#7 The Patient Connection
○ What we will discuss this time:
■ The Patient- Provider relationship.
■ How to establish that connection.
■ And how that connection benefits both you and patient.
I know that we are living in a modern techie world with EMRs, electronic devices, apps to monitor blood pressure readings, apps that can obtain an EKG for you, apps to track food, apps to track glucose levels, average expected A1C, ovulation and even menstrual cycles. You can download a report of all of those things in a beautiful graphic form. If you are lucky enough to have a techie person that can set it up, you can download and interface these things into the patient’s EMR system right from their phone or other tracking device. You potentially could have all the data you need in a click before the patient comes in. With all of this you should be able to manage your patient, perfectly right. And they should be able to manage their comorbidities, well right? Because with all of the tools available everyone involved should have everything that they need to live in perfect health.
So, I ask the question, why are our outcomes no better?
I propose it’s the human experience.
What about the human experience? The provider patient connection? What about the value of those subtleties that you pick up on in human interaction, communication and observation that are not included in all of these tracking devices?
What about the motivational piece? What is going to keep them going when they STOP tracking the data? A who is more motivating than a device.
There is much research on the missing element of human connection in our modern-day world. This has been further evidenced during the COVID pandemic.
An electronic device can never replace a personal interaction. I think they are causing more stress. They are causing more health decline. On the stressful aspect, people are constantly monitoring numbers that they may not understand. I believe this data overload is more likely to increase anxiety than to improve health outcomes. Because when you put all that data mixed with some symptoms into Dr. Google what happens?
In my experience they always come out with diagnosis of either cancer or something that is going to kill them. And then they come in in a panic.
I have been concerned about the concept of healthcare being moved towards the virtual world for some time. We are not robots. We are not computers. We are humans and we have our own hard-wiring that requires interpersonal interaction. Do not get me wrong, there are several things that once you have become established with a patient you can take care of virtually. However, there are many things that require face-to-face interaction and to see the entire patient.
Think about perception in interactions without humanism. For example, when getting a text message from someone and not understanding the intention of the words without a voice from the other side. You can take a message that was meant to be lighthearted and joking as an absolute jab or an insult and be angry. That is because it’s missing the facial expression and voice inflections and all the other things that go around the meaning of just words.
At the beginning of the stay at home orders during the pandemic, I personally was forced to implement the virtual visits, so that my patients were not left hanging. I still wanted to be able to speak to them and see them, even if it were through the computer screen or a telephone encounter. There are so many things you can get from nonverbal communication that help manage the patient, however, given the situation I had no choice but to follow the virtual path.
I was anxious to see how they would receive this virtual world. Would they be happy they didn’t have to leave home? If it were not for the safety factor during the pandemic… Would they start to think that it was easier to not have to take a day off work? To be able to do that visit and go on about their day?
I am happy to say that I am no longer fearful of losing the one on one patient encounters to my computer screen! With most every visit that ended, the patient would say “I really hope I get to see you in person next time.” Not very many were happy with the cold computer screen interactions. As for the the lack of the physical aspect of visit, I was concerned about not being able to track vitals on patients I had initiated medications on prior to the abrupt shut down. Assessing fluid volume status on patients that I had placed on diuretics. Were the home weights accurate? Were they telling me the truth? Or were they maybe adjusting the numbers a little bit, so they didn’t get fussed at?
How about those who were experiencing emotional challenges due to the pandemic? Did they feel that they were able to convey their feelings to me appropriately through the computer? But, Was any contact better than no contact? That question I can answer positively yes. At least there was some contact, but not the same.
I have been very fortunate to have established many wonderful therapeutic relationships with my patients. I am confident that from the very first meeting they can feel my energy of compassion and genuine interest in their needs. My patients are very important to me. Whether it is the first time I have met them or the 20th time we have had an encounter, each person matters. I believe that conveyance genuineness improves the quality of care.
When a patient comes to you they are often nervous, in pain, distress, worried about something, happy about something, wanting your advice and your guidance for something or looking to you to help them with something pertaining to their own physical or emotional self.They could have read some thing on the Internet that is stuck in their mind or heard something from another person that has caused them a lot of anxiety and worry about how it may affect them or someone they love. They don’t always tell you this in the beginning. A lot of times you have to ask, you have to get deep into the conversation you are having to read their body language and watch the expressions on their face to make sure that you explain something completely or that you have addressed all their concerns. Sometimes you are the only person they have to confide in or to ask something without feeling as if they’re being judged.
