Amanda Dinsmore:
Hey everyone, welcome back to the podcast. I'm Amanda.
Laura Cazier:
I'm Laura.
Kendra Morrison:
I'm Kendra.
Amanda Dinsmore:
We recently conducted some market research at a conference, and a common theme that kept coming up was patient expectations, especially when we can't meet them due to reasons beyond our control. So, we thought it would be beneficial to talk about expectations today. Kendra, take it away.
Kendra Morrison:
Yeah, so expectations—it's touchy. It's something we experience in every relationship, really. With our significant others, our kids, and definitely at work, especially feeling it more these days. We often blame society and entitlement, but most of the time, expectations are unexpressed and become stories we've made up.
We create these movies in our minds but forget to tell the actors their lines and where the scene is set. This happens with our patients too. They have expectations just like us, whether it’s a meal at a nice restaurant, a gift from loved ones, or a competent service at a salon. These expectations come from movies, TV, social media, family, and friends. So, when patients come to us, they have a script in their heads, but it doesn’t always play out that way in reality.
Being dissatisfied breeds disappointment, and if unchecked, it spirals into deeper issues. Brene Brown, in her research on shame, notes that disappointment is one of the most frequently experienced emotions and is often linked to shame. People may not have the language to express this and instead say they're hurt, angry, or upset. This disappointment can be projected onto us when their expectations aren’t met, even though it often has nothing to do with us personally.
Amanda Dinsmore:
Absolutely.
Kendra Morrison:
Recognizing that most of the time we are competent clinicians offering the best care we can in the emergency department is key. However, patients come with preconceived notions influenced by media and personal experiences, which don’t always align with the reality of emergency care.
Amanda Dinsmore:
Yeah, and it's similar on the other end. In the ER, we might set expectations for follow-up care that don’t align with reality, causing frustration across the board.
Laura Cazier:
Exactly. When patients come to us, they might already be upset due to wait times or previous disappointments. Early in my career, I’d get riled up by this, feeling personally attacked. Now, I find that identifying and validating their emotions can deescalate the situation. For example, I might say, "I'm so sorry you have to be here today. I know things didn’t go as planned for you, but I’m here to help." Acknowledging their frustration and expressing empathy can create a connection and make the interaction smoother.
It's also important to set personal boundaries. During COVID, I had a patient whose girlfriend became extremely hostile over a COVID test suggestion. I chose to step out and return once we were both calm. My boundary is not staying in the room when someone is being unkind unless the patient is unstable. This allows me to think clearly and use the best part of my brain.
Amanda Dinsmore:
Absolutely.
Laura Cazier:
There are extreme cases where security might need to intervene, but usually acknowledging emotions and setting boundaries helps. It’s also about being open and honest about the limits of our practice. We can’t always find every problem or meet every expectation, but being upfront about our capabilities helps manage those expectations.
Communicating timeframes and processes is crucial, especially in the ER where wait times vary. Keeping patients updated and being specific about what’s happening next helps manage their frustration and expectations.
Amanda Dinsmore:
Yeah, who doesn't want a full-body MRI? Unfortunately, it's not always feasible. Being respectful, validating emotions, and clear communication are key.
Laura Cazier:
A game-changer for me is asking patients what they’re worried about. Often, their concerns are influenced by things like Dr. Google or social media. Understanding their specific fears helps us address and reassure them more effectively.
Amanda Dinsmore:
Are you done now?
Laura Cazier:
Yeah, that was the last part that came in after mine. Yeah.
Amanda Dinsmore:
Okay, perfect. Brene Brown gives examples of unchecked and unexpressed expectations, which we can apply at work. I have a personal example: my husband and I debated whether to go out for dinner or grill at home. He decided to cook salmon, which made me realize I had an unexpressed expectation to go out. This could have caused issues if I hadn’t recognized it.
Another example involved a friend stressing over her son's health due to her mother's metastatic brain cancer, projecting her fear onto a relatively minor issue. Open communication about expectations can prevent misunderstandings and disappointments.
In the ER, a straightforward case might seem clear to us, but have we communicated this to the patient or considered the consultant’s perspective? Sometimes, taking things personally creates unnecessary conflict.
Laura Cazier:
And sometimes you can get a laugh out of it.
Amanda Dinsmore:
Yes, like the time a surgical consultant compared our situation to Desert Storm. Not taking it personally helped me support him better.
Kendra Morrison:
Yeah, I have a good one for that.
Amanda Dinsmore:
It’s important to recognize that people have their own lives and struggles. Keeping cool and not jumping to conclusions helps us handle their reactions better.
Kendra Morrison:
I used to get defensive and take things personally, but now I use filler phrases like, “That’s interesting,” to buy myself time to calm down and respond thoughtfully.
Amanda Dinsmore:
Yeah, it’s better for me on the phone. Apparently, I have a signature stare when processing wild statements. Nurses find it hilarious because they know exactly what’s happening.
Kendra Morrison:
That’s why I still wear a mask at work. It helps me keep a straight face.
Amanda Dinsmore:
Exactly, the mask was great for hiding my reactions. Patients are allowed to complain, especially under stress. It’s not personal—they don’t know me. Brene Brown says many people choose to live disappointed rather than risk feeling it, which is sad. Our job isn’t to change them, but to provide the best care possible without taking it personally.
Amanda Dinsmore:
We need to separate what’s a "me" thing from a "them" thing. Emotional regulation helps us stay grounded and not derail our day over someone else’s bad mood. Instead of ruminating, we can reset and do our best.
This stuff can go on in the periphery and it doesn't have the same effect that it used to. It doesn't derail you for days where my previous default would be to ruminate about it. Like, what did they think I was supposed to do? Or like, what was their deal? Like, why did they do that to me? Like, it really isn't that complicated. They're having a bad day. Okay, well then let me reset and do the best I can.
Kendra Morrison (25:26.574)
with you on that it would definitely go into the spiral of rumination and it's so helpful too to consider that you know like we talked about being a star thrower every you guys are star throwers you are showing up to do the very best job that you can for the number of patients that were there to see you today and so keep that in mind don't let you know a crabby person on their worst day because of fear and security derail you you guys show up and
every single day and you are giving your all to take care of those that are on their very worst day. So thank you for joining us today and don't forget, just like Amanda said at the beginning of the podcast, go rate us, give us a review, even if you just found it a little bit comforting today or one little nugget that you came away with, go leave us a review. It helps other doctors find us and it helps just increase our ripple.
in the universe. So we just launched a new version of our online course Wellness 911. Go to our website www .thewholephysician .com to get more information. We take demoralized doctors from fried to fantastic with our easy and evidence -based Wellness 911 program. So until next time, you are whole, you are a gift to medicine, and the work you do matters.
