Louisville Medicine Volume 67, Issue 2 - Page 6

A EXPECTATIONS AND DELIVERABLES s mentioned in my article last month, my wife, Carolyn is a pathologist. She was the director of the Jewish Hospital Laboratory for nearly 20 years. She left private practice in 2011, her self-proclaimed midlife crisis, to pursue a consulting career in Patient Blood Management (PBM). For those unfamiliar with PBM, this is a field beyond transfusion medicine and includes the appropriate use of blood components, managing anemia, minimizing bleeding and blood loss allowing for limitation or potential elimination of transfusions. She has learned much along the way, not the least of which are the concepts surrounding “expectations and delivera- bles.” As an ophthalmologist, I have never ordered a transfusion, and do not necessarily completely understand her new “space,” but as a fellow physician and dutiful husband, I have listened over the years. After hearing these terms bandied about on more than one occasion (perhaps ad nauseam?) I did start wondering how I could and should apply these two words. Seemingly they appear to be more relevant to business, human resources or management than to the practice of medicine. In preparation for this article, I found numerous references to engineering projects, research ini- tiatives and educational goals. Many have written about how the understanding of these concepts fits into the overarching arena of “change management.” Defining the expectations and ultimately assessing the deliver- ables in our capacity as health care providers requires this change. There must be a paradigm shift in the way we approach our pa- tients, understand them, and implement the processes to make ev- ery effort to ensure best outcomes. To expect and subsequently de- liver change, this demands commitment from all of us at the table, physicians, nurses, administrators and allied health professionals. This isn’t easy. In the words of Dr. Michael Wilson, our “…dogma shows remarkable tenacity; despite new evidence, too many of us are unwilling or unable to change our minds.” [American Journal of Clinical Pathology 2015; 144: 359] Given these new-found concepts, some dedicated reading and acceptance of my own need to change, I have begun implementing this approach to patients in my practice. This is particularly im- 4 LOUISVILLE MEDICINE portant when discussing cataract or LASIK surgery. The bar has been set very high and patients arrive with their expectations and anticipated outcomes for their sight post-operatively. They come to us with expectations acquired from social media, advertising, family, friends and yes, Dr. Google. Our staff discusses our thor- ough pre-operative assessment, potential premium lenses, laser procedures, etc., which we hope can reduce or eliminate their need for glasses or contacts. While we pride ourselves on the provision of excellent care, we all know there can be that occasional patient for which the outcome might have missed the mark. I am certain you have seen this, too, within your own practice. We must, there- fore, stop and think: Did we do our best to understand the expec- tations? Did we outline and review these clearly with the patient? Did we discuss potential barriers to these? Did we adequately as- sess the outcome in a caring and supportive manner, even when sadly enough, it perhaps did not entirely deliver? Taking time to prepare our patients (and ourselves) through focused and caring conversation of the informed choice will go a long way to meeting these expectations and deliverables forwardly and more fully. In conclusion, the concepts of “expectations and deliverables” are not confined to professions outside of medicine. The discipline of medicine can clearly benefit from incorporation of these ideas, whether this is the appropriate use of an intervention, such as transfusion, in Carolyn’s world, or my discussion of surgical in- tervention. Defining patients’ expectations for their personal care plans makes discussion of the hoped-for improvements much more realistic. Delivering what the patient feels is needed is rarely perfect, but certainly can better match what is possible, as opposed to imaginary. We all must look to accept our need to change. We are obli- gated to change the way we view our patients and our practice of medicine. What are your expectations? What are your delivera- bles? Most importantly, where should your patients fit into this? Carolyn and a colleague have a saying: “If you keep doing what you always do, you will get what you always got.” I believe this says it all. Dr. Burns is a private practice ophthalmologist. His practice, Middletown Eye Care, is located in Middletown, KY.