Friday, June 4, 2010

In Search of a Miracle 911

We have all been there. The frustrated parent on the other end of the line is searching for someone to make her child better now. Tomorrow is too late. As you attempt to calm this anxious mother, and gather the necessary information to give an accurate assessment and advice, she becomes angry, and questions why you are asking her "unnecessary questions" when she just wants some straight answers. Does this sound familiar?
Let's pause for a moment, and consider what this parent may be going through.Parents like to be in control of every aspect of their child's life, especially when they are small. Most parents take the charge that is given to them seriously,and therefore,they desire to meet that child's basic needs for food, clothing, shelter, and love, and they continue to want to meet that child's needs when they are sick. Consider for a moment though, illness is the one thing that parents have no control over. They can't just pick that child up, love them, read them a book,rock them to sleep, and make it all go away. If the child has a chronic illness, the parent may have to endure watching their child suffer through hours of pain, tests, and treatments, and that is all they can do is watch. They feel very helpless, and often become angry at themselves, at God, at the physicians, nurses or anyone else who just happens to be there at that moment. They are angry this is happening to them, and to their child, and there is nothing they can do to stop it.
How do you deal with it you ask? It is certainly not an easy task to be the nurse on the other end of that line. It is very easy to become frustrated with the difficult parent, and feel like they are just being belligerent and inconsiderate of the Golden Rule.The best technique is to stop, take a deep breath, and consider some effective communication skills for a more effective outcome.
Even though the non-verbal aspects of communication are minimized when performing a telephone assessment, one study suggests that 85 percent of the telephone interaction is based on "tone of voice" with the remaining 15 percent being the word content.
When we think of communication skills, we often think of speaking, but active listening comes first and is often overlooked.
Let's look at blockers that prevent active listening. Are there environmental distractions? If you are in a call center, is it busy? Is there alot of background noise? Is someone standing in front of you? Is you cell phone going off simultaneously?
Do you have Third Ear Syndrome? Two ears are listening to the patient, but the 3rd ear is listening to the siren outside or to the teenager having a tantrum just outside your room.
Be careful of jumping ahead. We can think at 500 words per minute, we can hear at 300 words per minute, and we speak at 125 to 150 words per minute. It is easy to jump ahead in attempts to be more time efficient.
Be careful of emotional filters. Is the caller the same demanding one that calls about the same issue all the time? Good listeners will avoid the emotional filter unfairly influencing the interaction.
Avoid mental side trips. You are on your fourth call of the day giving out diarrhea advice, and what you are really thinking about is what you want for lunch.
Sometimes, it is easy to deal inappropriately with emotional cues, and instead display blocking behaviors, such as: offering advice and reassurance before the main problem has been identified, explaining away distress as normal, attending to the physical aspects only, switching topics or "jollying" the patient along.
Some more common sense approaches are paying attention, assess the patient's level of knowledge, read between the lines, consider the patient's prospective with empathy, and consider hidden agendas/unspoken requests.
The following are seven speaking principles when triaging a call:
*Use the caller's name.
*Reflect back important points
*Incorporate courteous remarks
*Display empathy
*Mirror the patient (using similar vocabulary, if appropriate)

Finally, don't use jargon or abbreviations when speaking, don't mumble, and don't use negative language(eg. "I am sorry the doctor will not go back to the office to see you" versus "The quickest way to be seen would be if you are able to make it to an Urgent Care".
Remember the angry caller? One rule of thumb to always keep in mind is "They don't care what you know, until they know you care".