Using the BLAST Method to Manage Unhappy Patients

I'm Me-Ga-Tron !!!

Ever had a patient like this kid? Think about the last time someone got angry with you or accused you of something that you didn’t do. How did you respond? If you’re human, chances are you defended yourself, explaining to the other person how he was wrong.

As physicians we all encounter angry, frustrated patients. After all, they don’t come to see us when they’re happy and feeling well. Yet, no matter the cause for their anger, we need to remain professional. Unfair? Perhaps. But it’s just the way it is. When it comes to managing unhappy patients, it’s a good idea to use the BLAST method:

B: Believe

L: LIsten

A: Apologize

S: Satisfy

T: Thank

Believe: You have to express belief even if the patient is exaggerating or is factually incorrect. Expressing belief to the patient engenders understanding, support, and empathy, which leads to trust. And when you have trust, you eliminate the desire to argue. Conversely, belittling or trivializing a patient’s belief hinders communication, trust building, and ultimately successful outcomes.

Listen: Stop your mind and your mouth. No matter how hard it is for you, let the patient express his or her complaints without interruption. Don’t be thinking of how to formulate a retort; instead, be an active, engaged listener which will assure the patient that his concerns and expectations are understood. Active listening also means never defending or justifying your actions. Doing so makes the patient feel like you’re not taking responsibility. Ultimately, patients want solutions not excuses. 

When the patient is done talking, rephrase what they have said to ensure that you’re both on the same page. You’re not changing what the patient said; you’re merely making sure that you’ve heard him or her correctly.

Apologize: Apologizing isn’t weak, and it isn’t an admittance of wrongdoing. It’s simply the right thing to do for the patient  A sincere apology, even if you did nothing wrong, will help diffuse fear, frustration, and anger, and lead to trust. Many physicians falsely believe that an apology will increase the likelihood of being sued. The opposite is true. Apologizing reduces the likelihood of litigation because the patient feels that you have listened to him or her and have taken responsibility.

Satisfy: Your goal is to have a satisfied patient. Therefore, try to solve the patient’s problem and allay any concerns. If something cannot be fully resolved, then calmly explain why to the patient. He or she will appreciate your honesty. Then, ask the patient what he or she wants. Sometimes it’s much simpler than you think. If it isn’t, then propose 2 to 3 options that you can follow through on. This will show that you really want to satisfy the patient and will give him or her a feeling of control. Finally, remind the patient that you are available to talk in the near future, and follow up.

Thank: Thank the patient for giving you a second chance and for giving you the opportunity to work with him or her to resolve the problem. Also, be sure to also thank them for not damaging your reputation. Gratitude goes a long way in building trust and rapport with patients.

Photo credit: FCC, Mith17

The Secret to Beating Burn-Out


I’ve learned the secret to beat the grind — gratitude.

Last week, on a typical overbooked Tuesday, my receptionist handed me a message: “There’s a patient out front to see you. His appointment is actually tomorrow, but he thought he would come today instead.” Ordinarily I would say “You’re kidding right? I’m already 20 minutes behind.” Sound familiar? But not this time.

Instead, here’s what I did: Rather than thinking of him as just another pushy patient, I pictured him as an elderly man who needed my help. Maybe he was confused but embarrassed to admit it. Maybe his wife is ill and today was a better day for him to leave the house. By thinking of him as a real person who needed me, it changed how I felt about adding extra work to my already full schedule.

Medicine is hard work, and it’s only going to get harder. Patients and peers alike will be expecting more of us. By focusing on the reason why we wanted to be medicine in the first place we can combat feelings of frustration.

Gratitude journals are a proven way to increase your happiness. I’ve started one recently and it has helped me significantly. All it takes is a few minutes two to three times each to write something for which you are grateful.

There is no way to balance work and life when you’re a physician. The best we can do is increase our happiness while at work.

The next time a patient calls or comes in without an appointment to see you, and you’re feeling the heat of burnout, stop. Close your eyes. Take a few deep breaths. Actually picture your patient who needs your help. Doesn’t it make you feel good?

Now, back to work.

Photo credit: FCC, marynbtol

Book Review: Transforming Health Care by Philip Fasano

Phil Fasano bookI’m a healthcare digital native. While I was in medical school in the 1990’s we transitioned from paper to electronic medical records. Every student in my class was given a PDA — the cathode-ray tube of smartphones. Hey, it was a start (they used to give out a carton of cigarettes in the 1950’s; Yes, we’ve come a long way, Baby).

