“Blessed is he who expects nothing, for he shall never be disappointed.” -Alexander Pope
Expectations are a funny thing. You aren’t even aware that you have them, until the disappointment of them not being met hits you squarely in the face. When it comes to any experience in life, expectations come into play, but perhaps never so much as with interactions and procedures in healthcare.
Before an important medical consult, as a patient we think about what might happen, what might we need for testing and treatment, what will be our prognosis? Will we need surgery? How painful will it be? How long will I be in the hospital? How much school or work will I miss? So many questions that help shape our expectations for not only future care, but our life after that care has been delivered.
I will never forget one of my earliest experiences with healthcare. I was a healthy kid, so not unlike most people, my first real experience with any serious medical procedure was getting my wisdom teeth pulled. Unlike most people, by the time I was told my two wisdom teeth needed to be pulled, I was 24 years old, already a physical therapist practicing myself on my very own health insurance. And the teeth were already fully erupted, useable teeth, but unfortunately, became infected easily. So I was told to visit the special type of dentist that did this type of work called a periodontist.
The specialist was very quick in his assessment of my situation. He could pull them quickly and easily right in his office, with just some nitrous oxide sitting in the dentist chair. That was it. That was the explanation. I set it up for a Thursday after lunch, planning to return to work the following Monday. No Big Deal.
Fast forward to my appointment. Just in case, in preparation I ran this procedure by one of my best friends who happened to be a dental hygienist. She tried to tell me another story, that perhaps this was a big deal. She filled me in on all the things I should and should not do afterward to avoid complications, namely dry sockets. Things I should eat and drink and to avoid straws. But because the dentist had made it all seem so benign, I didn’t even think to purchase any of the special foods to numb my empty gums before the procedure. Why waste good work time on shopping when I could be treating patients, right?!
I recall sitting in the dentist chair, and the assistant setting me up with laughing gas. Now mind you, I had never had nitrous oxide before. So I was focusing on breathing it all in, thinking that’s what I was supposed to be doing when she put the mask on my face. Then I started getting very lightheaded a couple of minutes later, so I told the nurse when she came back in the room. She laughed and said I didn’t need to be breathing it in so hardcore, that a little room air mixed in would help. So I breathed outside of the mask, only to panic when suddenly the periodontist walked in the room, and I realized I didn’t have any more nitrous oxide in my system. I gulped in the gas as quickly as I could, suddenly wishing I was very lightheaded again, and there was little time to get there as he was ready to begin. The periodontist took my head in what was essentially a headlock, and spent what seemed like minutes yanking on my teeth one at a time, cracking them into pieces to remove them more easily. He must have seen the look of terror in my eyes as he violently manipulated my teeth with his pliers, my wide eyes silently yelling for help to rescue me from the pain and horror I was experiencing from my headlocked position. The periodontist must have read my silent plea for mercy as he told me, “God didn’t put these teeth in there just to fall right out.” The nitrous oxide must have been kicking in strong at that moment, as I spent the remaining minutes in the headlock considering the very deep and profound thought he had just uttered.
Then the teeth were gone, and I was released from the headlock. Easy peasy, right? Time to drive myself home. I stopped at the grocery store on the way home to get the applesauce, jello, and pudding I had been advised to purchase. Once home, I packed for the upcoming three day weekend and trip to Eau Claire I had planned to visit my brother and his family to attend my preschooler nephew Coby’s little kid birthday party.
When I crawled into bed that night, my teeth and gums were feeling sore and swollen. My cheeks were puffy, and no matter how much jello I ate and Tylenol I swallowed, the pain really never went away. Lying flat in bed made it all so much worse, as now I was gagging on blood and crud dripping down the back of my throat. Gross! Not sure if I slept at all that night.
Undaunted, I got up in the morning and followed through on my plans to drive 3 hours away to visit my family. It wasn’t until my sister-in-law said something about my chipmunk cheeks that I looked in the mirror and noticed just how awful I looked all puffy and bruised. Nonetheless, I helped my sister-in-law wrangle a house and yard full of preschoolers, to help make Coby’s 4-year-old birthday party a fun one. It was another rough couple of nights of sleeping, but somehow I made it through the rest of the weekend.
When I returned home Sunday evening, I checked the messages on my answering machine. There was one from the nurse at the periodontist’s office, calling the day after the procedure to check on me and see how I was doing. How was I doing? I was incredulous. They had made it seem like it was a walk in the park. Like a teeth cleaning. And now I had bags under my eyes, a never-ending ache in my jaw, and no doubt my patients on Monday were going to laugh at my purple and blue, chipmunk cheeks that didn’t disappear no matter how many times I iced them. And lying down to sleep that night, I was still gagging on the gross bloody strings hanging down the back of my throat. Had I known they would call me the very next day to check on how I was doing, I wouldn’t have even made the trip to my nephew’s party. Was I not supposed to do that? Was I supposed to just stay home and rest? Sleep in a recliner to help recover? Why didn’t I know this before?
And then it hit me. It was all about expectations. The periodontist and his office staff had made the whole thing seem like it would be easy. Pain-free. Problem-free. And perhaps to them, compared to a surgery to remove unerupted wisdom teeth, it was. But to a 24-year-old who had never had any medical procedures in her lifetime to date, it was a major pain-inducing, drainage-producing, sleep-depriving, looks-diminishing, very big deal! I wish I would have known, so I could have approached it differently, whether only in my mind, or perhaps slowing down and resting instead of traveling across the state immediately after.
It's been over two decades since that very first healthcare procedure, but I still remember it like it was yesterday. It taught me a valuable lesson about the importance of setting accurate and appropriate expectations for my patients, so they are more comfortable with the care I provide and not feel surprised by any pain or side effects that might accompany that care. Communicating expectations in healthcare helps patients feel safe and secure, the stepping stones to a solid, trusting relationship with their medical providers. Patients remember more about HOW their healthcare experience made them feel in its delivery than what type of care or procedure they had completed. Thoughtfully delivered care focused on the patient experience is where healing begins. And it all begins with expectations.
Jill Murphy is a Doctor of Physical Therapy and founder of MotionWorks Physical Therapy and an advocate for patient-centered care. A Christian wife and mother of three, she survived a seven year journey through the broken American healthcare system in search for an answer to a heart arrhythmia that appeared during pregnancy. A stroke, open heart surgery for constrictive pericarditis, and several other complications and surgeries later, Jill is telling her story of unfailing resilience in her upcoming book, Doctor Heal Thyself. Having grown up on a dairy farm 40 minutes from Lambeau Field, Jill is an avid Green Bay Packers and Wisconsin Badgers fan, and is up for any outdoor activity with her three children including throwing the football around, hiking in scenic locales, gardening, and coaching a middle school basketball game or two.