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First Impressions by Pat Iyer

Monday, January 18th, 2010

One of my friends (Sara*) told me she ran into trouble on a substitute teaching job. It seemed the teacher disliked Sara based on her initial impression, and requested that Sara not return to the school. Sara was devastated and showed me a letter she wrote expressing concern about this comment. She asked my advice on what she should do.

negative first impressions sow seeds of discontent

The expression, “You never get a second chance to make a first impression” applies to all aspects of life. It applies to the patient who approaches the crowded check in desk of the busy emergency department. Is he greeted warmly, or is he seen as an intrusion? Do healthcare providers remember the patient may be scared, in pain, hungry or confused?

Have you had the experience of approaching a receptionist desk in a doctor’s office and having difficulty getting attention? Have you felt like you were an intrusion on the conversations going on behind the desk?

Have you ever felt like a diagnosis instead of a patient? In August 1996, my husband had a colonoscopy that revealed a large colon cancer. He was sent with a requisition form directly to the x-ray department to have a barium enema. The requisition form’s diagnosis stated “colon CA”. I sat next to my stunned husband; we had only a few minutes to absorb the news of his diagnosis. There was a technician responsible for getting him into the waiting area of the radiology department. One of her colleague asked her if she was ready to go to lunch. She called out, “No, I have to do a CA patient now.” I felt like someone had punched me in the stomach as I now realized my husband was branded as a CA patient.

None of these first impressions are cause for a medical malpractice suit but they set up a climate. An opportunity for establishing a caring environment is lost. If any mistake is made that causes harm, there are no credits in the bank- no kindly feelings towards the healthcare provider.

I advised Sara to make two copies of her letter and go to the school to express her concern about what had happened with the teacher. She learned, to her gratitude, that there were many positive comments in her file. She had made positive first impressions on lots of other teachers. What started as a negative experience turned into an opportunity for her to become of aware of how highly others regarded her.

* name changed

What are these?

Tags: customer service, first impressions, seeds of malpractice suits
Posted in Communication skills, Emergency Medicine, Medical malpractice, Personal observations, medical errors | No Comments »

Emergency Medicine On Board

Monday, January 11th, 2010

I was sleeping on a flight to Brazil when my husband woke me up and told me a passenger needed medical attention. I walked to the back of the plane where a middle age Brazilian man was holding his chest. Through an interpreter, I found out he had chest pain. He looked pale and frightened; his pulse was rapid.

Giving medical care on an airplane

I asked the flight attendant if she could give him oxygen. She produced an oxygen tank and mask; there was nothing else I could do. The ambulance met the plane in Sao Paulo and he vanished from my life.

Be sure to fly with any medication you might need on a an emergency basis- nitroglycerin, inhalers, and so on. The story below made me think of my Brazilian experience. She discusses the medical and legal aspects of rendering care on a plane.

One physician learns firsthand that you are never really off-duty: An emergency on a flight teaches a young doctor that she’s never off duty by Laura Syndman MD

I met Brent after he was dead.

Neighboring passengers later told me that he took one bite of his sandwich and then his head dropped back. It wasn’t until 10 minutes later, when his wife tried unsuccessfully to wake him, that anybody realized anything was wrong.

I was sitting in Business Class with my parents – a trip to France to celebrate my near-completion of my Intern year in Internal Medicine (just 2 weeks of night float still to go). About 15 minutes after passengers were allowed to unbuckle their seatbelts, a flight attendant ran to the front of the plane, grabbed an AED and raced back down the aisle to Coach.

I was sitting across the aisle from my father, who had 30+ years of medical experience under his belt in comparison to my 11.5 months. “Should we go back there?” I asked, but my father said they would call for a doctor if they needed one.

I decided to check it out anyway.

Behind the curtain was a scene I will never forget: a man lying in the aisle with his feet towards the front of the plane, one flight attendant doing mouth-to-mouth, one doing chest compressions and a third attaching the AED pads. I tapped the last flight attendant on the shoulder, “Do you need help? I’m a doctor.”

“We’re fine,” he said, which surprised me. I wasn’t expecting that. Granted, I was in baggy pants, sneakers and a hooded sweatshirt, but was it protocol to decline help from a physician in a medical emergency aboard an aircraft?

Medical-Legal Topics

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First Impressions by Pat Iyer

Emergency Medicine On Board

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