This doesn’t happen without a connection. This doesn’t happen if you were staring at your laptop or whatever device you take into the room. If you are not fully engaged with that person during the visit you were going to miss a lot. They are going to leave that visit in the exact same way that they came in. What is the good in that? Do you want to send them back to Dr. Google or to get their advice from the neighbor or coworker Who tells them do something crazy, like I don’t know put an onion in your sock when I go to bed. That would help a diabetic ulcer wouldn’t it?
I’m going to share with you how I believe you can establish a connection with your patients that will benefit both of you.
Establishing that connection is very worth your time and effort. Remember that nurses are one of the most trusted professions. There’s a reason for that. There’s a reason why patients tell us things that they don’t tell others. They feel safe and they feel like you care. Remember our role is to advocate for patients. You can’t advocate for someone you don’t know anything about. Because each person is an individual and each person deserves your time and your expertise to make them feel well and improve their health.
I believe first and foremost; you must treat them as an individual and give them your full attention. The first time that you meet with a patient, it is almost like an interview process. YOU get to set the tone of the interview. You both most likely are on your best behavior and put your best assets forward.
I believe that one of the best assets in practice is listening and being intuitive to what the patient is saying, or trying to say, so that you may guide the visit in a manner that gathers information efficiently that is real relevant to the situation at hand.
This comes with time. This comes with each patient you encounter. This is why being an advanced practice nurse matters. All of the years you spend bedside gives you the intuition you need. If you are still new to this, don’t worry. You will develop this overtime. It is called experience. If you’ve been doing this for a while, you understand that there are many things you can pick up on non verbally when you were actually present in the encounter. Every encounter, with every patient is a learning experience.
Here is the way to start that connection:
In that first visit, make sure to enter the room with a smile, set that tone. You should never appear to be in a hurry no matter how behind you are. Always make eye contact and shake the persons hand if appropriate. Then sit. When you sit, even if it’s only for 30 seconds, it is perceived as if you have all the Time in the world. The patient perceives this as if you care about them and what they have to say, That You are present and that you are listening. I like to think we are sitting for a cup of coffee. Professional boundaries in place of course, but when your patient is comfortable the conversation flows. No need for hierarchy here.
Do not focus on an electronic device, with your face in that device instead of looking at the patient. There will be time to get out that device our later. You can’t possibly chart it all in the room anyway, so give them your attention instead. If you have reviewed the information, they have submitted on their forms prior to going into the room you can give that attention. Typically, I start with, “I understand that you’re here today for…” you want to be able to summarize some of that knowledge to them, so they know again that you really are there and present and you reviewed their information. Some of those forms have a lot of questions on them and they took the time to fill out those forms and if you look at them you were going to get a lot of insight. Even if you look at their handwriting. I still have my patients fill out a form manually because handwriting matters. Did they misspell something? Is it sloppy that might indicate there is a tremor? again, the little things you learn to evaluate with attention to detail.
I do not type while I’m speaking to the patient. I will take in a good old fashion pen and paper and write on the back of their intake form if it’s their first time or the charge sheet that comes back with them. Whatever I have.
Then there’s this crazy thing that happens, I listen to them. I may guide and direct the conversation when appropriate, but I listen and let them finish their sentences. Many times, you will hear that they have been from provider to provider telling the same story and still have not gotten any answers. And I truly believe that that is because many providers don’t take the time to listen. It’s more about numbers getting to the endpoint. What’s your cholesterol, what’s your blood pressure how much do you weigh, this is what your goal should be, these are the test we’re going to order.
Patients are not going to confide in you or interact with unless they know that you care. The more you gather on that first visit and the more that you connect with the person on that very first visit, the better your experience is going to be in every subsequent visit. And you just might get that one piece of information that will bring everything together.
THAT helps your patient.
What also helps them is that knowing you care, improves their willingness to make an effort towards the plan of care developed. They will “TRUST” you will do no harm and have their best interests at heart. You see, they don’t understand what you understand. All of the numbers, all of the guidelines, all of the medications mean very little to that person. That person is thinking about how they feel. How they want to feel. The person is thinking about the family they want to be around for or the life that they want to enjoy, without illness or limitation. When you connect with them in such a way that they trust that you are doing what is right for them, they will work towards the goals that you have set together.
