Worst shifts

[LaBusqueda]

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What makes for a really Fd up shift?

This is particular to the individual, but an extremely general idea for me are the ones where I get off on time-even EARLY (parish the thought), and I am as angry and one where I had to stay over for 2 hours not doing fun stuff.

As in today, the idea for this post, I was asked to not one, or two, but three or rooms. Why? Not for an acute, life threatening condition, but for "service recovery". One on my pt for nursing issues and button responsiveness. One on an admit who is waiting for a bed, and one on a PA pt.

Even just one of these makes me want to drink heavily.

 

[WilcoWorld]

Totally agree, the last minute service recovery emergencies are what will ruin an otherwise entirely good shift. Even worse is when you come out of the angry family's room (it's never actually the patient who's mad) and then have to do service recovery on the nurse too.

 

[RustedFox]

Oh yeah. At one of my job sites, we just had a pep talk about how those "customer experience" gestures are oh-so-important.

I thought it was the door to greet time that was oh-so-important.

It used to be it was getting those charts done that was oh-so-important.

Or maybe it was the medicine that's oh-so-important?

I don't even know anymore.

 

[Promethean]

Oh yeah. At one of my job sites, we just had a pep talk about how those "customer experience" gestures are oh-so-important.

I thought it was the door to greet time that was oh-so-important.

It used to be it was getting those charts done that was oh-so-important.

Or maybe it was the medicine that's oh-so-important?

I don't even know anymore.

It is actually ALL oh-so-important, and if you find yourself unable to keep up with the shuffling demands, that is YOUR fault for not being better at time management and organization. Of course, the facility bears no responsibility for the systemic issues or environment of care. It all comes down to the failures of the individuals trying to work within the broken system.

 

[cbrons]

Sorry but what is a "service recovery"?

 

[RustedFox]

Sorry but what is a "service recovery"?

Did your day suck? Let me buy you a beer. Makes it better.

 

[Birdstrike]

Sorry but what is a "service recovery"?

Let me help you here. It means you're about to get coerced to worked harder, longer past your allotted time when your brain is near fried, and be expected to fix the healthcare/overwhelmed-ED crisis in this one single shift, ie, "take one for the team" or be asked to "bend over."

Again.

Remember that thing they said about EM, where you just "punch in and then punch out," no muss no fuss, no being on call, no getting pressured to work or be on call beyond your shift? Uh-huh. It's a lie. Your job is not to provide Emergency Medical care for 10 hr. It's to keep a team of hospital administrators happy. It's industry standard stuff. Stubbed toes can't wait more than 15 min. They are a "crisis." It doesn't matter how killed you feel.

 

[Psai]

hm i thought you guys worked in emergency rooms, not hotels

 

[alpinism]

Sorry but what is a "service recovery"?

Basically if you have a dissatisfied or angry patient (or family member) its a process to boost your patient satisfaction scores.

hm i thought you guys worked in emergency rooms, not hotels

You joke but...

http://journals.lww.com/em-news/Ful...tters__Make_It_Right__Service_Recovery.5.aspx

"The process begins with an apology and taking responsibility for the error or the inconvenience. The patient must be given something of value as compensation, something that says, “We value you, and want you to continue to use us for your health care.” A hotel can upgrade a disgruntled guest to a suite. A restaurant can offer a free appetizer. A cell phone company can offer 500 free minutes. What product or service can you give that will cost you little or nothing but that has value to the patient?"

"What separates leaders in service excellence from the rest of the pack is how they respond to mistakes. Leaders will do whatever it takes to solve a patient or family member's problem. They understand the importance of service recovery to their bottom line. Service leaders like Amazon, Dell, Southwest Airlines, General Electric, Commerce Bank, and Lands' End have mastered the critical elements that drive a service-focused business and customer service excellence strategically. That means everyone from the CEO on down walks the walk and reinforces the importance of customer service."

 

[Birdstrike]

hm i thought you guys worked in emergency rooms, not hotels

Anyone who thinks they're going into Medicine as a science, is sadly mistaken, has fallen prey to recruiting slogans, is a victim of wishful thinking and/or has been lied to. You're choosing a career primarily as a customer service agent of someone who never went to medical, PA or even nursing school, albeit a well paid customer service rep. To those that control you (unless you've been brave enough to go into non-hospital based private-practice) your primary purpose is to secure maximum profits for them. The "medicine" and the science of doing so is secondary to them, and essentially your problem alone, particularly when your bosses' goals make your best-practice treatment goals impossible or nearly so. I'm not saying that's how it should be (it shouldn't) but that's the way the politicians you've elected, the hospital administrators, insurance men and medical society leaders have made it, in collusion with each other.

