The Patience of Patients

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When I was a resident, one of my attendings said, “You know why patients are called ‘patients’? It’s because they have a lot of patience. For us.”

Patients in hos­pi­tals do a lot of wait­ing. They wait for physi­cians. They wait for nurses. They wait to use the bath­room. They wait to undergo pro­ce­dures. They wait for their IVs to stop beep­ing. They wait for the per­son next door to stop vom­it­ing up what sounds like all of their inter­nal organs. They wait for the per­son down the hall to stop scream­ing. They wait to eat. (Doc­tors: Reverse those NPO orders as soon as you can! Food is at the base of Maslow’s hier­ar­chy of needs! Food is more impor­tant than safety and secu­rity of health!) They wait for the nurs­ing assis­tants to fin­ish tak­ing their blood pres­sures so they can sleep. They wait for the unit clerk to answer the phone so a nurse can help them get out of bed with­out the bed alarms screech­ing through­out the unit.

They wait to feel bet­ter. They wait for good news.

No one has any idea how much patients wait in the hos­pi­tal until you become a patient in the hospital.

Some­times it’s not even clear what patients are wait­ing for. Hos­pi­tal staff arrive and they have no idea why they are there:

“Hi, I’m the phys­i­cal therapist.”

“Hi, I’m here to take you down for an ultrasound.”

“Hi, I’m the dietician.”

“Hi, I’m the con­sult­ing psy­chi­a­trist (Hos­pi­tal­ists: If you call a psy­chi­a­try con­sult for your patient, tell your patient. Most peo­ple, with or with­out psy­chi­atric issues, do not appre­ci­ate an unex­pected visit from a psy­chi­a­trist. “I’m not crazy! Get out of my room! No one asked you to come here!”)

Because of the nature of acute care in hos­pi­tals, rarely do things run on a con­sis­tent, pre­dictable sched­ule. This lack of punc­tu­al­ity is not inten­tional; things change. Hos­pi­tal staff triage patients all the time and, unfor­tu­nately, patients and patient care are shuf­fled around in order of acuity.

Thus, if you’re in a hos­pi­tal and some­one tells you that So-and-So will see you at 2pm, don’t believe it. Yes, So-and-So might actu­ally see you at 2pm, but it takes extra­or­di­nary plan­e­tary align­ment for that to hap­pen. So-and-So might show up at noon… or at 4:30pm.

Yes, doc­tors wait, too. The wait­ing doc­tors do, though, is informed by the knowl­edge they have about why they’re wait­ing. Doc­tors wait for patients to come out of the bath­room. They wait for patients to go for a study or imag­ing test. They wait for fam­ily mem­bers to arrive to get more his­tory. They wait for the pathol­ogy or study results to clar­ify diag­no­sis and treat­ment. They wait for infor­ma­tion that affects what hap­pens next.

Patients often wait with­out know­ing what will hap­pen next.

If you work in a hos­pi­tal, remem­ber that most patients have an extra­or­di­nary amount of patience, given the cir­cum­stances. Yes, there is a minus­cule minor­ity who have the frus­tra­tion tol­er­ance and impulse con­trol of tod­dlers, but that is not a com­mon means of cop­ing in adults. (Physi­cians tend to call psy­chi­a­try when this hap­pens. This is not a com­mon consult.)

Do what you can to ori­ent patients to what is going on. Give them approx­i­mate times for your vis­its and if you are run­ning late, send a mes­sage to them to let them know. (Tech­nol­ogy could help here: What if we could send text mes­sages to patients through the tele­vi­sion? or if the text mes­sage could become a voice mes­sage on their in-room tele­phones?) If patients are not around when you come by to see them, leave a note to let them know that you’ll try again later. (Tech­nol­ogy could help with this, too.) Tell them why you don’t want them to eat after mid­night. Tell them why you want them to work with phys­i­cal ther­apy. Tell them the pur­pose of the bed alarm.

Help them under­stand what they are wait­ing for. Don’t take their patience for granted.

Maria Yang, MD, is a psy­chi­a­trist, teacher, and writer. She cur­rently works as the med­ical direc­tor of a jail and hos­pi­tal diver­sion pro­gram for peo­ple with men­tal ill­ness and chem­i­cal depen­dency prob­lems. For much of her career she has focused on pro­vid­ing and improv­ing psy­chi­atric ser­vices to peo­ple who have strug­gled with home­less­ness and have sig­nif­i­cant psy­chi­atric conditions.Maria enjoys read­ing, learn­ing, and cook­ies. She cur­rently lives in Seat­tle with her husband. Read more of her writing at www.mariayang.org.