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Patience with patients: a must for outpatient labs.

It's the little things that make a big difference in how outpatients perceive their care and ultimately determine whether they will return for future services. Here's a light-hearted look at some outpatients who may seem all too familiar.

TO SAY that the outpatient blood drawing laboratory is a busy place in today's hospitals is an understatement. As a result, lab staffs come in contact with vast casts of characters daily--most of whom have a lesson to teach those of us willing to look, listen, and learn.

To provide our patients with the level of care they expect and deserve, we find it helps to try to understand something about their lives. Believe it or not, we can tell a lot about our patients by the containers they use to collect urine specimens at home. For example, the baby food jar people are generally a bit uptight, overwrought, and scattered due to the trials and tribulations of new-found parenthood. The peanut butter jar people have kids a bit older and in school, but life is more hectic than ever. The marinated artichoke jar people haven't contemplated parenthood yet; they're working on joining the ranks of tomorrow's yuppies. And the occasional half-pint whiskey bottle people? Well, who knows?

Once a patient submitted a urine specimen mixed with craft-like sparkles. On the bottle was a note from the patient's mother instructing us to please ignore the glitter, which had accidentally fallen in during play time.

Our all-time favorite patient was an elderly woman who, wearing a veiled hat and black orthopedic shoes, approached one of our phlebotomists as if she were a double agent with a top secret document in her handbag. After glancing around the room, she carefully pulled out her urine specimen and whispered that she had thought it best to put it in a perfume bottle so that it wouldn't have an unpleasant odor.

* The need for understanding. Visiting an outpatient laboratory causes anxiety for many of our patients, so it is essential that the staff be alert for signs of embarrassment, apprehension, and fear and that they respond to these emotions with patience, reassurance, and kindness. Unfortunately, this is sometimes easier said than done. Case in point: One morning one of our phlebotomists threw away a Popsicle stick that had fallen to the floor next to a child sitting beside his mother. The parent went berserk. "What right do you have to throw that stick away?" she scolded. "He was playing with that!" She continued to make a scene until another phlebotomist brought the crying child a tongue depressor from another department.

Before the mother left, she admitted that she was having a bad day and that she had overreacted. It is not uncommon for patients to fly off the handle for no apparent reason. They may be nervous about an upcoming procedure, feeling under the weather, or reacting to an incident that occurred before they arrived at the lab. The possibilities are endless. Regardless of the reason, it is crucial that we maintain our composure and respond with compassion.

Another frequently played out scene requiring a great deal of diplomacy is the one where the patient has lost or forgotten his doctor's order sheet and becomes annoyed when we don't automatically know which test has been scheduled. "It's the same one you performed on me last month!" he screams, or "You know, just a routine blood test!" she impatiently growls. The laboratorian who takes the time to treat these patients with temperance and tact does the hospital a great service.

* Communication static. Sensitivity and tolerance are also required in situations in which special instructions for collecting specimens must be given to patients, for example, in the case of semen specimens, 24-hour urine samples, clean-catch urine samples, and stool specimens. It is important that instructions are given clearly, first verbally in a private area, then in a written form that patients can take with them.

Never was this point made clearer to me than when a patient, who was supposed to provide us with a semen specimen, thought abstaining for 24 hours meant that he couldn't void for that time period; he brought us a urine specimen instead.

Don't underestimate the importance of privacy when giving instructions. Laboratorians sometimes discover the hard way that what we consider routine is not always felt to be so by patients. Few patients appreciate being asked the date of their last menstrual period or being told how to collect a semen specimen in the middle of a crowded waiting room.

If a language barrier exists between a patient and laboratorian, see if anyone else in the office--patient or employee--speaks the language. If not, consider hiring an interpreter. You can imagine the creativity and perseverance we needed to conjure to make a non-English speaking foreign student being treated for a parasitic infection understand that we needed a stool specimen.

It is not uncommon for patients to misinterpret what they hear and observe in a lab, which is why phlebotomists and other staff members must be extremely conscious of what they say in front of clients. On one occasion, a mother, upset at seeing her infant in tears during a blood draw, asked a phlebotomist, "How do you stand this all day?" Not taking her eyes off the needle in the child's arm, the phlebotomist responded simply and honestly, "I don't listen. I just concentrate on getting the procedure over with as quickly as possible." This response did not sit well with the mother, who wrote a letter to our patient relations department complaining that our workers are insensitive to crying children.

Proficient, clear verbal communication on the part of the staff is not always enough. Not too long ago, an adolescent came into the lab with her mother (clearly the more nervous of the two) to have her blood drawn. "I feel so sorry for her," the mother kept saying. "I always faint when my blood is taken. I hope she doesn't faint too." Guess what? Within a minute's time, the daughter fell to the floor despite our verbal reassurances that she would be fine.

Sometimes tone of voice, body language, eye contact, and the way instructions about a procedure are administered can make a big difference in allaying apprehension. And sometimes it is better that a parent not be present when his or her child needs to have blood drawn.

* Treating tots. Children undoubtedly require special treatment. One of our most successful projects was turning a blood drawing cubicle into a pediatric area. To help distract children during a procedure, we decorated the cubicle with Mickey Mouse wallpaper and covered the exam table with matching vinyl. Before leaving, young children are rewarded with pinwheels, wands filled with sparkles, or stickers. You'd be surprised how many adult patients now request Mickey's room too.

For a long time, we followed the treatment of a five-year-old girl suffering from leukemia. She enjoyed coming into the lab dressed in her mother's costume jewelry. The child took a liking to two male phlebotomists, who returned her affection by transforming an ordinary cigar box into a jewelry box decorated and filled with inexpensive costume jewels. Using an imitation rhinestone tiara and a magic wand, they crowned her "Queen of the Outpatient Lab." These are the days that make our jobs worthwhile. Fortunately, this patient has been in remission now for a year and is no longer one of our regulars.

* Unique customers. Servicing people in a health care setting is not the same as servicing people in, say, restaurants, banks, or department stores. Most of our customers are either sick or worried about getting sick, which makes it all the more important for us to overlook bizarre--sometimes rude--behavior, and which makes it all the more rewarding when kindnesses offered are remembered.

It's not always easy, but our patients deserve the best care that we can provide.

Susan E. Perkins, formerly manager of specimen acquisition and handling, is coordinator of point-of-care testing at Baystate Medical Center and a phlebotomy instructor at Springfield Technical Community College, Springfield, Mass.
COPYRIGHT 1993 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993 Gale, Cengage Learning. All rights reserved.

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Title Annotation:dealing with outpatients
Author:Perkins, Susan E.
Publication:Medical Laboratory Observer
Date:Apr 1, 1993
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