Doctors are taught to deal with complaints painlessly

The Ministry of Health has issued guidelines for doctors and hospital staff on how to communicate with patients during remote consultations. The document says about the inadmissibility of phrases and intonations that demonstrate indifference and indifference. Also, officials are against value judgments, direct or veiled insults and phrases that do not carry a specific meaning. The All-Russian Union of Patients hopes that this is a step towards a patient-centered approach in healthcare. And the head of the psychological service “Clear Morning” Olga Goldman believes that patients should also have their own “safe words”.

The Central Research Institute of Organization and Informatization of Healthcare of the Ministry of Health published methodological recommendations for organizing remote appointments with a doctor. The document states that all patient appeals can be divided into requests for information (“I just need to ask”) and targeted appeals aimed at obtaining medical assistance. Since a face-to-face appeal is processed longer than a remote one, and the processing time of a “request for information” is even longer than a “target one”, the authors formulate an “organizational vector for processing incoming calls” – it is necessary to minimize face-to-face appeals and requests for information from patients. It is proposed to do this “by eliminating defects in informing patients through the website of a medical organization, stands with information and other passive methods.”

The authors of the recommendations remind colleagues that the “key task” of medical and non-medical personnel is to solve the patient’s medical problem.

It should be implemented “from the moment of contact through the recording channel”. Employees of medical institutions and regional call centers are encouraged to use conversation scripts or speech modules in order to “correctly build responses to any objections, clearly and convincingly articulate the benefits of a particular proposal, and easily and painlessly work with complaints.”

The speech turns that can be recommended for communication with patients depend on the characteristics of the healthcare system in a particular region, the compilers note. But the recommendations give a list of “phrases-provocateurs” that are unacceptable in conversation, which must be excluded and replaced with more correct expressions.

Among the forbidden words, for example, are the appeals “woman”, “girl”, “young man”, “man”. They are suggested to be replaced by the patient’s name or the pronoun “you”.

The phrase “your problem”, according to the authors of the recommendations, should be replaced with “our question” or “our situation with you”. Instead of accusatory phrases “I didn’t advise you incorrectly” or “What else does not suit you?” you need to apologize and ask how else you can help.

In addition, diminutives and expressions such as “can’t” or “we can’t” are prohibited.

“Thus, phrases and intonations are unacceptable in use: demonstrating indifference and indifference; interpreted as an attempt to evade responsibility or directly speaking about irresponsibility, reflecting lack of initiative or unwillingness to help; any value judgments, direct or veiled insults; phrases that do not carry a specific meaning, ”the document says.

Commenting on the recommendations, Assistant Minister of Health Alexei Kuznetsov emphasizes that the growth of citizens’ satisfaction with medical care is of paramount importance. “And the first impression is formed already at the moment of the first contact — making an appointment with a doctor,” notes Mr. Kuznetsov. “Today, a lot of work is being done to increase the availability and efficiency of remote recording. The new guidelines are designed to make interaction with the patient supportive and constructive.”

Yuri Zhulev, co-chair of the All-Russian Union of Patients, believes that the rules for conversation are a step towards the implementation of a modern patient-oriented approach.

“Patient-centered healthcare is building conflict-free communications, with a respectful attitude towards each other. The patient community can only welcome this initiative,” says Mr. Zhulev. But it’s important, he adds, that the new recommendations apply not only to call center workers, but to all healthcare workers.

The scientific director of the network of clinics for immunorehabilitation and preventive medicine Grand Clinic Olga Shuppo agrees that the proposed speech turns can be introduced everywhere where citizens’ appeals are being processed. This will further reduce the level of conflict and improve patient routing. Ms. Schuppo notes that such scripts have long been the norm in private medicine and are constantly being improved: “We made the last changes this year. The level of anxiety in society and other disorders are growing, so communication with patients is built even more delicately.”

Olga Goldman, director of the Yasnoe Utro oncology service for oncologists, recalls that during the coronavirus pandemic, many hospitals opened call centers to reduce the risk of infection during face-to-face appointments, and this experience was recognized as successful. Uniform methodological recommendations for organizing such remote communication, according to her, are “a good undertaking”, since healthcare organizers will have something to rely on. However, Ms. Goldman believes that along with the rules for employees, rules for patients should be developed and published on the website of the medical organization – about what questions the call center can answer and what appeals are unacceptable: drunk, using profanity or with ” direct personal attacks” on the operator. “This is an important point, otherwise employees will quickly burn out and there will be a high turnover of personnel,” says Ms. Goldman.

She also notes that among the developers of the recommendations there is not a single medical psychologist and protocols for the crisis-psychological states of patients are not taken into account. “Sick people are a complex category of citizens. Among them, there will definitely be those who will call in passion. We see this from the experience of insurers who are already accepting citizens’ appeals remotely,” continues Olga Goldman. “An ordinary call center operator will be afraid of a person who, for example, cries, and, accordingly, defend themselves from him. And no stop words can compensate for the lack of empathy and indifference.” In her opinion, call center employees should be able to transfer the patient to a psychologist who can support him.

Recall that on December 1, Vladimir Putin, at a meeting with young scientists at the Sirius Center, noted that in Russia the psychological assistance service is not developing at the proper level. Minister of Health Mikhail Murashko said the next day that the availability of psychological and psychiatric care in the country is already increasing, but an important condition for successful work is the high involvement of the regions.

Natalia Kostarnova