Friday, July 13, 2007


“Change the way you look at things and the things you look at change.” Wayne Dyer

I'm veering off the access topic this week because my last two posts have me thinking more about the broader idea of patient-centred care/patient experience…

You guys like improv comedy? You know, where performers make up impromptu scenes, often based on suggestions from the audience. Here's an idea on using an improv game to help focus on patient-centred care.

In the "Switch" game, two performers are creating a scene when the moderator calls "Switch." The last speaker then repeats his line, with a word changed, or gives a completely new line. This changes the context of the scene and may take it in a completely different direction. Hopefully a funny direction. (Go to YouTube and search "Improv game switch" to check out some samples.)

Improv performers want to make their audience laugh; we want our patients to have a Great! experience. Here's how I've been playing with this game at work:

Scenario: Mr. Johnson is coming to see me for a second opinion about his newly-diagnosed prostate cancer. I call him in from my waiting room and am dismayed to see two daughters and a son get up to accompany him. Groan! This is going to take forever. Endless questions, high anxiety levels...


Great! His family has taken the time to come with him. I can discuss the situation once rather than fielding individual phone calls from each child. They all made a special effort to come and see me.

Some psychology-type is going to say: “Well you're just "reframing" the situation more positively; that's nothing new.”  OK, Professor Party-pooper, you stick with your stuffy psycho-babble; the rest of us can have some fun with this. Need some help getting started with this game? Audience members will sometimes call out suggestions for changes in the scene. When you want to switch your attitude, imagine a tiny audience member perched on your shoulder, wearing wings and a halo, whispering suggestions in your ear.

Scenario: What's this? A message to call Mr. Jones. He's got some blood in his urine. Well, of course he does. He just had prostate surgery. Why is he wasting my time?


(Suggestion: Strengthen the physician-patient relationship)

He's worried that he’s having a serious complication. I can reassure him and give him instructions on what activities he should avoid.

(Suggestion: Make the system work better for patients)

This is a common postoperative problem. It's too bad he's had to wait for me to call him about this. Maybe we need to improve the information given to patients when they leave the hospital. Even better, we could post information about common post-op problems on a webpage so patients can access it at their convenience.

(Suggestion: You’re the man!)

He trusts me as an expert. I'm the best person in the world to help him with this problem.

You see? Do whatever it takes to get a positive mindset before your patient encounter.

Kind of kooky? Sure. Just a mental trick? Of course. But no one knows you’re using a kooky mental trick. They’ll just see your commitment to patient-centred care. Break a leg!

P.S. I’m on holidays next week, so check back in 2 weeks. After that, I’ll be posting every 2 weeks. (Blogging is hard work!)  Have a great summer!


  1. Originally posted by Joy Dobson (RQHR Anesthesiology) 7/13/2007 6:12 PM

    Another great entry, Kishore. Once again, I am forwarding the link to every doctor on my email address list. Heard you were on CBC spreading the word today too. You are my latest hero in my small personal series!

  2. Originally posted by Janet Tootoosis (North Battleford Medical Clinic) 7/16/2007 6:47 PM

    Kishore, your latest entry was refreshing. I plan to play the "switch" game myself. Keep up the excellent entries. I appreciate your effort.

  3. Originally posted by Eleanor 10/11/07 11:40 AM

    I am a 36 year old woman who has been self cathing for one year. I do not live in Saskatoon. After reading your blog, I'm in tears over the fact that I don't. I read your *SWITCH* posting. I am just now able to calm myself enough to type after a good cry. The comment about Mr Jones blood in his urine really affected me. I had my first 4 days of very bloody urine output due to a severe infection this past summer. My husband took me into the Moose Jaw ER because we had only come across that amount of blood once before - when my best friends kidneys shut down the weekend she died from cervical cancer. Needless to say I was panicked. Well there was no learning experience there. I was yelled at and treated awful. It took over 4 hours to be told I had an infection, we had no idea what was going on.

    Dr V, you sound like a very compassionate man. I hope your idea of how to run things more smoothly, therefore getting more patients seen/the correct treatment is needed.

    I have a neurogenic bladder according to urodynamics done in Saskatoon (and yes those trips are hell! I have a chiari malformation and tethered cord dx in the States - but my spinal cord is perfect according to Canadian NSG's. ) So I think your wanting to make the most of those appointments is the way to go - I feel the same myself. Just traveling there is hell on me. If I'm going there - it better be worth it.

    From what I've read on here, your ideas are great ! I wish more physicians were as open minded as you and willing to want to make things run smooth and try to HELP the patient. Could be I've just been turned bitter over lack of help for my personal medical care in Canada, but you, your 'A' ok !

    I wish you the best Dr V !

  4. Originally posted by Dan Florizone (CEO, Five Hills Health Region) 10/19/2007 9:13 AM

    I would like to follow-up with Eleanor who described her experience in Moose Jaw. It would be very helpful if she could call our quality of care coordinator at 694-0294 (or toll free at 1-888-425-1111). We are very interested in following up. By posting this note - I am hoping that she may follow-up - so that we can learn from her experience.