 

[LaBusqueda]

Basically if you have a dissatisfied or angry patient (or family member) its a process to boost your patient satisfaction scores.



You joke but...

http://journals.lww.com/em-news/Ful...tters__Make_It_Right__Service_Recovery.5.aspx

"The process begins with an apology and taking responsibility for the error or the inconvenience. The patient must be given something of value as compensation, something that says, “We value you, and want you to continue to use us for your health care.” A hotel can upgrade a disgruntled guest to a suite. A restaurant can offer a free appetizer. A cell phone company can offer 500 free minutes. What product or service can you give that will cost you little or nothing but that has value to the patient?"

"What separates leaders in service excellence from the rest of the pack is how they respond to mistakes. Leaders will do whatever it takes to solve a patient or family member's problem. They understand the importance of service recovery to their bottom line. Service leaders like Amazon, Dell, Southwest Airlines, General Electric, Commerce Bank, and Lands' End have mastered the critical elements that drive a service-focused business and customer service excellence strategically. That means everyone from the CEO on down walks the walk and reinforces the importance of customer service."

I am not, was not, nor will I ever be a leader in service excellence.

I do not apologize for what is not my fault. It's disingenuous. If it's not a me or medical thing I turf it right back and let them know the admin of the day's contact info!

 

[RustedFox]

I am not, was not, nor will I ever be a leader in service excellence.

I do not apologize for what is not my fault. It's disingenuous. If it's not a me or medical thing I turf it right back and let them know the admin of the day's contact info!

That's not a bad idea. Give admin someone else's nuts to squeeze for a bit.

 

[Daiphon]

I am not, was not, nor will I ever be a leader in service excellence.

I do not apologize for what is not my fault. It's disingenuous. If it's not a me or medical thing I turf it right back and let them know the admin of the day's contact info!

I have two styles of "business card" that I use in my private moonlighting shop (where we get satisfaction bonuses).


Both have the hospital address and a little blurb about PG:

One has my info for patients to use if they're happy.

The other has the hospital administrator info if they're not.


Two birds, one stone, and didn't cost me a dime (vistaprint trial deal).

d=)

 

[LaBusqueda]

I have two styles of "business card" that I use in my private moonlighting shop (where we get satisfaction bonuses).


Both have the hospital address and a little blurb about PG:

One has my info for patients to use if they're happy.

The other has the hospital administrator info if they're not.


Two birds, one stone, and didn't cost me a dime (vistaprint trial deal).

d=)

My CMG shop previously had these for the docs.
I did not use them.

I used them a couple of times when they were first introduced. I had to stop as would find myself spontaneously discussing free oil changes and ...

 

[Daiphon]

My CMG shop previously had these for the docs.
I did not use them.

I used them a couple of times when they were first introduced. I had to stop as would find myself spontaneously discussing free oil changes and ...

I don't discuss them for this exact reason. I simply attach them to the discharge papers.

It's moonlighting anyway, so I don't really care... but if I get a few extra bucks, or at least deflect negative press, it's a win.

-d

 

[Angry Birds]

I used to believe in the importance of customer satisfaction... Now, as an attending, I say F that.

 

[Birdstrike]

I used to believe in the importance of customer satisfaction... Now, as an attending, I say F that.

Customer satisfaction is rooted in the philosophy, "The customer is always right." That may apply when you are choosing a cheeseburger at McDonalds, a vacuum cleaner at Home Depot or a shirt at Macy's. But we know it's not true when practicing medicine. The "customer" doesn't always know what's right. Often times the customer is there because they're absolutely and profoundly wrong in their health choices, behavior and actions. Examples are ubiquitous, such as: overuse of prescription drugs, overeating and resulting cardiac disease and death, willfully inhaling smoke repeatedly and subsequent lung disease and death, and sawing fingertips off while intoxicated. The scope and number of things the "customer" is doing to worsen their own health and even kill themselves is profound. Yet those most base and self destructive instincts are those in which we now, must also comply with.

