “Hallelujah! Praise Jesus! My baby’s going to save someone’s life!” There was singing, there was hugging, there was laughter through all the tears. The mother signed my consent form and couldn’t wait to hear about how her son’s organs were going to be used to help people.

I was stunned. This was the very last thing I thought would happen.

Imagine what that family’s night would have been like if I had not been pressured by that chaplain, if I’d gone with my gut, decided it wasn’t a good time, and left the hospital labeling this family “Unapproachable.” They would have gone home feeling just as terrible, just as heartbroken. They would have had no hope, nothing to help them get through this awful event. All because I thought I knew what was best for them. By not asking, I would have made the decision for them. And it would have been the wrong decision.

When I think about how we as healthcare workers make decisions for patients – always with the best of intentions – I wonder just how often we end up doing more harm than good. We make assumptions about people and think we’re acting in their best interests when, in fact, we should be letting them make those important decisions for themselves. We can assist, guide, educate, and support but we should never do it for them.

“Difficult” Patients

I’ve written before about patients who are ‘difficult’ or ‘impossible to please,’ and I usually conclude by asking you to tell a different story about that patient. Get to know them. Ask them a little about what they’re going through. Find out the back story that’s causing them to act that way. I still stand behind that, but I think there’s another element at work here.  

Each of us wants to do a good job. We want to go home at the end of the day knowing that we made a difference, made someone’s life better, helped someone. When we can’t do it, it’s easier to blame the patients.

When we have so many things to do, demands to meet, meetings to attend, call lights to answer; when we didn’t get enough sleep the night before, had an argument with our spouse that morning, or are struggling with a difficult personal issue; when we’ve reached our limit and just can’t do one more thing to help, we call a patient ‘difficult.’

I know I do it when a person has a complaint about something and I’m genuinely at a loss as to how to fix it.  I like to think I’m good at my job so when someone brings me an issue I don’t know how to solve, it’s hard for me to imagine that the problem lies in me. I’d much rather believe the problem is with them.

Don’t get me wrong; I’m sure there are plenty of people out there who really are difficult, who really are hard to please, and who really are attention-seeking. The key in caring for them is not to let that stop us from trying. Difficult patients still need their call light answered, still need to be assisted to the restroom, and still need their questions answered.

As for what we can learn from patients like this, I think they can make us better at our jobs. It’s easy to be nice to patients who are nice; it’s much harder to be nice to patients who are more demanding. I’ve learned how to be better at not getting defensive, I’ve learned patience, I’ve learned how to ask questions that go deeper to try to get at the root of what’s really bothering them. These are all skills I can apply to my personal life, too.

Admittedly, I still have a lot of work to do to get better at these things, but I wouldn’t have gotten these skills at all if every patient I’d encountered had been sweet. Think about the backstory of your difficult patient, yes, and also think about what they may be teaching you.

The Crabby Old Lady Who Hates Our Food

It was the end of a long week. 4:35 on a Friday afternoon and I was the only one left in the office. As I was answering the last of the email, there was a knock at my door. Four people from food service were looking for some help.

There was an older woman on one of our inpatient units who had been complaining about the food every day for the past five days. It was too cold, it was burnt, it was tasteless, it had too much salt, it was covered in grease, it was dry. You get the idea.

Normally, the dietary staff can handle those kinds of things. They’ve heard a complaint or two, but this woman had started to get pretty unkind to the staff and no one wanted to be the one to bring her a tray. They came to my office, hoping I might be able to talk her into being a little nicer.

One quick look at the clock and a heavy sigh later, I was off to go see what I could do.

I found her nurse and told her why I was there. She rolled her eyes. “Good luck. Nothing anyone has done this week has been good enough. I think some people are just always going to be unhappy.”

I walked in and found a tiny, little old lady who couldn’t have weighed more than 90 pounds. I told her I was from the service excellence department and I’d heard she wasn’t happy with our food. “That’s an understatement,” she answered.

She spent the next 15 minutes telling me about every meal she’d been served here. There was essentially nothing on the menu that was appealing, everything was cooked incorrectly, and nobody seemed to care just how awful it all was. I listened patiently, reflected back to her what I was hearing, and told her how frustrating it must be to not be able to enjoy eating.

She paused, looked me in the eye and asked, “Do you know why I’m here?” “No, I don’t,” I answered.

“I’m here because the doctors wanted to do a few more tests before they told me there’s nothing they can do.” She paused for a moment.  “I’m going to die and I guess that’s okay. I knew I would someday. But do you know what’ll happen to me if I don’t eat while I’m here?  If I don’t get enough nutrition and I’m not strong enough to be by myself, they’re going to send me to a nursing home. You know what happens to people my age in nursing homes? They die. Well, I don’t want to die there. I want to go home. I want to be with my family in my own bed and if I can’t eat…” She stopped, took a deep breath, looked at me and said, “I need my strength. I need to eat. Do you understand?”

In that moment, the crabby old lady turned into a frail, frightened woman. I no longer found her demanding and impossible to please but vulnerable and in need of help. I set her up with some meal vouchers from our full service restaurant at the hospital (different from the hospital kitchen) and told her to contact me if she continued having trouble. I told her nurse what the real issue was, that it wasn’t about the food as much as it was about dying in a nursing home. She shrugged, thanked me, and continued charting.

I got back to my desk and even though it was well past quitting time, I was really glad I had been there. The visit with the old lady reminded me of why I do this job. I’m not there for my ‘To-Do’ List, I’m there for people. I don’t know if she’s still on this earth or if she was able to die at home, but I’m glad she had someone who listened and tried to help.

Take a few moments to find out the real issue behind the complaint. Change the story you’re telling yourself about the other person. It can make all the difference. To both of you.