Hospital Medicine: Conveying Respect Through Identifying Priorities

This is a featured Hospital Medicine coaching tip by Mark Shapiro, MD.

It was a Friday evening, I was asked to admit an elderly patient in the emergency department. I went down to see her and also got to meet with her family. She had a malignant pleural effusion that had been expanding, she was progressively more short of breath, she’d been sent to the emergency department and admitted for drainage and placement of a pleurx catheter. 

This all seemed perfectly reasonable and she seemed agreeable to the plan before we adjourned. 

I asked her one question: “For this admission, what matters the most to you?” And her answer completely changed the course of the next few hours. 

When we are looking to not only treat patients with respect, but to openly and honestly convey that respect, probably the most important skill is the ability to access their priorities and allow what they share with us to inform and guide the treatment plan.

The Core Of Patients Feeling Heard

From the flip side, if we fail to access this, we will be walking towards one of the most negative comments that hospitals get from patients: “I felt dismissed. I felt like they were not interested in me as a person. I felt like they did not care about me.” 

This is not where we want to be as physicians and we will never be able to recover the relationship when patients have that experience. The skill bundle here is simple. We have to ask the question, then integrate the answer into our plan.

So the next time you see any patient, whether they are a new admission or someone you’ve already been rounding on, during the encounter, ask them something like this: “It is really important to me to understand what matters most to you so that we can make this hospitalization as effective as possible.” As they share their answer, you can reply with something like, “I appreciate you sharing your priorities with me. Let’s integrate them into our plan.”

When I asked my patient about her priorities, turns out her granddaughter was graduating from high school the next day. She only shared this with me when I explicitly asked. Hearing this, we were able to get her fluid drained in the emergency department, we were able to get follow-up arranged for Monday for reevaluation, and she made the graduation. 

I’ve got to tell you, that felt really good for all of us.

Try This Challenge

Come up with a question that feels comfortable for you around inquiring about your patients priorities. Commit to finding out what matters most to patients and what they want to achieve. 

What did you discover? How did the patients respond? We have to be really dialed in: We’re sitting at the bedside, not staring at the electronic medical record while entering an order.

Share with us your stories about what happens when you ask your patients about their priorities.

Interested in learning more about how our Hospital Medicine Patient Experience program can advance your organization’s engagement and patient experience goals? Take the first step with us by Getting Started.

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