Passage 2 Expecting the Expected Expectations are the anticipation of our experiences, from the mundane What? Were out of milk? to the emergency department patient's"What? You want to admit me to the hospital? We as humans like to try to predict the future: it makes us feel more in control of our destiny when we re frequentl just bystanders of chance. People love to talk about their cars as reliable because they like having their expectation met that the car is going to start when they turn the key. People will tell you how they got seated at a really nice restaurant without a reservation because their expectation was so low that they would ever get a table It's really the same in the ED. You read a triage note of a patient with six seemingly unrelated complaints, and your stomach fills with dread. You look at your watch and figure,Yeah, I've got 30 minutes to spare, and march in About 30 seconds in, you immediately realize they ' re actually all related issues and you make the diagnosis of carbon monoxide poisoning in five minutes Low expectations, high yield. Or the patient who the nurse warns you is"al drama, and you walk in the room, and find the patient actually to be quite reasonable and pleasant Wow that wasn't so bad So why not use this to our advantage? We can set appropriate expectations for our patients, our colleagues, and even ourselves -to make sure everyone is on the same page, knows what's expected and reasonable, and what may happen in the emergency department PATIENTS At wit's end, on a busy, post-holiday tuesday, a patient with a runny nose and cough came up to my friend Lisa to complain about having waited an hour without being seen. In a very direct but polite tone, Lisa told the man, "Sir, if you think that that's unreasonable on a day like today with very, very sick patients, I think you need to adjust your expectations. (I, of course, started laughing because Im a jerk like that, but I think Lisas intent was spot on.) We should make sure patients know a time frame and course, and understand thatthat time course may change. Under-promise and over-deliver is a well known business strategy, but I think it's pretty appropriate in medicine as well. Letting them know that blood work and a Ct scan usually takes three hours but can be longer if we have critically ill or trauma patients gives patients a time frame before they start giving you the stink eye. You can also let patients know immediately that they' re going to be admitted regardless of the workup in the ed so that can sink in from the very beginning(especially when they were expecting to go home. ) Similarly, I've found that with VIP patients(who are not used to having a stranger direct them and make decisions about them, itPassage 2 Expecting the Expected Expectations are the anticipation of our experiences, from the mundane “What? We’re out of milk?” to the emergency department patient’s “What? You want to admit me to the hospital?” We as humans like to try to predict the future; it makes us feel more in control of our destiny when we’re frequently just bystanders of chance. People love to talk about their cars as reliable because they like having their expectation met that the car is going to start when they turn the key. People will tell you how they got seated at a really nice restaurant without a reservation because their expectation was so low that they would ever get a table. It’s really the same in the ED. You read a triage note of a patient with six seemingly unrelated complaints, and your stomach fills with dread. You look at your watch and figure, “Yeah, I’ve got 30 minutes to spare,” and march in. About 30 seconds in, you immediately realize they’re actually all related issues, and you make the diagnosis of carbon monoxide poisoning in five minutes. Low expectations, high yield. Or the patient who the nurse warns you is “all drama,” and you walk in the room, and find the patient actually to be quite reasonable and pleasant. Wow, that wasn’t so bad. So why not use this to our advantage? We can set appropriate expectations — for our patients, our colleagues, and even ourselves — to make sure everyone is on the same page, knows what’s expected and reasonable, and what may happen in the emergency department. PATIENTS At wit’s end, on a busy, post-holiday Tuesday, a patient with a runny nose and cough came up to my friend Lisa to complain about having waited an hour without being seen. In a very direct but polite tone, Lisa told the man, “Sir, if you think that that’s unreasonable on a day like today with very, very sick patients, I think you need to adjust your expectations.” (I, of course, started laughing because I’m a jerk like that, but I think Lisa’s intent was spot on.) We should make sure patients know a time frame and course, and understand that that time course may change. “Under-promise and over-deliver” is a well known business strategy, but I think it’s pretty appropriate in medicine as well. Letting them know that blood work and a CT scan usually takes three hours but can be longer if we have critically ill or trauma patients gives patients a time frame before they start giving you the stink eye. You can also let patients know immediately that they’re going to be admitted regardless of the workup in the ED so that can sink in from the very beginning (especially when they were expecting to go home.) Similarly, I’ve found that with VIP patients (who are not used to having a stranger direct them and make decisions about them), it