When The Complete Care Experience isn't so Complete

We often talk about trying to close all care gaps at every encounter.  In fact, we are pretty good at doing the care gap part of the work because our support staff set up the patient, stage the orders, and prepare the room.  What happens though when a patient comes in with a couple chief complaints that have nothing to do with care gaps? Should we attempt to address all reasonable concerns at that time? What if that patient isn't seeing their PCP, but another member of the care team - should we have the same expectation?  I'm not talking about the patient that comes in with a list of 5-7 "oh by the ways...", but the one that comes in with a couple saved up concerns.

I recently blogged about my own personal experience where I saw a physician who wasn't my own pcp, but treated me as if I was. That experience left me feeling a great sense of pride for the organization I work for and as a patient, I felt listened to and cared about. That's the kind of experience I want EVERY person in our care system to walk away with 100% of the time. Unfortunately, that is not always the case.  There are other care experiences that can leave our patients disappointed and frustrated. Those, to me, are the ones that we have the greatest opportunity to learn the most from.

Since the time my daughter was about 6 years old, I noticed her tiny fingers would shake ever so slightly.  She is almost 23 and those shaky fingers have become much more noticeable.  A few months ago when we were out to dinner I watched her try and eat a chip with quacamole.  Typically a pretty simple task done without much thought, but she had to really focus just so she didn't wind up with quacamole on her face.  It was a little funny, but there was this panic and concern that rose inside me.  I calmly suggested she go see her doctor to have her hands checked out.  Being a typical 22 year old who believes she is invincible, she said "It comes and goes mom(with an 'oh brother' tone), but I'll go soon."  Three months later and she still hadn't gone in.  A week and a half ago she came down with a cough that was keeping her (and us) up at night so she finally made an appointment.  She told the call center agent she wanted to have her cough and her hand tremors checked out.  "Hand tremors? I'd like to transfer you to the advice nurse to discuss those first."  The advice nurse wanted her to come in that day, but she had to work so they scheduled a visit for two days later with another member of this KP Clinic care team since her PCP wasn't available.  The doctor she saw checked her out and determined she had a cold and told her to use some nasal spray, then he turned to walk out of the room.  She stopped him and asked "What about my hands?" His response was "that could be more complicated so you should make an appointment to see your PCP."  Who knows what this physician's day was like.  This could be a rare occurance.  But it really doesn't matter to the patient now does it.  They paid for a 20 minute appointment, during that time, we should try our best to understand what it is that brought them there and how we can help.  By the way... Here is the text message I got from her after her visit, "I waited 30 minutes for a 3 minute visit to have a doctor tell me to buy some over the counter nasal spray - nothing for the cough - and he told me to see my own doctor for my hands.  UGH!!!" 

My first feeling as her mother when I saw her text was concern she might not go back in to have her hands checked out.  My next thought as an employee who preaches about a complete care experience was that we just missed a significant opportunity to address a potential issue.  That this person, whether she is the child of an employee or not, left our system frustrated and dissatisfied.  What did she do with that frustration?  She put a not so happy message on facebook to her 324 friends/followers.  Not great advertising when you are trying to appeal to a younger healthier generation.

So what do we do to make sure our patient's are being heard?  How do we continue to improve the patient care experience?  


I think the first step is in talking about it. Since I always encourage people to share their care experience, I spoke with the DA who sent a message to their Physician in Charge.  There are always opportunties to improve.  The only way to be the best at getting better is take advantage of the opportunities to learn from both the good and the bad experiences.  


So don't be afraid to speak up. We want to hear what you have to say. You have a voice.  You can help make a difference.  And together... we can all improve the patient care experience.