Saturday, June 3, 2017

The Art of Complaining - Part 2 - Informal Complaints

What is a complaint?  Complaint sounds like a negative word.  In the context of this blog I don’t think of a complaint as a negative.  The reason I complain about issues in health care is to create dialogue with health care providers.  As a patient advocate I want to raise expectations.  Do we not deserve the best care available?  Is the purpose of health care to be “average” or is the purpose to be “excellent”?  The quickest and easiest way to understand areas where we need to improve is by listening to the complaints of patients.

When I talk about complaints many immediately think of the formal processes involved in doing so.  Contacting patient relations and filing a formal complaint.  The problem with this is that when you get to that point you have probably missed several opportunities to reach a positive outcome.  If you are at the point of going through the formal complaints process, then it is likely that communication with your care team has degraded significantly or harm has already been done.  The whole point of this exercise should be prevention.  This is why informal complaints are the best tool a patient has of enhancing their care right here and right now.  Not 8 months from now.  It is also important to raise issues effectively while maintaining a good relationship with your care team.

What is an Informal Complaint?

When I talk about informal complaints what I am really talking about is communication.  The skill of raising concerns and complaints in a constructive way to achieve a mutually beneficial result.  These kind of complaints usually involve front line staff who interact on a daily basis with patients, not the high powered executives who manipulate the levers of the health care system.

When you talk to many patients and they explain some of their frustrations with health care, many of the concerns are not medically related.  Numerous studies show this.  Many times, patients are frustrated by a lack of communication or not being given information that is relevant to them.  Patients frequently complain about not have a clear understanding of the diagnosis or the treatment plan.  Having talked to many people who work in patient relations the biggest issue that comes up over and over again is poor communication.  Simple misunderstands that erode trust until the health care relationship is damaged so badly that quality of care is negatively impacted.  Communication is a massive issue in health care.

We have to remember that health care is a world unto itself.  They have their own language and processes that are completely non-intuitive to those who do not experience it on an ongoing basis.  Many who are patient advocates are trying to help change this culture but it isn’t going to happen anytime soon.  So what do you do today?

Ask Questions

Many of us who are not medically trained can be easily overwhelmed by the health care system.  Even clinic visits can be very challenging if you don’t know the processes involved.  You have to ask questions to figure things out.  When making an appointment ask about parking.  When arriving at a massive hospital stop at reception and ask for directions.  When arriving at a clinic ask how long you may be waiting.  Do they have Wi-Fi?  If you step away to go to the bathroom and they call you will you miss “your turn?”  All of these questions are simple (and necessary to survive) but did you notice how many very subtle complaints were contained in those questions.  Parking is horrible, your clinic is impossible to find, Wi-Fi is an absolute must, and your cattle call waiting room system is archaic and demeaning.  If every patient asked these questions and staff had to answer these questions over and over again…perhaps someone may get the hint and realize they need to improve.  This is a great way to complain in an informal way that doesn’t get anyone upset as these questions are all very legitimate.  In this example the questions I posed served two purposes.  It provides you the information you need to survive your appointment and it also provides feedback to the health care system about the types of issues that are important to patients.  

Modes of Communication

It happens to all of us.  We wait 6 months to see a specialist and we dutifully do our homework and prepare for the appointment.  We prepare questions, bring a pen and paper to take notes, and do all of the right things we as patients are supposed to do.  We have an engaging 10 minute conversation with the esteemed Doctor and feeling empowered at a job well done we leave the appointment.  Inevitably, on the way home we think of a couple more questions and then recall one really important issue we failed to bring up.  You arrive home feeling like an abject failure feeling the entire appointment was a waste of time.  Here is my problem with the conventional Doctor’s appointment.

If you met a really nice girl, engage in some conversation and after several requests she finally agrees to go out on a date with you.  After the date, what message would you take away if she never gave you her phone number or any way of contacting her in the future?  Probably not a good sign.  So if a Doctor gives you no way of contacting them after an appointment, are they sending you the message that they would prefer to never see you again?

When an appointment is concluding there should ALWAYS be an exchange of information of how to contact either the Doctor or a Clinician who works with the Doctor if there are any questions or follow up.  We have so many methods of communication today this should not be a difficult request.  Ask what works best for the Doctor.  Phone…email…text… what works for them?  This is not an unreasonable request.  If your physician refuses to offer any effective way of communicating outside of a planned clinic visit (that you may have to wait weeks for), maybe you should think about finding another Doctor.  Which brings me to my next point.

Build Your Care Team

When you ask questions or make inquiries about your health, the hope is that you start a conversation.  In a conversation you can learn much more than reading a pamphlet or dutifully listening to a well-rehearsed speech.  In a conversation, two people interact and learn about each other.  You start to build a relationship.  If anyone in health care is willing to engage with you… hang on to those people.  As you start to build a relationship, from that relationship you begin to build trust.  Trust is a huge issue.  What is the point of having a physician who is highly regarded and the “best in their field” if you can’t communicate with them?  In spite of their list of qualifications, if they can’t communicate effectively they can easily alienate a patient and trust becomes a factor.  When we are admitted to hospital we always try to make a connection with someone (anyone) who is willing to engage in conversation and explain what is going on.  The trust that you build gives you the confidence to leave your child’s bedside and actually stop, go to the cafeteria, and have a meal without the fear that “something” might happen when you are gone.

Our care team is our life line.  The beginning of our care team was formed on the day of my son’s diagnosis.  In addition to our Doctors, we were introduced to our nurse clinician who gave us all of the clinic’s contact information, the 24 hr pager number for Cardiology, her office number and her own personal pager.  We were encouraged to call if there were any concerns.  They were available 24/7 for us.  We felt like we had support.  5 weeks later we needed that support.  It was the openness and engagement that we felt that prompted us to page our cardiologist, without the fear that we were taking up someone’s valuable time.  That phone call that likely saved our son’s life.  To this day I trust our team implicitly.  When we have a negative experience in their clinic or in the hospital I have complete confidence in them to address any issues and openly communicate with is.  We may not always get the answer we want, but we do get the best information available. Trust also adds the benefit to our clinicians who don't feel like they are being second guessed when we ask questions.

Minor Communication Errors can have dire consequences

It's the Little Things that Matter

Yes, many of the things that I have discussed are small things.  Little frustrations that we all face.  However, when we don’t say anything we facilitate the gap that exists between us (the patient) and our health care system.  There are many things we can do to engage our health care providers, establish relationships, and build trust.  If we don’t question policies & processes we are admitting failure before we even start.  It is important to challenge the status quo as we need to give our health care providers the feedback they need to improve and succeed.  They will never succeed if we aren’t providing feedback.  Even in an Emergency Room environment it is possible to make a connection with a doctor or nurse, engage with them for only a few hours in spite of the fact you may never see them again.  We are all capable of this.  Health care relationships should not be sterile and unfriendly. 

The whole point of addressing the small issues is so they don’t become big issues. 

Next Blog Post: Part 3: The Formal Complaint Process aka “The Slow Boat to Frustration”

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