Gratitude, Generosity and Peace

How does gratitude serve you? When someone expresses thanks to you, how do you feel? When you feel genuinely grateful to someone, what do you do?

Recently Dan Rockwell posted on his blog, Leadership Freak, on gratitude. He writes:

“Ungratefulness spoils everything it touches.

“Ungratefulness slithers out of a black muck that’s called, ‘don’t like,’ ‘don’t want,’ ‘don’t have,’ and, ‘not enough.’  There is no positive side to the slimy beast of ungratefulness.”

This post reconnected some dots for me between gratitude and generosity.

When I feel grateful, there is enough. I am enough. Even just saying the word, seeing it on the screen, brings me to a more peaceful state of mind and body. It brings to mind the people in my life—my parents, husband, children, friends, colleagues. I recall instances when someone went above and beyond to help me, or when they thought of me and took to the time to call or write. I feel humble. I feel connected.  I want to share what I have with others.

Maybe it was seeing the words of ungratefulness, ‘not enough.’ It reminded me of my favorite book, The Art of Possibility, by Rosamund Stone Zander and Benjamin Zander. The authors make a distinction between scarcity and scarcity thinking. Scarcity is when there actually aren’t enough resources to meet everybody’s needs; scarcity thinking is operating as if this were the case, when it really isn’t. Scarcity thinking at its best may foster healthy competition and innovation, and at worst, aggression, indifference, or even violence. In contrast, the Zanders discuss the notion of abundance. If we lived and operated in a world we assumed to be abundant, or at least enough for our needs, what would that look like?

For example, the woman parked down the street does not have enough coins to feed the meter. She asks me if I have change for a dollar. If money between us were actually scarce, then it would make sense to have an equal transaction—she gives me her dollar bill, I give her four quarters. In a world where we each need to look out for our own, we cannot afford to give anything away for free. But that is scarcity thinking, because I have spare change. Sure, I could spend those quarters to buy a candy bar later; or instead, I could trade them for human connection. If I stop even briefly to think about it, I know which one is the higher value purchase. But it’s not about buying gratitude from someone else.   It’s about the origin of generosity.

That peace that comes with thankfulness is the antithesis of scarcity. When I needed coins for my meter, and a stranger gives me her spare change, it shows me that there is good in the world. I can seek the help of strangers and they will offer it. And if that’s the case, how much more wonderful when I think of my amazing tribe of friends and family who stand ready to hold me up, as I do them? I feel safe. There is enough. So I can give away what I have today, because I know I will get what I need tomorrow, or whenever I need it.

When we practice gratitude, we practice peace. We exude it. It manifests in our expressions and actions. Gratitude makes us creative, by lifting the need to hoard and compete. We come together, collaborate, look for our common passions and visions. We offer more of ourselves to others because we have faith that they will do the same. We know because they did it before—that is why we are grateful.

For a much more eloquent and important view on gratitude, please read David Brooks’s most recent op-ed: http://www.nytimes.com/2015/07/28/opinion/david-brooks-the-structure-of-gratitude.html

Physicians and Journalism: Responsibly Meeting the Challenge

An excellent discussion of the importance of physicians’ mindfulness. Our words and actions matter, often more than we know, in and out of the exam room. It is the contract of responsibility that we signed when we took the oath of caring.

Dr. Kevin Campbell, MD

As a physician journalist I find myself in a very fortunate and quite unique position—I am able to reach vast numbers of Americans on a daily basis and provide them with credible (and hopefully impactful) news on health and wellness. Medical journalism is similar to the practice of medicine in that we must put the PATIENT first. Just as physicians provide patients with information they need to better understand their disease state and treatment options in a clinical interaction, physician journalists must carefully choose their words when on camera or quoted in print. In a clinical situation, there is time for questions and two-way interaction between doctor and patient. In contrast, medical reporting in broadcast media is a very different situation–there is no opportunity for patient interaction and what is said MUST be something that will stimulate further conversation between viewers and their OWN private physicians. Statements must be clear…

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Closing the Satisfaction Gap

Speak the words “patient satisfaction” to any physician these days and stand back.  At best you may get an eye roll and/or an expression of disgruntled resignation;  at worst you may unleash a full-on rant about patient entitlement and how ludicrous it feels to be rated in the same way as servers at a restaurant.  Patient satisfaction survey data drives operational decisions in healthcare organizations across the country, for better or worse.  But what do these surveys mean for the patient-physician relationship?

What goes through your mind when you receive a patient satisfaction survey?

What moves you to fill in the dots, write comments, and then submit it?

What result do you expect from your response?

Do you think of it as communicating with the physician him/herself?

Or are you giving feedback to the organization as a whole?

Would you say to the doctor’s or the staff’s face the things you write in the survey comments?

Do you include your name?

