The Patient Comes Second


That’s the problem with putting others first, you’ve taught them you come second.

                                                                             –    Anonymous

Today, all health care providers are grappling with the impact of the COVID-19 pandemic which has swept countries across the globe. It is a stressful and anxiety-filled time for healthcare workers of all tiers. Why do ordinary citizens need to support them at such times and how? Perhaps, the answer lies with the authors of this book.

Every doctor, nurse, paramedic or healthcare worker is familiar with the maxim of putting the patient first. Till date, this work ethic has been considered the greatest virtue of health care services. Thus, the title of the book ‘The Patient comes Second’ by Paul Spielgman and Britt Berrett comes as a surprise. In their foreword, the authors themselves have shared how many of their reviewers suggested they change the title as it could clash with the sensibilities of most readers. Yet the authors persisted, as they believed the title would assist them in getting their message across to the healthcare sector. To understand their message, let us do a small exercise.

Try and recall your last visit to a health care facility as a patient and not as a healthcare worker. What do you recollect about your visit? A few weeks ago, I visited the clinic of my family doctor for a minor ailment. The doctor was running late for his appointments and the receptionist made sure the appointments were re-organized and none of the patients were forced to wait at the clinic. A few years back, I had to visit the emergency room for a few stitches on my forehead due to a minor accident at work. I was in a state of shock when I entered the ER. The attending doctor recognized my state of mind and with a gentle conversation, he helped me come to terms with it. As a patient, my long-term memories of my visits even today are focused on the way I was treated rather than the quality of treatment rendered. 

The authors in this book suggest that modern-day health care is judged by patients on the basis of cost, quality of treatment and patient experience. Cost and quality of treatment is many a time at par in different facilities. So, the choice comes down to patient experience! Patient experience can include the interiors of the facility, the equipment used etc. But if you re-read the experiences I mentioned above, you will realize my memory of them are primarily focused on the meaningful interactions I had during my visit with the doctors and the staff. Interactions, wherein the healthcare workers demonstrated their care and concern did far more for my mental health state than the treatments. If you read the experiences of the patient treated for COVID-19, the dominant theme in their stories is about how the doctors and nurses treating them ensured they could communicate with their families and motivated them to fight the illness. 

So then shouldn’t the patient come first, if good healthcare is about meaningful patient interactions? Well, no! The authors demonstrate and explain that meaningful interactions such as the ones I recalled are possible only when employees in a health care facility are engaged in the work they do and are themselves satisfied with working there. It is their belief that employee engagement is the primary driver for determining the quality of patient experience, these employees will deliver. Healthcare workers are empowered to care more for their patients when they know their organizations care for them, first. Revolutionary thought isn’t it!

Well, the authors, Paul Spiegelman, director of Beryl companies, a patient experience service and thought leadership organization and Britt Berrett, president of Texas Health Presbyterian Hospital have actually implemented this principle in various healthcare facilities and in this book they have shared the techniques they used and the unexpected results they got. 

The changes they suggest organizations should make include changing the leadership models from an authoritarian model to one wherein team members feel empowered to take snap decisions when needed, to better the experience for a patient. Something as small as the receptionist allowing a patient who needs urgent attention to see the doctor first. Another anecdote narrated by them is how they improved compliance with handwashing protocols in hospitals. Instead of offering financial rewards or making it a compliance issue, they had regular sessions with the staff and doctors to explain the importance of the same. Handwashing rates improved because employees realized how by following this simple method, they could have a positive impact on patients.

Ultimately, isn’t that what every employee desires? To feel that his work and his presence in an organization makes a difference to the leadership team, to his colleagues and to patients. Make sure every employee feels acknowledged in the team and you will see them coming forward to acknowledge your patients and other team members. That’s why the title of the book is ‘Patients Come Second’ as ‘Healthcare workers need to come first.’ The authors have also shown studies where organizations who scored higher on employee engagement surveys also did better in terms of financial gains. So, if you invest in your employees, automatically your patient volumes and patient satisfaction will increase and pay you rich dividends.

This is a book I recommend should be read by all those who are in leadership roles in healthcare facilities. Even if you are running a health care clinic with just one or two staff members, this book can help you work wonders in your practice.

So, coming back to our primary question, organisations are doing the best to support their workers but what about citizens? How can they support healthcare workers currently?  By caring about their well-being! Small gestures go a long way! Leaders such as Ratan Tata have shown the way by providing both accommodation and food to healthcare workers from the Taj group of hotels. An exemplary gesture, indeed! Cab companies are doing their best to provide them with transport in the absence of trains and public transport. The video by Akshay Kumar acknowledging their sacrifices and contribution is a public acknowledgement of the selfless nature of the profession. Everyone may not be in a position to help them on a public scale, but you can still make a difference. Follow the instructions given by governing organizations. Respect and acknowledge every health care worker you meet! Make a conscious effort from today to show them that you care! 

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About the author

Dr.Nikhita Gune is a qualified pediatric and preventive dentist, currently working at NH SRCC Children's Hospital, Mumbai.She is also a consultant at various private dental clinics and charitable trusts across Mumbai. She maintains her own blog on oral healthcare of children on a popular parental guidance website. A bibliophile right from childhood, being a writer has always been her dream.



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