Each month, AACH President Jenni Levy, MD, FAACH addresses AACH members through her president's message, sharing updates, goals, and information to keep members engaged and involved in the Academy.
The calendar says it’s spring. The piles of snow outside my window and the chill on my fingers as I type seem to argue otherwise. I am ready for some sunshine and balmy breezes; I trust they will eventually appear. In the same way, I trust that people who come into contact with AACH work will benefit from it, even if I can’t see it in the moment. It’s like throwing a pebble into the pond; you never know where the ripples will reach shore.
Early in my career, I was one of the presenters at an SGIM Pre-course on addiction in primary care. We offered the participants skills to ask about drug and alcohol use in a non-threatening way, and to use motivational interviewing approaches for brief interventions. One of the participants was openly skeptical. She was quite sure that she knew which of her patients were using drugs, and asking everyone would just be a waste of time - and insulting to those who weren’t using.
When I showed up for the following year’s SGIM meeting, a woman I didn’t recognize pulled me aside. She said “I was in the pre-course last year. I was convinced you were wrong, and I decided to prove it by asking all my patients for a week and documenting my results. It turned out that four of my long-time patients were using cocaine, and I never knew it. I wanted to thank you - and apologize.” She became a strong advocate for screening and brief interventions in her institution.
That experience gave me the patience to roll with skepticism and pushback when I teach. Most of the participants in our courses are experienced professionals. We are asking them to change what they do. It’s unsettling at best. No one wants to think they are doing a bad job of talking to patients. Conversely, most people believe that those who are “good communicators” are just born that way. These days, when participants in a course raise their eyebrow or their voice at what I’m saying, I validate the concern and keep going, trusting that if they actually use the skills, they’ll get it.
Last fall, I had the pleasure of teaching our one-day course on Relationship-Centered Care at a small hospital. This is not an academic center; they are a community hospital in a small town in what is still largely a rural area. They came to us through our collaboration with Press-Ganey. For a small institution, they made a sizable investment in and commitment to improving the patient experience by helping their providers develop better communication skills.
Adults aren’t any more enthusiastic than kids about compulsory training. Most of the participants were polite and did what they were asked to do. A few hung back and didn’t say much. A few asked pointed questions about how they could possibly do “all this stuff” as a hospitalist or ED provider. And one participant directly told me that he thought this was completely worthless. I validated the concern and kept going.
When I went back to do some coaching, I was interested to see that almost every provider - even the ones who had sat back or questioned the utility of the course - was using at least one part of our approach. Most were using PEARLS, and some were using agenda-setting, as they discovered that even on hospital day #4, patients may have agendas we don’t expect. In the ED, I encouraged one physician to go back in a room and ask the patient what her concerns were. The answer was so unexpected that it changed his testing plan.
Last week, the patient experience coordinator emailed me to tell me that the ED department had started their own patient experience improvement project with the goal of having every provider ask every patient about their ideas, concerns and expectations.
That wasn’t my doing. I was the conduit for the research started by Bob Smith and continued by Auguste Fortin, Francesca Dwamena, and a host of others. It’s a pebble in a pond. When we work together, we can make change.