Patient care: First and last impressions make the difference

Positive beginning and ending patient interactions fall into the “serial positioning effect” and can boost patient care reviews


By Steve Wirth, Esq., EMT-P

There’s an exercise often used as a mental demonstration at leadership conferences and similar gatherings. In this exercise, one person will rapidly list 20 random numbers, then ask the audience to repeat back as many numbers as they can remember. What numbers are the listeners most likely to repeat back? The first and the last numbers are the ones most commonly remembered.

This exercise illustrates the serial positioning effect – the tendency of a person to recall the first and last items in a series best; the items in the middle are not remembered nearly as often. Our brains tend to compartmentalize events into discrete experiences and rely on “cognitive bias” to remember them. The ability to recall items in the beginning of an experience is called the “primacy effect” and the ability to recall items at the end of an experience is called the “recency effect.”

From a risk management standpoint, if you make a good first and last impression, the benefit is that the patient may forget some of the less-pleasant experiences in the middle of the incident. (Photo/Flickr)
From a risk management standpoint, if you make a good first and last impression, the benefit is that the patient may forget some of the less-pleasant experiences in the middle of the incident. (Photo/Flickr)

In other words, we tend to be better at remembering the details that occurred at the beginning and end of past events – whether it be a vacation trip, a weekend getaway, a one-hour meeting or a one-hour interaction with a patient on a transport.  

Positive patient care

How does this effect relate to patient care and reducing your risk of a patient complaint or lawsuit? You can use the serial positioning effect to your advantage by making a good first impression and a good last impression with your patient. This can help increase the likelihood of patient satisfaction and decrease the frequency of dissatisfaction.

From a risk management standpoint, if you make a good first and last impression, the benefit is that the patient may forget some of the less-pleasant experiences in the middle of the incident, such as difficulty placing an IV, if you are nice to them up front and at the end of the experience.

Patient impressions

In the beginning of the patient experience, the first 30 seconds are the most important. That is when the patient is going to decide whether he or she believes you to be a competent and caring EMS practitioner. These early seconds set the stage for the rest of the encounter. Make a positive physical approach to the patient with affirmative body language – smiling, extending your hand in greeting – and use active listening skills as you introduce yourself and ask the patient what is troubling them today. Starting off on the “right foot” with the patient can make the rest of the experience go much smoother.

At the end of the patient encounter, you also want to leave on a high note. Without shoving a clipboard in the patient’s face, simply walk into the patient’s room look the patient in the eye and say with sincerity that it was a pleasure serving them today and that you hope they feel better and that they are in good hands.

This is when the patient is likely to smile back at you and thank you for what you did for them. This expression of gratitude from the patient back to the caregiver makes us feel good and motivates us to want do an even better job the next time. This conveyance of gratitude also releases endorphins in our brain that make us feel good about ourselves, and helps reduce stress.

The importance of positive patient care to EMS agencies

Of course we should be on our game 100 percent of the time in every patient encounter. The reality is that doesn’t always happen; things don’t always go smoothly. But setting the stage with a good, positive introduction and leaving with a pleasant ending to the encounter can go a long way toward improving the patient’s experience – even if things go a bit bad in the middle. This positive face at the outset and being kind and caring at the end of the encounter can lead to compliments and appreciation and, as a side benefit, a reduction in the number of complaints or lawsuits against you and your EMS agency.

Remember, patients generally do not sue you if they like you, even if you make a mistake or commit negligence. In this impersonal world of constantly looking down and interacting with our smart phones rather than the human beings around us, it is important to remember that we are in a high-touch profession. Patients expect us to treat them with care, compassion, and competence – the three Cs – at the outset.  They want us to look them in the eye and treat them as if they are our only priority – as they should be. Applying the serial positioning effect to our everyday patient encounters can help us improve the patient’s experience with us.

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