How Doctors (And Patients) Can Reduce Medical Errors

This week's headline news that hospital errors are the third leading cause of death in the U.S. is a wake-up call for both hospital leaders and us potential patients. This would not surprise the author of Unaccountable, Johns Hopkins' Dr. Marty Makary, who wrote, "As many as 25 percent of all patients are harmed by medical mistakes."
Despite considerable evidence that requiring doctors to follow checklists for medical procedures results in better patient outcomes, it took a notoriously long time for even legendary surgeon, Atul Gawande to gain some acceptance for his now famous book Checklist Manifesto. Part of the genius of his list approach is that it mimics the list approach that pilots are required, for safety, to follow before taking off. (For patients and their loved ones, here's a pithy, plain language Patient Fact Sheet to help prevent medical errors, provided by the Agency for Healthcare Research and Quality.)

The check-off items for doctors to follow are simple and specific. Hospitals that agree to follow this approach enable observing nurses or other medical staff to ask the doctor to do the proper next step if the doctor has missed it. Such aids accountability and thus spurs higher performance. Similarly you can follow a checklist to create what Situations Matter author Sam Sommers calls the optimal context - in this case for your patients to view you as credible and caring. Yes, I am taking this somewhat long-winded way to nudge your use of a list that can spur greater patient satisfaction in their medical care and, more importantly, compliance.

Based on behavioral research, here are ten no-cost ways that medical staff can adopt to become more respected and high performing with their patients, and each other. You can remain authentic while adopting these techniques:

The two highest impact moments in patient interaction are the first and last moments in their experience with you. As Nobel laureate and founder of behavioral economics Daniel Kahneman notes, of vacations and colonoscopies have shown the last part of an experience disproportionately affects one's perception of the whole experience.

If even a short part of the end of your interaction feels especially positive to the patient it will positively color the whole experience. Consequently, when you first meet the patient and in your parting comments:

1. Show an expression of geniality on your face, with slightly elevated eyebrows and a warm smile - not a wide grin. This is the expression of caring being present in the moment.

2. Go slow to go fast. Adopt the Lower, Slower and Less Effect. In the beginning of a patient interaction and at the end, speak in a lower voice, and slower. Move more slowly and use fewer and lower arm and hand gestures. This conveys gravitas, warmth and credibility.

Just before you leave:
3. Shake hands. If it feels appropriate also briefly place your other hand over theirs as you are shaking hands or tap them lightly on the back part of one arm, slightly above the elbow.

Throughout your interactions with a patient adopt these other behaviors:

4. Address the patient by name, looking directly at the patient, at the same eye level, when possible.

5. Act right -- somewhat like them. We all have many facets to our personality and different people bring out different ones. One strong way to connect with someone is to show the part of your temperament that is most like the positive behavior the patient is exhibiting. For example, if the patient tends to move and speak quickly, exhibit the more active side of yourself. Mirror neurons kick in and, as you act more like, the patient, that patient is more likely to like you. You seem more familiar to the patient.

6. Wherever possible have a plain background behind you. The patient is better able to concentrate on what you are saying. In other words, avoid standing in front of a shelf of medical supplies, for example.

7. Sensory cues can help you bond, or not. While rare, some medical staff wear patterned clothing. Patterns, especially on the upper half of your body, distract others, even though they may not be consciously aware of this effect. They will not hear as much nor be as accurate in what they remember. Plus, where possible, speak to patients where the wall behind you is less patterned and the ambient noise is less.

8. Pay obvious, close attention. When they ask a question or make a comment, prove that you heard them by first repeating what they said, rather than paraphrasing in your language, before answer the question or responding to the comment.

9. At some point authentically praise or acknowledge something the patient said or did, characterizing their action with language that reinforces some trait related to their positive self-image. For example, you might say, "I am delighted that you are being so conscientious in reviewing the treatment with me," or "It's always good to see patients who actively ask questions because it means they are really focused on getting good care."

10. Avoid offering more than three options from which patients or colleagues must choose at one time as it puts people in overwhelm. They are less able to make a choice and often less satisfied with the choice they make, according to Barry Schwartz, author of The Paradox of Choice, who credibly refutes recent disagreement with this conclusion citing the Affordable Care Act as an example.

Some of these tips may appear more obvious than others. The keys to adopting them are to:
•Cultivate a growth mindset where you focus on continually improving rather than "worry how smart you are" advises Dr. Dweck.
•Practice just one or two of these tips at a time.
•Buddy-up, asking your colleagues involved in your interactions with patients to practice these methods with you and to give each other candid, brief and specific feedback after patient visits, sticking to the specific methods you are honing at that time.
•Aside from improving patient outcomes the rewards for you can feel enormous. You may find your work to be less stressful and more satisfying, and your colleagues and patients may become more responsive, supportive and appreciative.