What Does Going to the Bank Have to Do with Patient Engagement

Yesterday I went to the Chase Bank in Berkeley to open a new account.  I walked in and told the teller what I needed to do and she politely asked me to take a seat.  The bank was busy that day and I waited for about ten minutes along with a line of other customers.  After a while, a 40 something , dressed neatly in the conventional bankers costume or suit and tie, came up to me and asked me to follow him to his cubicle.  Before we sat down, he asked,  very sincerely, “Can I get you some water or anything.”  I thanked him and said no.  When we sat down, he put out his hand and introduced himself. This in spite of the fact that he also had a name badge that announced who he was.

Throughout the encounter, he was attentive and curious.  I was opening a checking account for our new documentary film Beyond the Checklist and he wanted to know what Beyond the Checklist was. I quickly told him it was a film about healthcare and  patient safety , and he evinced what seemed like genuine interest in the project.  When he learned about the fact that I was a journalist and about the documentary project he asked if I  had a website.  When I told him, he jotted it down.  “I always like to find out what my clients do,” he commented.

When the banker and I were discussing healthcare and patient safety, I talked about the state of play in healthcare. 

I pointed out that his introduction and further inquiry about my work would rarely occur in a healthcare setting in which a physician/nurse or other professional met and talked to his or her patient.  Standard operating procedure may include  no real introduction at all.  The doctor usually says a brusque hello, gives his or her name — as in I am Dr. Smith, what brings you here Suzanne (note the doctor has no first name and the patient no last name). The patient may thus be infantilized from the very beginning of the encounter.   When the patient begins to talk, the doctor interrupts within the first 19 (or is it 15) seconds. Opps! Turns out it’s actually 18 seconds, which is what the research on physician interruption of patients documents.

Nurses often think they are more effective at communicating than physicians but I can tell you that it depends.  Some are great and some not so great at all.  Needless to say short staffing and long hours does not help the mood of overworked RNs, who are usually exhausted because they are working 12- plus hour shifts, juggling too many patients, and dealing with unsupportive management and disrespect and poor team relations.  Enough to put anyone in a bad mood!

Workplace relationships and work organization does not improve the patient-centeredness of health professionals.  But that is not the entire story.  Part of the story lies in our long historical tradition of viewing patients  as if they were children who had to obey the authority of either physician or nurse/ other professional.  This is the traditional “sick role” that Talcott Parsons outlined in 1951.  According to this conception, people are allowed, when ill, to be exempt from normal routines and duties but must, in turn, seek professional help and do what the doctor orders.  This notion of the compliance or obedience of the sick person to the professional belies, of course, any possibility that the patient is a customer,since enacting the role of the dutiful patient obeying orders is totally opposite that of the customer who is served and who is always right.

Today, patients are still expected to enact the traditional sick role assigned to them.  Indeed, many patients feel it is not only their duty to obey the doctor or nurse or other professional but to actually behave in ways that please the professional.  Again, this expectation that many patients feel they must fulfill is the opposite of the patient centeredness  which many institutions and providers insist they embody.   The other day I was talking to a friend about this issue.  She told me about a relative who’d been in the hospital and who made sure to find out all about her nurses — details about their families, where they took their vacations, what their interests they had — so that she could be sure to get on their good side.  What is wrong with this picture, I thought.  It’s the job of health care professionals to learn about their patients and give them high quality care not the job of the patient to make nice to the nurse.

By raising the issue of how the bank manager greeted me, I do not in any way want to suggest that I believe that healthcare is like banking and that the kind of exchange I had with the bank manager equals in seriousness that which patients typically have with physicians and other healthcare personnel.  But health care can’t have it both ways.  Healthcare institutions can’t insist that patients are now customers and then continue to treat them like supplicants who must worship at the shrine of contemporary science and medicine.  And nurses, doctors and other health care professionals cannot continue to insist on the sacred nature of the physician/nurse/patient relationship while they continue to neglect the simplest of relational courtesies and etiquette.  When was the last time, for example, that a physician apologized to you for being an hour or more late, or when someone, anyone in a hospital asked you if you had concerns, or if you wanted just a plain old glass of water?  In some hospitals, fortunately, things are changing.  Let’s hope they change faster and not only because hospital reimbursements depend on it because patients’ lives and well-being do to.