My generation believes in technology. We believe it will improve physicians’ lives, advance patient care, and reduce costs. Like Iron Man, there is no limit to what we can do when we put the suit of information technology (IT) on the body of medicine. Yet, despite the obvious impact of IT on our lives, we’ve yet to see it revolutionize medicine. We need someone to report on the condition of digital health and to articulate the opportunities and outline the strategy for healthcare transformation. Phil Fasano delivers that digital health State of the Union address in his book, Transforming Healthcare: The Financial Impact of Technology, Electronic Tools and Data Mining.

Fasano is the CIO of Kaiser Permanente (KP), the integrated health care system where I work. He directs our impressive 6,000 member health IT team and has led us to the forefront of health information technology (HIT) in care delivery.

In the book, Fasano briefly covers the history of HIT with an emphasis on electronic health records (EHRs). He recounts KP’s experience in rolling out the world’s largest private EHR system and shares successes such as our computer care registry that has reduced deaths by heart disease by 73% in our members. He goes on to cover the basics of mobile, virtual, and analytics along the way highlighting bright spots in KP and in other systems on the HIT leaderboard, including The Cleveland Clinic and Intermountain Healthcare.

In the chapter “Investing in Healthcare IT Innovations,” Fasano picks his winners in HIT investments including cloud computing (it could cut costs by 30-40%). He sees health information exchanges (HIE) as a business opportunity for entrepreneurs and uses the salient example of Lee Moffitt Cancer Center as a winner in the analytics model — They are tracking cancer patients’ data with the aim of designing targeted treatments. The book is filled with such tantalizing tidbits like this and the Spanish OR where doctors navigate CT scans and MRIs with the wave of a hand.

Fasano’s call to action is for governments, payors and the private sector to join forces to drive healthcare IT innovation. He also calls for the formation of a national health information exchange and for the creation of health financial exchanges that can support primary care as the hub of patient care and could act as a payment agent for specialists and hospitals.

This book is meant to educate — Fasano makes a convincing argument that if the public knew of all of the advantages of HIT, then healthcare leaders would be compelled to implement them more quickly. However, it’s written both for the public and for health IT professionals. In doing so, it is sometimes too complex and sometimes too shallow. Other chapters in the book include Virtual Visits, Connected Care Teams, Global Healthcare IT, Real-Time Learning, Predictive Medicine, and Connected Systems.

Overall, he writes in an engaging, approachable manner and supplements his arguments with good references. As in real life, he employs stories of real-time, personalized health care that offer compelling visions of our nearby future.

If you believe technology will fundamentally change the way we deliver and consume health care, then you’ll find this book is a comprehensive and inspiring vision of how that will happen.

AIDET: 5 Essentials of Doctor-Patient Communication

Sometimes the smallest gesture, explanation, or “thank you” can be the difference between an unhappy patient and a happy one.

For Dr. Howard Steinman, a practicing board-certified Mohs surgeon from Irving, Texas, creating a positive patient experience comes down to a communication tool called AIDET, which stands for acknowledge, introduce, duration, explanation, thank you.

I had the pleasure of hearing Dr. Steinman’s talk this past February at the Maui Derm conference and left his session feeling inspired. Whether you’re just starting your medical practice or are nearing retirement, the principles of AIDET will do you and your patients good.

Here’s how AIDET works: When you’re treating a patient, you want to:

A: Acknowledge

I: Introduce

D: Duration

E: Explanation

T: Thank You

Acknowledge: Acknowledge every person who enters the room when you’re with the patient. If a nurse or MA enters, address him or her by name so the patient knows who is there. And make a visible, audible or tactile sign acknowledging the patient’s presence to the new person in the room.

Introduce: Introduce yourself by name, describe your role, your background and experience, and your intention to provide excellent service.

Duration: Give patients estimates for every procedure and result, such as, “This treatment works successfully for about 75-80% of patients I see.” Also explain how long they’ll have to wait for a procedure or test results. It will show that you’re appreciative of their time.

Explanation: Explain what you’re doing throughout the visit and procedure. It helps allay patients’ concerns and makes them feel more cared for. If something is going to hurt, let the patient know. You don’t want to shock them in any way.

Thank You: Thank the patient for the choosing you as a doctor, for waiting, and for giving you the opportunity to care for them. Those two small words can go a long way to building trust and respect.

What are your thoughts? Are you a physician or other healthcare provider? Do you practice AIDET? Any other tips you’d like to share to improve doctor-patient communication? If you’re a patient, what else would you like to see happen?

Photo credit: FCC, Hollis Queen