by Dr. Trina E.
Dorrah
What is Me first! behavior?
Recently, I read an article in USA Today by Christopher
Elliott entitled, “Me first! Why is
selfish behavior on the rise?” When I saw the title, I immediately thought,
this article must be about health care. In fact, my friend and I were just discussing
the fact that since we initially became physicians 10+ years ago, we’ve seen a
definite increase in selfish behavior among patients and families. Who’s to
blame? The health care industry, whose increasing prices and cost-shifting
strategies frustrate so many? Doctors and health care professionals, who have
lost some of the public’s respect and trust over the years? Or do we blame the
patients themselves, and attribute it to unrealistic expectations fueled by the
increased focus on patient engagement?
Before you think, “She’s just a doctor who cannot handle
having an empowered patient,” let me stop you right there. In addition to being
a physician, I am a strong advocate for improving the patient experience. When
I talk about selfish, Me first! behavior, I’m not talking about the
knowledgeable patient who plays an active role in his or her health. Nor am I
talking about patients who prefer to have a collaborative relationship with
their doctor. Most physicians agree – these are the patients we love taking
care of because they are motivated to work with us to improve their health.
Me first! behavior describes patients who act as if their
illness takes precedence above anything else their doctor is doing or any other
patient their doctor is seeing. Patients or families who display Me first!
behavior are often frustrated, and as this frustration grows, it turns to anger.
Unfortunately, the doctors and medical staff are on the receiving end of this
anger. This leads to a situation where the very people who have dedicated their
lives to helping patients and families through illness are the ones being yelled
at and disrespected.
How did we get to this point, and what can be done to
correct it? Interestingly, Christopher Elliott’s article was about selfishness
among airline travelers, but in my opinion, his observations perfectly explain
why health care has seen a similar increase in Me first! behavior.
Why the increase in Me first! behavior?
1.
Selfish behavior flares during times of high
anxiety. When people are stressed, they lapse into survival mode, and they primarily focus on themselves.
o
Being ill, especially if you are hospitalized,
is one of the most stressful experiences in life. In addition to their normal
stressors, patients and families are also dealing with the added stress and
uncertainty of illness. This increased stress causes many people to revert to survival
mode, where they are incapable of caring about anyone or anything other than
themselves. As one of my attending physicians told me in residency, “Trina, you
must always remember - the people we care for are not at their best.”
2.
The industry adds stress through surprise fees
and unanticipated hassles.
o
As employers decrease their health insurance contributions,
patients are being asked to pay a higher portion of the cost. In addition, many
clinics and hospitals have become more aggressive in terms of bill collection,
and they require higher payments up front. Most patients are not used to this
model of cost-sharing, so being asked to increase the amount for which they are
financially responsible is a huge stressor.
3.
Customers are outside of their comfort zones.
o
No matter how much patients consult the Internet,
navigating through the health care system is difficult. Delays, medical
complexity, and communication barriers are only some of the factors that make health
care frustrating. Even when patients are engaged in their care, the doctor is still
the medical expert. In fact, patients educate themselves not to annoy their
provider, but in part to ease the anxiety that comes from being in an
unfamiliar situation.
4.
Customers often have unrealistic expectations.
o
When patients enter our health care system, they
do not just compare us to other health care organizations. Patients compare us
to any other business they’ve interacted with. Our society has evolved, and
customers increasingly have the ability to make their opinion known. However,
health care is different in some very important ways from other service
industries. For example, in the business world, the customer is always right.
In health care, the patient cannot always be right, because what the patient
wants may lead to illness, injury, or even death. It is up to the medical
community to educate our patients and help them set realistic expectations.
Now that we know the causes, what can health care providers do
to prevent patients from engaging in Me first! behavior?
What can health care providers do to prevent Me first! behavior?
1.
Communicate
– more than anything, I believe frustration arises from a lack of knowledge
and understanding. When patients feel like they are not listened to or
communicated with, they become defensive. They feel like they have to protect
themselves above all others, and they slip into the destructive patterns of Me first! behavior. Through
communication, patients feel that they know what is going on, and their anxiety
is decreased. One easy way for doctors to improve communication is to end the
visit by asking patients for questions. This gives patients the opportunity to
clarify anything they do not understand.
2.
Engage in
collaborate relationships – when patients feel like their health care
provider values their opinion, they have a better patient experience. Even
though the doctor has the medical expertise, patient input is vital to reaching
the collective goal of caring for that patient. One way to improve
collaboration is to ask patients their one or two top concerns that they want
to addressed, then have the doctor address those concerns that matter most to
the patient before ending the visit.
3.
Educate
our patients – patients need to know what to expect so they can have
realistic expectations. A great deal of stress and frustration can be averted
when patients know, and education helps patients to better prepare for their
health care experience. One easy way to improve education is to engage patients
with technology. Numerous medical apps and websites exist that can be used to increase
patients’ education and understanding about their illness.
4.
Show them
we care – in the end, being compassionate and showing patients we care goes
a long way toward creating a positive patient experience. When patients know
their doctors truly care about them, they are much more willing to deal with
the inevitable stress that illness brings. One of the best ways to demonstrate
empathy is to simply stop and listen. Ask patients how they are doing. Find out
what’s going on in their lives. Patients know their doctors are busy and
pressed for time, but when you take an extra moment to show you care, you’ll be
surprised by how quickly Me first! behavior disappears.