January 2021 Communication Tip

Agenda Setting/Setting Expectations

This month’s communication tip is about one key to satisfaction: setting expectations.

Patients who get what they expected (or more) from you tend to be much more satisfied than patients who did not get what they were expecting (even if the quality of the care was excellent).  Although patients’ expectations can be elevated by all sort of things (e.g. coming to a world-class medical center, meeting with a national expert, your reputation, what their referring doc told them, etc), it is helpful for patients to have realistic expectations.  Then, you can deliver as promised (or even more).

Setting appropriate expectations is useful for a whole course of care, but also for each particular visit.

In medicine, we’ve typically envisioned the process of setting expectations as being part of “Agenda Setting,” which is an element of shared decision making.

At the start of each visit, take just a moment to get clear about:

1. How much time you have (many patients don’t know how long their appointment is, leaving them disappointed even if you are running on time)

2. What the patient is hoping to accomplish (encourage them to lay out their entire list by continuing to ask “Anything else?” as they list their concerns)

3. What you are hoping to accomplish

Then you and the patient can identify shared priorities and negotiate about what will actually get done in the time available (and when/how other issues will be addressed).  Although the visit will unlikely address everything on the patient’s list, at least all can be satisfied that you got done what you agreed to discuss (and made a plan to address other things in another way-- e.g. a follow up visit, working with another member of your team, referral to another specialist, etc)

This process inherently demonstrates respect and situates the visit in the reality of visit lengths and realistic goals.

The encounter can then be about working together, aligning you and the patient.

The classic business advice applies here:  under-promise and over-deliver. 

May everyone find a year of health, clear talking, and generous listening.

Best,

Mike