Published in the April 2008 issue of Today’s Hospitalist
How much thought do you put into how you introduce yourself to new patients? If you’re like most hospitalists “working at a breakneck pace most of the time “you probably make it up as you go. But if you believe the old adage that you never get a second chance to make a first impression, you would do well to pay more attention to how you introduce yourself.
“The introduction is one of the most important elements of hospitalist communications,” says Winthrop Whitcomb, MD, who practices at Mercy Internal Medicine Service in Springfield, Mass. “Most patients still don’t understand the role the hospitalist plays in their care.”
John Nelson, MD “who, along with Dr. Whitcomb, helped co-found the Society of Hospital Medicine “agrees, saying that misconceptions about hospitalists still tend to be the rule, not the exception. He notes that he has heard nurses tell patients and family members that he is an intern, for example, or that he is the primary care physician’s assistant.
Then there are the ED doctors who offer the following description of Dr. Nelson when asked by patients: “He is one of our house doctors who sees a lot of our patients.”
“They’re just not thinking carefully about how the patient hears that,” Dr. Nelson says, “that the patient might think he’s getting a doc ‘off the shelf’ and that special patients get to pick their own doctors.”
Dr. Nelson, who is director of the 14-hospitalist program at Overlake Hospital Medical Center in Bellevue, Wash., says that such off-the-cuff remarks can “and sometimes do “get things off to a rocky start. Using a standard script to introduce yourself and asking other hospital staff to use a similarly structured narrative may go a long way to reduce patients’ concerns and confusion.
“You have to assume that everyone is naive about this,” Dr. Nelson explains. “Ironically, it’s not just the older patients who are confused about who hospitalists are, but the younger patients who don’t see doctors frequently and end up in the hospital.”
When it comes to helping patients understand the concept of hospitalists, a good word from primary care physicians can help minimize confusion. When primary care physicians don’t have a chance to tell their patients that a hospitalist will care for them in the hospital, Dr. Nelson says, misconceptions abound.
Some patients worry that their insurance company is “passing them off” to a substandard doctor, he explains. Others fear that the relationship with their primary physician “has somehow been severed” by the hospitalization.
So what should hospitalists say after hello? A lot of what physicians say in their introduction varies based on the practice setting, who they’re treating, and when and how they enter a patient’s care. But Dr. Whitcomb says that regardless of the specifics, the message should cover the basics “the who, what and why “and it ought to be consistent.
While all providers who come into a patient’s room should introduce themselves, he explains, it’s even more important for hospitalists. “It’s still a new role,” Dr. Whitcomb says. “The most crucial thing patients need to know is that the hospitalist is working in partnership with their PCP.”
To that end, Dr. Whitcomb says that introductory remarks “his take about 30 seconds “should state that the hospitalist will have access to “important parts of the outpatient medical record,” and that he or she will send the primary physician a full report on admission and discharge.
“Ideally, that part of the scripting should happen before the hospitalist meets the patient,” he says. “But if it doesn’t, it should be covered in that initial conversation. If you do this well, you’re transferring the trust the patient has in her PCP to the hospitalist.”
Should you start with a script?
For that initial dialogue, Dr. Whitcomb says he favors using a script. Standardizing the content of the intro rap, he claims, potentially saves time because it leads to fewer questions from patients and families down the road.
“It’s difficult to tell a physician to follow a script,” he admits, “but groups should at least decide on the content of the script and make that standard.”
While the hospitalists at Boston’s Beth Israel Deaconess Medical Center don’t rely on a formal script, they are expected to explain the basics. “We don’t want to dictate a style because most people don’t want a script,” says Henry Feldman, MD, a hospitalist in the program. “Besides, when you have 25 hospitalists, it’s hard to formalize something that can accommodate personal style. But we all have our own schtick to explain who we are and why we’re there.”
Community Hospitalists in Solon, Ohio, on the other hand, has helped develop introductory remarks for its 45 hospitalists. While that script is not intended to be memorized or read, having a basic narrative helps ensure that key messages make it into the conversation, notes Stephen Shaw, MD, regional medical director for the group’s Cleveland area.
“We have created a script meant to be taken informally, as a foundation or outline of what should be covered in the hospitalist’s initial encounter with a patient,” Dr. Shaw explains.
Tailoring the level of detail
The script used by Community Hospitalists includes two options or degrees of detail. The first level is for patients who seem very accepting of the hospitalist concept. The second, more detailed level is designed “for those patients who are dubious or interested,” Dr. Shaw says.
