September 9, 2016
By Margie Coloian, MSJ
Last year emergency medicine residents Maia Dorsett and Alicia Oberle from Barnes Jewish Hospital and Medical Center chose something that hadn’t been tried before for their Right Care Action Week activity. They wanted to know what their patients’ greatest worries were. Along with other colleagues, they handed out index cards to patients in the ER asking them to write down their ‘biggest worry.’
“We chose this activity specifically because in the emergency room setting, we don’t have long- term relationships with patients, and there are time pressures, as well,” said Dorsett, who also sits on the Right Care Alliance Emergency Medicine Council and, along with Oberle, is one of last year’s Right Care Educators. “We think we know what the patient wants and what their needs are, but that isn’t always so.”
Their goal? To improve overall communications with patients and decrease ‘preference misdiagnosis’—a failure to elicit patient preferences regarding treatments, and/or inform patients about realistic outcomes.
The dozens of responses the residents received from patients were eye-opening. A large subset of the worries centered not on specific medical concerns, but anxiety around having a place to live, safety, social supports and insurance. One patient’s card indicated that ‘getting killed in the streets’ was her biggest worry. The St. Louis hospital where the two practice is located near Ferguson, the city now sadly known for its civic disturbances from last year. The ER treats victims of gunshots and other trauma on a daily basis. In fact, last year the FBI named St. Louis the murder capital of the nation.
Dorsett and Oberle photographed and compiled the patient cards, discovered how their own assumptions had been wrong, and designed a survey for fellow residents who engaged in the activity and learned that their reflections, too, about the activity were just as enlightening. But they did not stop there. The pair made a presentation at the Council of Emergency Medicine Residency Directors meeting—where their talk was recognized as the Best of the Best Oral Presentation.
Did the ‘worry’ cards change the way Dorsett practices? Yes. “It made me realize that even in a busy emergency department, if you take a couple of minutes for direct line communication between doctor and patient, sometimes you see the patient in a new way, and it improves the relationship.”
“We have the pressure [in the ER] to see more and more patients, and there is a risk of depersonalization–charging through your day–which decreases the meaning of our work. Over the long term, you get to enjoy your job less. This effort renewed meaning in our work,” she said. “We’re too often engaging with computers and EHRs when we should be spending more time with patients.”
For this year’s RCAW (October 16-22), Dorsett is galvanizing emergency medicine residents at a dozen other health care facilities across the nation, inviting them to distribute cards to patients to find out what worries them. She’s also organizing other Right Care Alliance Council members to get involved in the activity. Perhaps as many as 100 providers could be participating. If the final card results are just as telling, she’ll ask the IRB for authorization to publish in a medical journal.
“I love my job. We need to support folks with what they need. We need a meaningful relationship with another person, and that’s why we went into medicine in the first place,” she added.