By Anthony J. Brutico, DO 
One of the most important things we can do as emergency department providers is to always be aware of “the show.” Dr. Greg Henry describes the emergency department as “show business for ugly people.” And he’s right; sometimes the perception of the care we provide is just as important as the quality of the medicine.
There are two types of patients: those who use the emergency department as a place to get quick care and fast answers as a means of bypassing their primary care physician and those who believe they have a true emergency. Although the patients without a true emergency often are less ill than many of the other patients we see on regular basis, they also can be the most vocal and demanding.
They often are “well enough” to take careful notice of what we do, how we behave, and how long everything takes. When a person is waiting for an ankle X-ray, they don’t have much else to do than to look and listen. They hear gossip and staff complaints and can pay close attention to how our processes work. They also usually have an expectation of their visit. It is up to you as the provider to figure out what that expectation is–and to moderate it if you must, and to meet it if you can.
Is the patient with hematuria here for a urinalysis, or to see if he has cancer? Is the person with a cough here because it’s hard for her to breathe, or to see if she has Enterovirus D68? This may not always be apparent based on the complaint, but satisfaction for these patients can pivot on finding the answers to these questions. Patients often have, consciously or not, agendas.
Patients also like to see that they are getting something for their money. Emergency department bills are often in the four to five figure price range. And for that money, patients have expectations–including getting answers to specific questions. Sure, you’ve determined the patient with foot pain for a week doesn’t have a fracture. “Take ibuprofen, and follow up with your doctor.” Realize a patient may have paid $3,000 for that “I could have done that myself” piece of medical advice. Sure, our medical exam and opinion are highly valuable, but let’s face it, it’s not like they’re coming to see the Dalai Lama. Remember the show – what else can you do?
Your goal is to have each patient leave the department feeling better than when he or she arrived. Ask what concerns the patient has. Allay the fear; it’s very real, even if unrealistic. Ask if they need a work or school note. Offer crutches and an ACE wrap. Think, “What can we do?” instead of “There’s nothing to do.” In my decade of treating patients in the emergency department, by far the most complaints have to do with:
- Pain
- Waiting
- Getting what they came for
This by no means implies that you always should do what the patient wants. I wouldn’t hand them a menu of tests and ask them what they would like. I would, however, suggest that you always try to ascertain what specific concerns they have, address them, and do what you can to give the maximum attention to their issues, no matter how non-emergent they may be. Patient satisfaction depends on it.
Anthony Brutico, DO, is the interim director of the emergency department at Newton Medical Center, Newton, N.J. Dr. Brutico received his medical degree from Lake Erie College of Osteopathic Medicine, and completed his residency at Memorial Hospital of York.