The more detailed script describes how the hospitalist model dovetails into quality improvement efforts. It also addresses questions that patients may have about why the hospitalist has stepped in.
Patients who need even more of an explanation also receive the group’s brochure, which includes brief bios and photos of the hospitalists working at that facility.
Like Dr. Shaw’s group, the hospitalists at Lehigh Valley Hospital in Allentown, Pa., are moving toward more standardized remarks.
“We have a basic script in development that details the role of the hospitalist,” says Michael Pistoria, DO, director of the 18-hospitalist program and chief of inpatient medicine at the hospital. “We’re trying to ensure that everybody is on the same page and to foster communication with patients about who we are and how to reach us. The hope is that a script will reduce the potential for missed information.”
Scripting narratives for nurses, ED doctors
While hospitalists may have the perfect introduction, there’s also the problem of what other providers are saying about you. Dr. Nelson says that’s just as important because they are often a font of misinformation.
When possible, Dr. Nelson recommends giving ER doctors and nurses a basic script that should go something like this: Your doctor wants you to see Dr. X, who stays in the hospital all of the time. We have a lot of confidence in the hospitalist because he sees a lot of sick people like you.
“They’re actually building up the hospitalist and using language that suggests the patient will get excellent care,” Dr. Nelson points out, “and that people have thought carefully about what’s best for patients.”
Bonnie Darves is a freelance writer specializing in health care. She is based in Lake Oswego, Ore.
Putting a face on the introduction
A PILOT PROGRAM at the University of Chicago is trying to head off confusion “and/ or misrepresentation “about who hospitalists are and what they do.
The Feedback and Care Evaluation (FACE) project has hospitalists making rounds on new patients introduce themselves and explain their role. They then place a card containing their photo and name, as well as more details about hospitalists, in a plastic sleeve in the patient’s room.
The sleeve also contains cards of other team members, including residents, interns and specialists. On the card’s flip side, patients are invited to write comments about their hospitalist.
“We developed this intervention because we found that very few patients during follow-up interviews post-discharge could remember their doctors’ names,” explains Michael D’Arcy, who manages the project.
While the project is fairly simple, it has proven to be enormously effective. In the first year after the FACE intervention was implemented, Mr. D’Arcy says, name recognition of hospitalists has jumped 30%.
Vineet Arora, MD, a hospitalist who oversees the project, says the cards do more than identify who and what hospitalists are. They give patients a big-picture view of the entire provider spectrum, which is especially helpful in large academic centers.
Dr. Arora says the information also may help reduce post-discharge problems by helping patients follow up with a hospitalist. “FACE cards are useful because patients may be confused about who is providing their care,” she explains. “It is important for patients to be able to remember their doctors’ names after a stay in the hospital, because it may be necessary for them to reach their physicians after discharge to follow up on tests or ask questions.”
What should you say after hello?
" ‘I’m Dr. Shaw. I understand that you’re Dr. Jones’ patient. I am an associate of his who will take care of you while you’re here. Your doctor has decided that it’s better to have a close colleague who works in the hospital take care of you while you’re here.’
If patients ask a lot of questions or appear skeptical, I move to a ‘level B’ discussion, which includes a spiel about what hospitalist care is and the quality issues the model addresses. I might also explain how patients who end up in the hospital these days may be sicker than in the past and require closer supervision."
‘Stephen Shaw, MD
What should you say after hello?
" ‘Hello, I’m Dr. Whitcomb. I’m here in place of Dr. Murray “he’s your primary care doctor, right? [The patient says yes.] I take care of Dr. Murray’s patients when they’re in the hospital. He’ll get a full report when I’m finished with you now and another full report when you leave, so he knows exactly what’s going on.’
Patients may not have any questions about who I am and why I’m there, but they’ll often ask, ‘Well, how is Dr. Murray?’ At that point, I tell them that I’m in partnership with him but not actually in his practice."
‘Winthrop Whitcomb, MD
Mercy Internal Medicine Service
What should you say after hello?
"I walk in, shake the patient’s hand or put my hand on them somehow, and say my name. Then I say, ‘Your doctor, Dr. Smith, has asked me to see patients of his who need to come to the hospital because this is what I do all the time “and he and I work together in this way. I’ll be preparing a full report about you in a few minutes and sending it to Dr. Smith. And when you get home, you’ll certainly need to go back and see him.’ "
‘John Nelson, MD
Overlake Hospital Medical Center