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Because every patient's journey through the emergency department (ED) involves a series of service transitions from one area to another and from one person to another, there are predictable interactions among patients and staff. The concept of scripting the interaction with the patient simply anticipates these interactions and seeks to provide specific words or phrases to effectively address issues and improve the interaction with the patients and their families. Scripting is evidence based because it relies on verbal skills which have been shown through long experience to reliably and predictably manage the service transitions and interactions in a positive fashion by prospectively managing patient and family perceptions of care. Just as an evidence-based approach is widely used in clinical settings, scripts allow clinicians to benefit from decades of experience with patients to guide our language skills.1

The American Association of Medical Colleges (AAMC) is responsible for designing and administering the Medical College Admissions Test (MCAT). In an effort to better prepare future physicians to work in a reformed healthcare system in which patient satisfaction is highly valued, the MCAT 2015 Project has added an entire section on social and behavioral aspects of care. The AAMC recognizes the importance of sociocultural and behavioral determinants, including communication skills, in the successful practice of medicine. Beginning in 2016 and culminating with the graduation class of 2020, all medical students will be educated in a system in which communication skills are highly valued.2


For several reasons, many staff members may initially resist the concept of “scripts.” Most healthcare workers believe that the care that they provide is excellent. For those colleagues, it may be helpful to remind them of the difference between the care that they provide, which may be excellent, and the patients' perceptions of caring. Further, professionals perceive it as demeaning to be told what to say. They may assert that a sophisticated healthcare worker is not an actor on stage, who just “parrots” words in response to certain cues.

While many may initially state that scripts are objectionable, all will admit that the dictates of culture lead everyone to use scripts on a daily basis and even teach these scripts to children. These routine phrases in response to certain interactions conform to societal expectations and allow communications to occur easily and habitually. Table 11-1 gives several examples of typical key phrases that are learned as children and then used throughout life.

Table 11-1 Common Phrases (“Scripts”) Used Everyday

Another form of resistance occurs when professionals are encouraged to take responsibility and advocate for patients and then are ...

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