Despite our best efforts, at some point in our careers, we have all read a triage note, saw the name, chief complaint, or history and rolled our eyes or sighed.
“Knee pain for 4 years. Today is THE DAY!”
“Why couldn’t they see their doctor?”
“Not another vag bleed.”
“Don’t they know we don’t have a dentist?”
“Bob’s drunk again? I just discharged him 3 hours ago.”
After identification of a difficulty patient, 57 providers (29 residents, 22 attendings, and 6 midlevels) in a family medicine clinic were randomized into a control group and intervention group encompassing 112 patient encounters over 5 weeks. Providers were evaluated based upon the Physician Satisfaction Scale using the BREATHE OUT intervention (see below), with outcomes being measured immediately after the encounter in both the control and intervention group.
Using the protocol – which probably takes less than a minute before walking into the exam room- physician satisfaction scores were statistically significantly improved with about a 17% improvement overall. And this is after evaluating patients whom providers thought to be “the problematic patient.”
Younger clinicians and those who are earlier in their medical career are more likely to consider their patients difficult, and physicians who believe they have a large number of difficult patients are 12 times more likely to experience burnout. This will likely lead to lower job satisfaction and poorer psychosocial attitudes. Here, we have a simple tool to improve upon provider satisfaction, so perhaps we should be teaching all of our budding providers how to utilize this tool rather than lose good providers to burnout.
The intervention is as follows:
-List one bias/assumption you have
-reflect on why you identified this patient as “difficulty”
-list one thing you’d like to accomplish today
-think about a question you’d like to address to further explore your assumption (beyond a substance abuse screen)
-take 3 deep breaths
after seeing the patient
– reflect on the outcome of the encounter
– did you accomplish your agenda, and if not, how do you feel about it today?
– did you learn anything unexpected?
– list one thing you look forward to addressing if you were to run into this patient tomorrow.