Sunday, December 11, 2011

SIT DOWN!!

Sometimes the best ideas are so simple that you both marvel at their eloquence and wonder why you never thought of them.

In a perspective in the New England Journal of Medicine, Dr. Dan Wolpaw, a General Internist and Educator at Case Western Reserve University presents a simple and eloquent idea that can transform the quality of medical care and medical education. Dr. Wolpaw suggests we add a portable stool to the equipment we carry on patient care rounds.

Morning walk rounds are a long standing part of medical culture. Teams of doctors walk the halls going from room to room to see each of their patients and develop care plans. But Wolpaw notes that less and less time is spent truly talking to patients. Team members talk to each other outside the room. Then the team approaches the patient, often standing around the patient who is lying in bed. We don't see the patient eye to eye, but literally look down on them. Wolpaw observes that after rounds, the team does take time to sit down, as they approach the computer "eye to eye" to do their charting. As Wolpaw notes:

"There is a bizarre geography that has doctors standing over patients, and then later sitting eye to eye with computer screens--a geography that sets the stage for intimidation. poor communication, and quick exits from human beings, while supporting intimate relationships with an electronic medical record."

To encourage more eye to eye patient contact, Dr. Wolpaw started carrying a portable camping stool on patient care rounds. (If you google "portable camping stool", you will find many that you can purchase for less than $20). As the team entered rooms, the stool was passed to the member who was going to talk to the patient.

The stool totally transformed patient care rounds! Wolpaw observes:

"It was remarkable how a low-tech piece of equipment moved our team from the dry efficiency of updates and to-do lists to the fundamental process of caring for the patient."

Somehow, talking to patients eye to eye changes the tenor of conversations. Team members stopped using jargon and started talking more naturally with patients. Team doctors understood their patients better, and patients felt more cared for. This deeper connection brought a new found joy of doctoring to the team.

What a great idea! How could we not try this? Maybe a portable stools should be as common place on patient rounds as a stethoscope!

by: Ken Covinsky

5 comments:

marachne said...

This echos something I was taught, and emphasise with my (nursing) students. The way I put it is that I do not want to ever see them carrying on a conversation with a patient where they are standing over them. Anything more than a passing communication, or when performing specific tasks, I expect eye-to-eye communication. Chair is best, but I'll squat down next to a wheelchair or other setup as needed. Makes a world of difference in the interaction

GracefulAging said...

Communicating at eye level is plain common sense for folks of any age or disability. Sometimes the simplest things slip past our blind approach to our encyclopedic race for the right answer. Eye level reduces a critical barrier to understanding.

Talking "with" and not "at" patients, among other topics were covered in a recent show of Graceful Aging. It can be watched at http://www.gracefulaging.com/health/caregiving/talking-with-your-doctor/

GS said...

I second what Graceful Aging said "Somehow, talking to patients eye to eye changes the tenor of conversations. Team members stopped using jargon and started talking more naturally with patients." I always sit down and face my patients on rounds or in the clinic. My patients often estimate that I spend twice as much time them, they tell me more information is a shorter period of time, and their levels of satisfaction is higher.
It is amazing how basic communication skills transform the physician patient interaction into an actual fact finding and therapeutic interaction for both the patient and physician.

John said...

It is so true that making level eye to eye contact can change the whole interaction for provider and patient.
I remember as a nursing student how I was filled with the excitement and possibilities of interacting closely with my patients. Then..for a time, the practical realities and inevitable cynicism of hospital nursing and ICU care dulled that starry eyed vision. I stand here now filled with the wonder that I had all those years ago.
I would add that touching your patient- the simple holding of a hand; placing your palm on a feverish (or cold) forehead; a gentle massage of a foot- these actions (sometimes avoided for overblown fear of some infectious disaster) hold such power. I have seen effects better than IV ativan. I have had a dying patient tell me that " nothing the doctors have given to me over the course of this hospitalization has felt as good as this" so I know it is true. And again it is an action that has a powerful effect on both the patient and the medic, no drug can do that.

Alex Smith said...

I have a very practical question - does anyone have a recommendation for a good stool to buy? It should be portable and not too low.