We know that often, what the "customer" does, expects and demands often is wrong, catastrophically so. Yet the politicians at the highest levels, and hospital businessmen want us to look the other way, appease, enable and "satisfy," under the guise of "patient centeredness." Yet ultimately, the aim is to empower and enrich those in control, yet it's bad for patients, harms them, and can even kill.

"Give me more opiates, tell me they're good for me with no limit or restriction..."

"Scan my belly and increase my radiation exposure and cancers risk..."

"Tell me I'm thin and doing everything right..."

"Tell me it's okay to keep smoking just a few less cigs per day..."

"Tell me it's okay to drink again, and that my pancreas can handle it..."

"Tell me I need admission even though I may die of an infection caught in the hospital..."


Have you ever faced these situations?

Does "satisfying" such demands help or harm such "customers"?

JAMA on increased death and harm associated with higher patient satisfaction-based care: http://archinte.jamanetwork.com/Mobile/article.aspx?articleid=1108766

 

[deleted480308]

I'm assuming there is no rvu code for "service recovery"?

 

[Birdstrike]

I'm assuming there is no rvu code for "service recovery"?

Lol. Good one [emoji119]

 

[Angry Birds]

Customer satisfaction is rooted in the philosophy, "The customer is always right." That may apply when you are choosing a cheeseburger at McDonalds, a vacuum cleaner at Home Depot or a shirt at Macy's. But we know it's not true when practicing medicine. The "customer" doesn't always know what's right. Often times the customer is there because they're absolutely and profoundly wrong in their health choices, behavior and actions. Examples are ubiquitous, such as: overuse of prescription drugs, overeating and resulting cardiac disease and death, willfully inhaling smoke repeatedly and subsequent lung disease and death, and sawing fingertips off while intoxicated. The scope and number of things the "customer" is doing to worsen their own health and even kill themselves is profound. Yet those most base and self destructive instincts are those in which we now, must also comply with.

We know that often, what the "customer" does, expects and demands often is wrong, catastrophically so. Yet the politicians at the highest levels, and hospital businessmen want us to look the other way, appease, enable and "satisfy," under the guise of "patient centeredness." Yet ultimately, the aim is to empower and enrich those in control, yet it's bad for patients, harms them, and can even kill.

"Give me more opiates, tell me they're good for me with no limit or restriction..."

"Scan my belly and increase my radiation exposure and cancers risk..."

"Tell me I'm thin and doing everything right..."

"Tell me it's okay to keep smoking just a few less cigs per day..."

"Tell me it's okay to drink again, and that my pancreas can handle it..."

"Tell me I need admission even though I may die of an infection caught in the hospital..."


Have you ever faced these situations?

Does "satisfying" such demands help or harm such "customers"?

JAMA on increased death and harm associated with higher patient satisfaction-based care: http://archinte.jamanetwork.com/Mobile/article.aspx?articleid=1108766

It seems like a quarter of my patients are drug-seekers and another quarter come to the ER for absolute BS.

I know my views may be biased (recall bias?) but it's really getting frustrating.

 

[namethatsmell]

Great way to ruin is a shift is to pick up the pt with CC similar to: "sent in by PCP for MRI to assess for [insert bogus/completely non-emergent reason here]."

When pts are sent in to the ED with unrealistic expectations given to them by other physicians it's a no-win game.

 

[GeneralVeers]

Great way to ruin is a shift is to pick up the pt with CC similar to: "sent in by PCP for MRI to assess for [insert bogus/completely non-emergent reason here]."

When pts are sent in to the ED with unrealistic expectations given to them by other physicians it's a no-win game.

I just tell them that "they" (meaning administration) are heartless and cruel and won't let me order the bogus test that they came in for. Gotta just deflect everything back to Admin.

 

[Birdstrike]

I just tell them that "they" (meaning administration) are heartless and cruel and won't let me order the bogus test that they came in for. Gotta just deflect everything back to Admin.

Lol. [emoji122][emoji122] awesome

 

[Docinthetrenches]

People suffering from what I term "Entitlement disorder" are often the largest source of my frustrations on shifts - worse that actually sick patients, subpar staff, lack of resources, etc. When you get someone flashing you a badge that says the donated X amount to the hospital and now they want that unemergent MRI on a Sunday evening, it's a guarantee to spoil the entire shift.

