The Scripting Games by Edwin Leap MD

Our nurses will soon have scripting guidelines for their interactions with patients. This is apparently widespread in many industries, the idea being that patients will be more satisfied with their care if certain key phrases are repeated to them, phrases that might possibly, just maybe, find their way onto satisfaction surveys. Wink, wink!

Whether I will have to engage in this tawdry bit of theater remains to be seen. But bless the nurses and clerical staff! Here are the early scripts, printed on yet another laminated card to go with the other assorted cards all the staff wear with their ID badges (predicted to weigh at least five pounds in total policy reminders before long):

“Hello, I’m (name, occupation).”

“I’m here to (meds, procedures, clean).”

“Is there anything else I can do for you?”

Our nurses and secretaries are wonderful people, and might have had careers in Hollywood if things had gone differently. But one of the last things they really want to do is act. Nevertheless, I know the game.

Someone will read this and think I’m a Luddite, a curmudgeon, a stick in the mud of progress. Others will say, as they do about every new customer service initiative, federal regulation, Joint Commission rule, or state nursing board policy: “It’s only a little thing, so stop being a baby and get with the times. Sheesh!”

Indeed. It may be the case. Only today I was reminded, in a meeting about STEMI, that my group is tragically, woefully lax. We are failing to use a key phrase that explains why thrombolytics might be given instead of percutaneous intervention. We must write the following magical incantation in the chart to meet quality indicators (and be paid appropriately): “The patient received thrombolytics because his time to cath lab would exceed 90 minutes.”

Silly, lazy doctors, trying valiantly to reach the bedside and touch a patient, make a good decision, and save a life when we could be populating data fields! Bad, bad doctors! To quote Monty Python and the Holy Grail: “You must spank us! Yes, spank us all!”

I digress.

Let me bring it round again. Scripts are about patient satisfaction scores, which remain quite the rage despite some rather damning suggestions that they might not be good for doctors or patients. Scripts come to us from firms hired, using hospital budgets, to teach us how to increase satisfaction scores to put more money in the budget … and on and on it goes. How much we lose on consultants to make enough increased money to pay for consultants is a bit of a mystery to me.

Still, progress marches forward. So let me suggest how I might find scripts useful:

“Hello, I’m Dr. Leap. I’m here to take care of you while you’re sick, not do data entry. Is that OK with you?” Key words: care, sick, data.

“Hello, I’m Dr. Leap. I’m here to preserve your airway and rescue you from your own alcohol toxicity. Is that OK? Is there anything else I can do for you? Sorry, I can’t understand when you vomit.” Key words: airway, sick, alcohol, toxicity, data, scores … vomit.

“Hello, I’m Dr. Leap. I’m here to decide if your pain score is really a 10 because you look uninjured. Is there anyone I can call to take you home?” Key words: 10, uninjured, call, home.

“Hello, I’m Dr. Leap. The last time you were here you stole an entire drawer of dressings and a dirty needle box. I’m here to report that. Is there a parole officer I can call for you?” Key words: stole, drawer, needle, parole.

‘Hello, I’m Dr. Leap. I’m here to commit you to a psychiatric hospital to help you obtain disability at age 30. Is there anything else I can give you besides my time and tax dollars to help perpetuate your life of inactivity?” Key words: commit, psychiatric, disability, 30, tax, inactivity.

“Hello, I’m Dr. Leap. I’m here to ease your suffering, my dear, stoic little lady. Whatever you need is fine. Is there anyone bothering you because I will shut them down?!” Key words: suffering, dear, stoic.

“Hello, I’m Dr. Leap. I’m here to find out why you’re smoking in the emergency department, and ask you to leave. Is there any way I can make that happen faster?” Key words: smoking, leave.

“Hello, I’m Dr. Leap. I’m here to explain to you that you can’t speak to our nurses that way. Is there a bar of soap I can use?” Key words: nurses, speak, soap.

“Hello, I’m Dr. Leap. I’m here to explain to you that you will not be receiving Valium, Ativan, Klonopin, or Xanax for your panic attack. Just like the last four times. Can I get you a cup of coffee with caffeine?” Key words: Valium, Ativan, Klonopin, Xanax … not.

“Hello, I’m Dr. Leap. I’m here to protect you from your neglectful parents, little one. Would you like a coloring book? Look! Your parents are too busy texting to hear us talk! Funny, funny parents in orange jumpsuits!” Key words: neglect, parents, little one, texting, orange jumpsuit.

“HELLO, I’M DR. LEAP! I DON’T SPEAK YOUR LANGUAGE. I’LL FIND SOMEONE WHO DOES OR A TELEPHONE! IS THAT OK? IS THERE ANYTHING YOU NEED?” Key words: LANGUAGE LINE!

“Hello, I’m Dr. Leap. I’m here to talk to you, not to text you. Let me know when you put it down. Is there any other means of communication I can get for you? Until then, I’ll ignore you.” Key words: text, communication, ignore.

“Hello, I’m Dr. Leap. I’m a health care professional who does a great job. I won’t always follow the script, but then you won’t always follow the textbook. I’ll do my best. If you’re unhappy, tell me and we’ll work it out. But let’s not play silly games. Let’s make you better, shall we?” Key words: professional, better, best.

Silly game.

Send me some samples of your own scripting to [email protected]! If we have enough, we can write a screenplay!

*Dr. Leap is a friend of this site and a great writer.  You can catch him at www.edwinleap.com/blog

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “The Scripting Games by Edwin Leap MD

  1. mamadoc
    March 13, 2013 at 8:39 pm

    Oh, for pity’s sake!

  2. judith
    March 13, 2013 at 4:41 pm

    “Hello, I’m your patient and I want you to look at/listen to me instead of typing on that computer.”

    “Hello, I’m your patient and I want to tell you why, after you’ve been looking at your computer screen for 7 minutes and you look at your watch and stand up, I stand up too and place myself between you and the door.”

    “Hello, I’m your patient and I’d like to assure you that I really would know about it if I’d had my knee replaced in 2010.”

    “Hello, I’m your patient and I’d like you to change the part of my husband’s record that has the woman who drove us here last time listed as his wife, living at our address.”

  3. Mary K
    March 13, 2013 at 9:52 am

    You’re a bit late with this. I have been retired from nursing since 2005 and scripting was in use for a year or so before I retired. Most of my fellow RNs didn’t buy into it and used their own words to deliver the messages sought by the administration. I get the weekly employee newsletter as a retiree and it’s usually filled with the kinds of scripts you should use–especially in service recovery–a nice word for “The patient is always right so apologize!” The emphasis is not longer on getting the patient better but keeping the patient happy so that the satisfaction survey points go up. What a joke!

  4. Pat Conrad
    March 8, 2013 at 11:32 am

    Brilliant, absolutely hysterical! How about…Hi, I’m Dr Conrad, and I’ll be performing a pelvic exam, with respect and as rapidly as possible, without regard to any glaringly evident lack of hygiene or recalcitrant bits of tissue paper, and,showing more care to your nether regions than you have in months, lift the pannus, nurse, please….key words, rapidly, please.

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