Jul 16, 2015
BOSCON 2013 ORATION
THE UNHAPPY PATIENTMY PERSPECTIVES
DR UDAY KUMARMS(ORTH),DNB(ORTH)
31ST March 2013
HAPPY PATIENTS
--ARE LOYAL
--WILL REFER OTHER PATIENTS TO YOU
--THEY GIVE YOU PROFESSIONAL SATISFACTION
--IF YOUR PATIENTS ARE HAPPY, YOU WILL BE HAPPY TOO
A happy patient will tell two of his friends
An unhappy patient will tell the whole PLANETthrough word of mouth/internet
INTERNET BLOGS
-just avoid Dr X at this hospital as he is incompetent
-Dr Y is fooling patients with false degrees— ?Mch(orth)USA
-please avoid Y hospital—WORST EXPERIENCE—20 year old equipment-uncaring nurses etc
UNHAPPY means-----sad, unlucky, depressed (webster dictionary)
first used in 14th century
Patients do not care how much you know
They ONLY want to know how much you care.
Why is the patient unhappy?
-communication gap in doctor-patientrelationship
-mismatch between expectations and reality
Unhappy with -- hospital/clinic
-- doctor
-- nursing care
-- surgical result—good/bad
--cost
-- re-surgery/rehab
“You are as strong as your weakest link”
doctor
-DOCTOR HAS
-- NO TIME TO LISTEN TO ME
-- NOT EXAMINED ME IN DETAIL
--NOT EVEN TOUCHED ME
--NOT EXPLAINED MY PROBLEM OR THE SURGERY PROPERLY
--LACK OF TRANSPARENCY ABOUTCOSTS
NURSING CARE POOR
FOOD VERY BLAND—NOT TASTY
AMBIENCE---BED NOT CLEAN
----BED BUGS
---AC NOT WORKING
---TOILET NOT CLEAN---ETC ETC
UNHAPPY FOLLOWING SURGERY
SURGERY—UNINDICATED
--INADEQUATE/IMPROPER
--ON WRONG SIDE/SITE—CATASTROPHIC
--POOR/GOOD RESULT
--POOR PHYSIOTHERAPY
--NEEDS RESURGERY FOR VARIOUS COMPLICATIONS
OH MY GOD ! XRAYS
UNHAPPY PATIENT AFTER POOR SURGICAL TECHNIQUE
Disclaimer: No ill will meant to any orthopaedic surgeon
• 40 yr old male
• # shaft L femur mid third
• Underwent open K nailing & cerclage wiring elsewhere
• After 1 and half yrs --
CASE 1
CASE 2
• 60 year Female, Domestic helper
• Pain Both hips few months
• Walks with walker
• Medically fit
PATIENT PRESENTED LIKE THIS
BILATERAL LOOSER’S ZONES
AFTER MANY SURGERIES-NO PAIN RELIEF-VERY UNHAPPY
BILATERAL ADDUCTORTENDINITIS – PAIN RELIEVEDWITH SIMPLE LOCAL INJ & OSTEO-MALACIA TREATMENT---HAPPY
• Male 55Years
• RTA 2 years ago . Gr III B comminuted fracture Right Leg
• debridement-
• minimal Internal fixation+ Ex-fix, Vascularised free flap.
CASE 3
Case 4
•19 YEAR OLD MALE
•AC COMPRESSOR BLAST
•SUPERFICIAL BURNS OF BODY
•COMPOUND # BOTH BONES UPPER I/3RD RIGHT LEG
•TREATED ELSEWHERE –DEBRIDEMENT-UNILATERAL EXT FIX-SSG
CASE 6—Neglected trauma
- 25 YEAR OLD MALE
- ROAD TRAFFIC ACCIDENT
- CLOSED INJURY TO RIGHT ANKLE
- TREATED BY A NATIVE BONE SETTER FOR 4 ½ MONTHS WITH BANDAGES
- NO NEURO-VASCULAR DEFICIT
PATIENT IS VERY COMFORTABLE WITH LEFT TKR
BUT IS GENERALLY UNHAPPY FOLLOWING
SURGERY DUE TO PSYCHO-SOCIAL PROBLEMS
General Guidelines
• Give the very best medical care possible
• Respect the patient’s dignity
• Listen to the patient’s and family’s concerns
• Always be compassionate and caring
-Listen to the patients and they will tell you what is wrong. Lawson Smith
-Welcome the complaints. “If you’re happy with the way we treat you, tell your friends.
If you’re unhappy with the way we treat you, tell us.”
HOW TO MANAGE UNHAPPY PATIENTS
Do not run away from unhappypatients.
-see patient repeatedly
-make house calls
-refer patient to your friends for second opinion(you may have missed out something)
-take patent’s permission - discuss his problem
on internet eg. Indiaorth
Inform patients about-- limitations of surgery
Eg “If you had a hip replacement, you are not going to run a marathon next day”.
-- inform that, despite our best efforts,no treatment is without risk orcarries a 100% guarantee of success
PREOPERATIVE STAGE
--- Discuss entire procedure in detail with patient
Informed consent
-Talk in numbers and give percentages eg, ’Twenty percent of patients may need
an adjustment with this procedure.’
--- Stress the time required to heal.
POSTOPERATIVE STAGE
-- never disagree with what a patient sees is wrong
-- Remind the patient that healing takes timeeg: from 6 months to a year.
-- See the patient with increased frequency
- show that you care
- Don’t send the patient away for a month and hope that they will cool down.
DEALING WITH ANOTHER SURGEON’S UNHAPPY PATIENT
--Never say anything bad about another surgeon.
“If you see a little fire,put a little water on it,not a little gasoline.”
-- Make a friendly call to the other surgeon who did the original surgery.
Let him know you have seen the patient.
Mention that you supported his original work.
-WHEN IN TROUBLE--STAY CALM
-LISTEN TO THE PATIENT- RE-ESTABLISH RAPPORT
-KNOW YOUR LIMITS
-DON’T COMMENT ON ANOTHER DOCTOR
CONCLUSIONS---FOR UNHAPPY PATIENTS
-WHEN IN DOUBT, REFER AND TAKE HELP
-EXPLAIN LIMITATIONS OF SURGERY
-PROVIDE OPTIONS
-TREAT THE unhappy PATIENT LIKE A VIP