She thinks I'm real

As a child, I looked forward to the infrequent family outings that involved a restaurant. As the eldest of three, it gave me a chance to strut my stuff in front of my sisters: I was allowed to order without much interference, so it was a rare opportunity to have a cheeseburger, fries and the most chocolate item available for dessert. 

My parents sought out Howard Johnson’s. They were predictable, familiar, family friendly, and (at the time) ubiquitous. We loved pulling into the parking lot and seeing the orange roof:



One meal, in particular, stands out in my memory. We had nearly finished ordering, and as my mother started to order for  my littlest sister, then around 5 as I recall, the waitress turned to face her youngest customer her and said: “And what would YOU like, young lady?”  My sister’s eyes got big, and in breathless amazement she turned to our mother and said” “Mommy. She thinks I’m real.”

There is a lesson here: our patients feel more real (and better served) when we directly address them and encourage them to help solve the problem and make their own decisions:

• “It’s nice to see you this morning. What can I do for you today?” (Instead of “I see you are here for your physical.cough/knee.”)
• “Did I leave anything out?” (And then read back what you have documented about their illness.) 
• “What do you think could be causing these symptoms?” (Find out what the patient thinks before telling them what you think.) 
• “Tell me what you’ve tried and whether it helped or not.” (Before telling the patient to do things that have already not been successful.)
• “Which would you prefer? A more expensive antibiotic you only have to take for five days, or one that is dirt cheap but you have to take three times a day for 10 days.” (When there are legitimate choices, don’t presume to act in loco parentis.)
• “Does that make sense to you?” (After discussing your assessment of the problem. There is no sense talking about a solution unless you agree on the problem.)
• “Do you think you will have trouble managing X?” (This simultaneously acknowledges that it may not be easy, and gives you a chance to help them problem solve a priori rather than post hoc.)
• “I usually see people back in 4-6 weeks to make sure things are going according to our plan and make adjustments. Will that work out for you?”
• “Do you have any questions, or are there things we didn’t address today that we should set aside time for?”

Our patients are real. Their perceptions, observations, fears, plans and life circumstances are real.  Like my littlest sister, our patients will feel more real and better served if we involve them in their care by asking questions and listening to the answers.