Just read a PED-EM-L post from Todd Z (in response to a questioner wanting to improve Press Ganey scores) that really resonated. Customer (parent) satisfaction is an important part of the ED visit, even if you are not beholden to Press-Ganey scores. Getting parent “buy-in” is key to getting them to trust in your diagnosis and follow your recommendations, and to avoid doctor-shopping. A summary of Todd’s recommendations and a few of my own:

  1. Make a show of using antiseptic hand gel or washing your hands on entry – this shows you care.
  2. Make a connection – notice and comment on the hat with a local sports team, the cartoon on a shirt, the video or book at which the child was looking. For babies, comment on how cute/alert the baby is – every parent loves to hear about how special their child is (and honestly, all the babies really ARE cute).
  3. Set expectations for how long tests will take to return and try to check in for updates or let the parent know that they can ask the nurse to get you if they have any questions.
  4. Sometimes in the interest of time, we do have to guide the history-taking process, keeping chatty parents on track. However, do spend at least some time focusing your attention fully, listening intently to the parent’s concerns. When you get the antsy feeling, count to 10 slowly in your head and let the parent talk some more. Doing this can help reset your mindset and body language so you don’t come off as rushed or annoyed.
  5. Always do a wrap-up at the end of the visit (even if no tests were done) – explain your thoughts on the diagnosis, all the bad things that you DON’T think it is and why, review your recommendations (and concentrate on alleviating symptoms), sometimes a layman’s explanation of underlying pathophysiology is helpful, and review return precautions. If no testing was done and only symptomatic therapy being provided, avoid “they didn’t even do anything” by emphasizing that you have done a thorough history and physical examination.