Clearly we doctors feel great when someone writes, “She’s fantastic, I love her!” and “She always makes me feel comfortable and I feel like she really cares.”  Conversely, it’s very upsetting when we get “He’s a terrible doctor,” and “He doesn’t listen and makes me feel bad about myself.”  If someone said the latter about you, what would you think?  One of my first questions would be, ‘What do I do to make you feel that way?’  It’s relevant to both positive and negative feedback.  What do I do that makes you feel comfortable, and communicates caring?  What do I do that causes you to feel shame?  Consider this story:

Dr. Kairselott’s patients consistently wrote on their surveys that they felt rushed when seeing her.  This baffled her, because she prided herself on taking time with patients, looking them in the eye instead of staring at her notes, and making sure she came to each encounter thoughtfully.  Her superiors thought it odd as well, because they knew her to be a compassionate and dedicated physician.  But they felt they had to act on the data, and so admonished her to do better—take more time, don’t just hand the patients a prescription.  Dr. K felt indignant.  Her bosses were not in the room with her, they didn’t see how much she really engaged and attended to her patients’ needs.  She felt attacked, demoralized, and invisible.  She worried that if her patient satisfaction scores remained low, her income and reputation would suffer, and she felt powerless to change it.  What were these patients talking about?  Finally, one of them wrote:

“I really like Dr. Kairselott, but I feel rushed during my visits.  She’s always tapping her fingers on the desk, and it makes me feel like she wants me to talk faster, get to the point.  I end up not saying everything I want to say because I feel like she just wants to get out of the room.”

This patient gave Dr. K the best possible feedback: An objective observation about a behavior, her subjective interpretation of it, and its consequence for their relationship.  This is how we communicate evaluations to medical students on their performance in clinical rotations.  There is no reason why it should stop at the end of training; it’s just that the evaluators have changed.

Dr. K knew about her finger tapping habit, but had no idea of its effect on her patients.  It made sense, and she felt validated—she was, in fact, doing things right, and after gaining this new insight, she could take action to improve her patients’ experiences, and thereby her relationships with them.

Feedback can go both ways, too.  If I sense a patient disengaging, I can point out that his posture is turned away from me, he is not looking into my eyes, and his brow is furrowed.  I can tell him that I feel he does not trust me.  I can invite him to tell me what he’s thinking in the moment, and open the door to clearer communication.  Sometimes he will accept the invitation, other times not, and our relationship will proceed according to the path we choose to take together.

Medicine is more than a business; physicians are more than shop owners who want return customers.  When patients and physicians alike can approach patient satisfaction surveys as an opportunity to improve our relationships, rather than a forum to simply compliment or complain, then the surveys will truly fulfill their highest purpose.

Help Me, Help You

When I am at my best, it’s a win-win.  I am present, attentive, and actively listening.  I am patient, cheerful, relaxed.  I am less judgmental, and more likely to acknowledge the things you already do to help yourself.  Not only do I hear what you say; I see and hear how you feel, and you know it.

When I am at my best, we feel connected.  You feel safe to reveal things to me that you might not if I were less than my best.  Then I get to know you—what you value, what you fear, and what you need from me.  I know better what questions to ask, and you can answer honestly.  My diagnosis is more accurate, my treatment plan more relevant.  You feel more comfortable asking questions.  We both leave the visit satisfied and fulfilled.

So what do I need to be at my best?  I need to take care of myself first: eat healthy, exercise, get enough sleep, manage my stress, and nurture my relationships.  If we consider each of these a bucket, then the ideal is to keep each bucket mostly full all the time.  How is that possible?  That is up to me.  I need to practice what I preach—a tall order!  It can lead to perfectionism, self-judgment, disappointment, and burnout.  It’s my responsibility to manage myself.

How could you help me be my best?  After all, you have a stake (and a hand) in how I show up.  Have you thought about this already?

What assumptions do you make about me?

How do those assumptions affect your body language, what information you give me, and how you perceive my words and recommendations?

What assumptions can you make about me that would maximize your chances of getting what you need?

I respectfully request that you consider the following about me, your physician:

  • I try my best to walk the talk. I know how hard it is.
  • Every day I bring all that I have to work, to do my best for you.
  • Some days (weeks, months, years) I have more than others, depending on what else is going on in my life.
  • I will make mistakes, and it’s not because I don’t care.
  • I know it’s my job to help you.
  • I need your help to do it.

When you feel that disconnect, like I have left Best Me somewhere else and you’re not getting what you need, what will you do?  Will you yell and storm away? Smile to my face and then write a scathing, anonymous Yelp review? What would you do if I were your spouse, colleague, friend, or child? You and I are in a relationship, not unlike these. Could you patiently, lovingly, ask me to slow down, take a deep breath, and be with you now? I think I would respond very well to that.

Guest Post from Fiona Scott, MD-To-Be

“There is immense power in showing love and support to others in our profession. Sometimes it’s the most powerful thing we can do and sometimes it’s the only thing we can do.”
Insightful piece by Fiona Scott, second year medical student.

MyWhiteCoatIsOnFire

So recently I was approached by a medical student asking if she could guest post on my blog about burnout.  I was more than happy to take her up on her offer, and not just because it has been WAY too long since I have blogged and her timing could not have been more perfect.  It’s easy to forget that physicians in training are not in any way immune from burnout and compassion fatigue that affects so many of us out in clinical practice.  Fiona shared with me that she had recently lost a classmate to suicide – something I unfortunately also experienced during my training when one of my fellow medical students killed himself during our first year.  If anything, the pressures and difficulties have only seemed to have grown during the time between my and Fiona’s training.

I welcome Fiona’s piece on her experiences so far during medical…

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