-EM Physician Writer for BoardVitals

 

[namethatsmell]

I just tell them that "they" (meaning administration) are heartless and cruel and won't let me order the bogus test that they came in for. Gotta just deflect everything back to Admin.

Ha, I likey a lot. Will try this next time.

 

[USCDiver]

I like to 'apologize' for the patient feeling butt-hurt. "I'm sorry you're upset that the coffee wasn't from Starbucks", "I'm sorry you didn't feel like the nurse respected you in the morning" etc.

 

[link2swim06]

I just tell them that "they" (meaning administration) are heartless and cruel and won't let me order the bogus test that they came in for. Gotta just deflect everything back to Admin.

I use that all the time. I blame admin at least once a shift or so.

Sorry...X,Y,Z the hospital admins don't allow us to admit for that.

Sorry...hospital admins/policy will not let me order a MRI for that complaint.


Then it doesn't turn into you vs. pt. It makes them seem like you are on their team.

 

[engineeredout]

Even worse is when you come out of the angry family's room (it's never actually the patient who's mad)

So true. I leave a room with a 9 or 10week pregnant chick who was in a low speed MVC coming in just to be evaluated (to my facility with no OB in house of course) who has zero Abd pain, zero vag bleeding, feels well. Talk to her for several minutes, reassure her, give her a bunch of return precautions. She's happy with plan. I leave the room. Nurse calls me back in the room 15 minutes later. A pile of drugged out friends show up literally screaming at me for not getting an ultrasound on her baby "to make sure everything is okay" cause "you're gonna lose the baby" and "we're going to go somewhere else". Attending then has to go in and try to settle them out, and it ends up with me having to do a bedside ultrasound to prove there is still a heartbeat.

 

[emergentmd]

Patients rarely bother me. Being busy doesn't bother me. One thing that bothers me is when I work with a slacking partner when the place is Busy.

If I have been working for 4 hrs, seen my 20th pt, and want 1 full hr to just clear my board and then see the new attending come in with 5+ pts to be seen....

Pick up a chart, see his/her 1st patient coming out of the room in 15 mintues, sit down and spend another 5 mintues to chart the H&P. Get up at the 20th minute to pick up another chart and repeat.

After an hour, he/she has seen 3 pts while there are another 5 to be seen.

Guess what I have to do? Pick up another 3 pts in that hr while giving him/her a nice stare down.

 

[GeneralVeers]

Patients rarely bother me. Being busy doesn't bother me. One thing that bothers me is when I work with a slacking partner when the place is Busy.

If I have been working for 4 hrs, seen my 20th pt, and want 1 full hr to just clear my board and then see the new attending come in with 5+ pts to be seen....

Pick up a chart, see his/her 1st patient coming out of the room in 15 mintues, sit down and spend another 5 mintues to chart the H&P. Get up at the 20th minute to pick up another chart and repeat.

After an hour, he/she has seen 3 pts while there are another 5 to be seen.

Guess what I have to do? Pick up another 3 pts in that hr while giving him/her a nice stare down.

You don't have to do anything. I long ago stopped over compensating for slow partners. I work at a fast pace which I feel comfortable, and doesn't put patients at risk. The end of my shift is the end, and I don't pick up more regardless of how slow the next doctor is. Patients waiting are his problem, not mine. If asked to stay late for extra pay, I will do it if convenient.

 

[emergentmd]

You don't have to do anything. I long ago stopped over compensating for slow partners. I work at a fast pace which I feel comfortable, and doesn't put patients at risk. The end of my shift is the end, and I don't pick up more regardless of how slow the next doctor is. Patients waiting are his problem, not mine. If asked to stay late for extra pay, I will do it if convenient.

We are part RVU based so seeing more does mean alittle more money and in the grand scheme of things, it is just alittle more money. I guess I still care, still care that pts don't have to wait 2 hrs in the room, care that someone doesn't crash b/c some lazy EM doc just walked in.

I am learning. The problem with these docs that wants to chart so they can always leave right on time it that it starts to become the norm. I don't want to work in a place where all the docs just sit around charting before discharging pts/admitting patient.

 

[emergentmd]

Great way to ruin is a shift is to pick up the pt with CC similar to: "sent in by PCP for MRI to assess for [insert bogus/completely non-emergent reason here]."

When pts are sent in to the ED with unrealistic expectations given to them by other physicians it's a no-win game.

If they are sent in for an MRI, I order an MRI. Nothing off my back.