The other thing is to always make it a point to explain what you were doing and the intentions behind it, as well as expected outcomes. To just say stop eating sugar. Or stop drinking soda sounds like a demand. But when you say, “if you continue to drink that many sodas per day, you’re going to keep putting out a lot of insulin that is causing you to gain weight and makes you feel terrible. So, if you were able to decrease those sodas by maybe one a day until you get off of them completely, you’re going to be able to lose weight and stop an insulin roller coaster that is making you that gain weight and feel so bad.” They hear you. When they look at it from that perspective, they are more likely to succeed.
You see, talking about your health and personal concerns, such as stress, anxiety, weight management, depression, symptomatology are all better when you’re discussing them with someone that you have a relationship with that you trust with your health. Not just your health, but with your life.
No how does it help you as the provider? Well, a pleasant experience for one thing. When you build a relationship, you enjoy going into each and every patient encounter. You look forward to beginning the visit with “how are you, how is the family, how’s that new job”, and then get down into business. Because once you set that relationship and set in motion the action plan that you get to review, the visits are way more enjoyable for both you and the patient. And then you can glide into the next goal. Get to know them first, get their take first, then you can either support their efforts with your clinical findings or help to revamp the plan a little bit to achieve that goal. But it’s much less labor-intensive once you have a relationship. There won’t be any hiding of information or worry that if they tell you something, you’re just going to look down on them or judge them or dictate another action that is inconceivable to them. This should be a reciprocal patient provider relationship. Not a dictatorship. We are working with in their life. We cannot put our life into their life. We help them to guide their life to improve their quality of life and their health.
Another great thing is, that if by chance you should be running behind, they are less likely to get upset with you. Not that it’s an excuse to always run behind, but they know that when the time comes that they need more of your time, you’ll be listening to them. I have on many occasions said, “I am really sorry that I ran a bit behind I do appreciate your patience. I know that your time is important, but someone needed a few extra minutes of my help” if needed I will add, “and you do know I would do the same for you if the situation came up that you needed more time with me.” And almost every time that I need to do that, the patient will sit back, relax, and verify that to be true. that is because I have given them my time before. I have set the stage and I have set the tone that they are important and that their time matters as well.
To further support that connection and patient provider relationship, at the end of each visit summarize what you have went over, what the action plan is and what the goal is for the next visit. Then they absolutely know that they were heard and if there’s anything that was missed, they have the opportunity to add that in now. Specifically ask, is there anything that I missed? Is there anything else that I can help you with?
I hope this was helpful. If you have been in a situation where you were a little bit rushed, where you don’t always have control over your schedule or you have other things that are coming into play during your day you may not always take the time to stop center yourself and go into the room to intentionally create that connection. But I can assure you, that if this is something that you are able to implement you were going to see the reward for both yourself and for your patience. I don’t want you to get burned out. And we are in a profession that has a high burnout rate right now. It’s because we are expected to go go go, see 30 to 40 patients in a day and not really spend any time with any of them. All you do is jump from room to room with the sole intent of getting finished before the end of the day. Don’t do that to yourself. Don’t do that to your patient. I urge you to work on this therapeutic communication and connection so that you can continue to practice what you love. I want you to be able to continue to do what you love. I hope that you love anyway.
So, the take-home from this podcast is to remember the human experience. Don’t get caught up in all of the technical world of healthcare. Even if it’s five minutes in a room you can make it a connected experience. You probably need that just as much as your patient does. This profession for most of us is who we are, not what we do. So, with that, give just a little bit of you and your time and every visit. It will change your practice dramatically. You might even find yourself smiling a few more times during the day instead of being always hurried and stressed.
I want to thank you again for taking your time to listen to this podcast. Let me know if you are enjoying the podcast! Subscribe so you don’t miss an episode! Share your thoughts. And if you’re feeling connected, give me a review! That will help others find this podcast to help with their practice also!
You can find more of me and what I’m up to on healthinterventions.net, Facebook and Instagram!
Have a great week! May it be filled with many Health Interventions!