A few years ago I had my first trip to the ER. In 39 years I’d managed to not need emergency care myself. Sure, I’d been to the ER with others. I’d picked glass out of my friend’s hair while we waited that time she walked through a plate glass door, paced the floor when my brother was admitted for a shocking diagnosis, and spent Thanksgiving in the hospital with a friend diagnosed with a rare disease. Those experiences had been mostly positive, setting me up to expect good, competent care. I’ve even worked in healthcare human resources and later in risk management so I have some experience from within the system. However, that also means I’ve seen the fallout when things go wrong. All these experiences came to mind as I sat bleeding in the ER.
I live in a rural area, one without a hospital. I’d travelled a little over an hour to get to the ER after waiting a few hours to decide to go at all. In my mind, I was still wondering if I should be there. Earlier that day I’d used a four-inch razor blade to somehow slice my left index finger to the bone. I was embarrassed. The gaping wound wouldn’t stop bleeding so at the urging of my better half I broke down and agreed to go to the hospital for stitches. My first question for the triage nurse that examined my wound: “Should I really be here? I wasn’t being silly, was I? I do need stitches, right?”
Nurse Warmth, as I’ll call her, assured me kindly that I did indeed need stitches, that, of course, I should have come to the hospital; I was not being silly. I told her that in my family we pride ourselves on walking it off when it comes to trauma. In fact, I spent 3 years walking off a foot injury! Not the best idea. She related a funny story of her own and we enjoyed a good laugh. I was reassured, we’d built a rapport, and I immediately trusted her judgment. She gently pushed me to come to the hospital sooner in the future. I thought, the system works, I’m glad I chose this hospital. Nurse Warmth did not make me feel unwelcome, uncomfortable, or overly concerned. I needed help and the doctor would help me soon.
After many hours waiting, long enough to see police officers escort several people out of the waiting area and a woman show up only in her underwear, I went into the hospital room prepared for my stitches. It was two in the morning after a long day but I was optimistic and calm. What I wasn’t prepared for was the attitude of the doctor that arrived to administer my care. Dr. Giggles, as I’ll politely call her, was abrupt, unkind, kept inappropriately laughing while she was hurting me, and didn’t seem to care if I got my four stitches or if my finger fell off. When I told her I was allergic to latex she made a big deal about getting the nitrile gloves. She needed to reduce blood flow to my finger for the stitches but no mini-tourniquet or substitute was available. She had to improvise by cutting a finger out of a glove. She trimmed off the tip of the finger and rolled up the piece of glove to use it like a large rubber band around the base of my finger . The problem was the local anesthetic didn’t work (she was trying to teach a medical student how to do it and the student had repeatedly failed). Somehow the area around the wound was not numb at all.
I have a pretty high tolerance for pain and no fear of needles so I’d been patient as I was repeatedly stuck and even watched them rub the needle along the bone to try to get the injection closer to the wound. The real pain hit, however, when Dr. Giggles rolled the tourniquet substitute over my wound repeatedly. At that point I just wanted to leave the hospital as soon as possible. I told her I didn’t care about the anesthetic, just to give me the stitches. She giggled, strangely, and then started sewing. Honestly, the stitches hurt much less than the glove tourniquet. I was relieved to feel the lesser pain and be distracted by watching the needle move in and out, sealing the wound. When Dr. Giggles was finished she informed me I needed to come back to the hospital in 10 days to have the stitches removed. She told me to watch for signs of infection, especially since I had waited so long to come to the hospital. I also waited many additional hours at the hospital, I thought. It occurred to me in that moment that I never wanted to see Dr. Giggles or the inside of that hospital again. I was sent to pay the bill, exited through security, and started the hour-long drive home at three in the morning.
Dr. Giggles never asked me about my life to find out that I’ve been a musician for more than thirty years and compose music. She didn’t cover any potential complications or assuage my fears that I might have difficulty playing music, since the wound went all the way across my knuckle. I went home angry and relieved to get away. After ten days I cut and removed the stitches myself. My one and only hospital experience left me wondering how one clinician could be so warm and another so cold. The difference, of course, was empathy. Nurse Warmth expressed empathetic concern while Dr. Giggles showed no signs of caring at all. This story plays out for patients every day in healthcare settings across the US. In fact, to drive home the point, Cleveland Clinic created this video:
Empathy is important because it increases pro-social behavior, which in turn, leads patients to develop rapport with and trust their clinicians. Trust and rapport are the currency of communication. Communication helps clinicians better problem solve leading to better patient outcomes. As Kasley Killam emphasizes in her interview with Dr. Helen Riess of Harvard Medical School about building empathy in healthcare, communication is vital.
“It's associated with higher patient satisfaction, better adherence to medications, lower likelihood of mistakes, and fewer malpractice cases. It even affects patient health outcomes; a review of research concluded that effective physician-patient communication improves patients’ emotional health, symptoms, physiologic responses, and pain levels. Empathy is good for patients. It builds trust, which increases patient satisfaction and compliance. When patients perceive that they connect on common ground with the physician, they have better recovery rates.” Dr. Riess says it is crucial for providers to help patients feel comfortable by giving them the opportunity to explain their concerns. Nathan Wanner, medical director of the University of Utah Hospital's palliative care service, put it this way, patients need to, "feel they are listened to, respected, and valued as individuals".
For these reasons, healthcare leaders who want to improve patient satisfaction need to understand that empathy is a key component of successful clinical communication. We tell each other stories to express and receive empathetic concern and convey information. When clinicians are too busy or detached to understand this, patients may not feel that clinicians care and important information gets left out of interactions. My story doesn’t have a particularly happy ending but it could have been much worse. While I’m relieved to say my finger healed and I only experienced some nerve damage, I wasn’t left with a positive impression of the hospital. While I certainly wasn’t angry enough and didn’t have significant complications in order to become litigious I’ll never return there to receive care, never recommend the place to someone else, and keep telling this story.
If you'd like to learn more about how to lead an organization toward higher patient satisfaction, contact University of Southern California, Price's Executive Masters of Health Administration staff to