Category Archives: physician

Legacy of the Rental Crisis

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Many thanks to all who expressed support and encouragement after my last post—this community continues to amaze me with its welcoming and generous spirit! Now that I’ve had time to reflect some more on the events of last week, I have clarity that I lacked before. Funny how crises lead to growth.

First, I regret that I resorted to name-calling when describing the previous tenant. ‘Renter from Hell’ and ‘Lucifer’ certainly represent how I felt about him, and still feel, from my judging self. But really, I don’t know him. I can’t say that he is truly evil. I can judge his actions as rude and inconsiderate, to say the least, but making sweeping claims about his character and shaming him publicly, even if anonymously, does not reflect my highest values. It would be fair to say that I was emotionally hijacked for a few days, fuming over how he desecrated my home. And we all know that we should not hit ‘Send,’ or ‘Publish,’ in that state of mind. Lesson learned.

If you have not watched Simon Sinek’s TED talks on leadership, or read his books, Start With Why and Leaders Eat Last, I highly recommend them. He is my new author-hero, sharing the golden bookshelf with Benjamin Zander and Rosamund Stone Zander, authors of my first favorite book, The Art of Possibility. Briefly, Sinek posits that leaders attract followers, and companies attract customers, when they are clear about their ‘why.’ In other words, they discern and exude their central purpose, their raison d’etre. When this is the case, the things they do, their whats, extend directly from the center where their core values live, and serve as tangible evidence for their why. He uses Apple as an example. We may think of Apple as a computer company, but Sinek asserts Apple’s why as ‘challenging the status quo.’ They revolutionized the computer industry with the graphic user interface, the music industry with ‘1000 songs in your pocket’ on your iPod, and the phone industry by dictating to the mobile phone carriers what the iPhone could do, rather than accepting the conventional, opposite practice. Computers, music devices, and phones, Sinek says, are Apple’s whats. They are the outputs of their why, and though disparate products, all align with Apple’s core values. Making great computers and phones is not an inspiring why. Challenging the status quo is. And people for whom that message resonates are the ones who will camp out overnight to be the first to get the next Apple product. They feel connected to the company and show loyalty.

For years now, I have used the phrase, “Live your best life every day” as a mantra in my work. This is what I aim to help people do, however they define it, and however they can achieve it. It’s my job to support them in their personal journeys. I try hard to apply it to myself, as well—what does my best life look like today? Best workdays in Chicago look very different from best vacation days in Colorado, and each day can be affected by myriad external and internal variables. But I find that when I can approach life in this way, newly open to possibility each morning, I feel liberated. I am free to redefine my best self, best day, best life, over and again. [You should know, however, that it is a constant struggle and I fall miserably short of this potential most days. But it’s a good practice to continue, and I think I’m getting better over time.] I started my career in a conventional primary care office. I spent five years in an integrative medicine practice, and now I do executive physicals and some concierge medicine. For a while I had a hard time reconciling this last step—it feels a little elitist and contrary to my usual liberal sensibilities. After digesting the Start With Why philosophy, though, I can confidently say that what I do now is entirely consistent with my core values.

Today I stand decisively at the intersection of Leadership and Health. My patients are leaders of their organizations, and it is my job to help them take care of themselves. Why? So they can better care for those they lead. By helping them live their best lives every day, they will role model this to their colleagues and staff, and empower those around them to do the same. How do I do this? By taking the time to know each patient as an individual, understanding their personal goals and aspirations. I collect objective data about their health and offer personalized recommendations, based on what I know aligns with their values. Today I happen to do it through executive physicals, but it’s what I have always done. I give presentations to colleagues on physician resilience, and I lead educational initiatives aimed at advancing professionalism and collaboration. This is my why—live my best life every day, and help others do the same, through our relationships.

Now I know how I must approach my rental property. It cannot be just another way to make money. It must be another what to my why. My reasons for keeping it must be consistent with my values and goals as a person, which must be the same as my goals as a physician, friend, spouse, parent, and landlord. Renting my home to a tenant is my contribution to their journey of self-actualization! Go ahead, laugh–it sounds completely whacky! And yet, approaching it this way clarifies all of my decisions and actions. As a landlord with the tenants’ best interests at heart, rather than simply calculating costs versus income, I will move swiftly and easily to repair or replace degenerating appliances and fixtures. I will take an interest in the tenants’ lives and check in with them frequently. I will monitor the upkeep of my property not just for myself, but for them. I will build the kind of trusting relationship that fulfills me in every other aspect of my life. The yield, I hope, will come in the form of respect and appreciation from the tenants, expressed in loving care of my home. You could see it as a manipulation, guilting them into cleaning up after themselves, I suppose. But it doesn’t feel like that. I know now that I want honestly to connect with my renters, to feel good about our relationship. Actions taken out of true caring are very different from mere transactions, and everybody feels it.

Before this last tenant, I never experienced this kind of drama and anguish over the apartment. But looking back, something about my relationships with renters felt distant and awkward, not like my other relationships. Now I know why, and it has to change. I have to be me in everything I do, including this. Some people will not want it. They will feel uncomfortable and see me as nosy and prying. Some patients don’t want a personal relationship with their doctor, either—they just want to have their cholesterol tested and their medications prescribed on time. I would not be a good fit for either of these groups, and the good news is they are free to not rent my home or choose me as their doctor. “People don’t buy what you do, they buy why you do it,” Simon Sinek says over and over. “The goal is to do business with the people who believe what you believe, not just the people who need what you have.” This sounds familiar: Seek the fellow lone nuts, the early adopters, the ones with whom my why resonates. If I can do that, no matter what happens, I can make a positive difference in the world, and attain peace for myself.

Who Are You and Why Have You Come?

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Is that a line from a movie?  No, it’s assignment #4 for Blogging 101, “Identify Your Audience: Publish a post you’d like your ideal audience member to read, and include a new-to-you element in it.”  Okay, here goes!

Welcome back, how was your week?  What phenomenal doctor-patient encounters did you experience, witness, or hear about since we last met?  What made them so?  Or maybe they were less than stellar…  I wouldn’t be surprised, unfortunately.  What made them so, and what can be done to make them better?

If you think the physician-patient relationship plays an essential role in our healthcare system and patients’ overall wellness, please read on.  If you think this relationship also plays a central role in physician wellness, welcome!  So do I.  Maybe you are a physician.  Most likely you have been a patient, or a patient’s family member, somewhere along the way.  I know you could be both.  It doesn’t matter, if you think the physician-patient relationship is important, and you want to help make it better for yourself and others, then I’m writing to you!

For a moment, think of our healthcare system as a vast, dense forest on a dark, moonless night.  It’s early fall in the Rockies, crisp and chilly tonight.  You are either the physician or the patient, and you are here alone, tasked with finding your counterpart, somewhere else in the forest.  Maybe you’ve never been here before, and you’re scared.  You’ve only heard about it, or walked through in virtual simulations.  Maybe you’ve hiked here many times already, and feel quite confident–cocky, even.  But every encounter in this forest is unique.  Insurance plans, drug formularies, government regulations, and technology can alter the topography like lightning strikes and wildfires–and almost as quickly.

The objective is to find your way to each other, and then journey together to the place in the forest where at least the patient can camp in health.  If you really work well together, then the doctor will also find solace in that spot.  What would that look like?  What will you need?

You’ll need to identify dangers in the forest–most of which you cannot control.  They will affect you both in different ways, and it will help if you know the potential consequences ahead of time, for yourself as well as the other.  You’ll need to learn each other’s strengths, vulnerabilities, tendencies, and talents.  You’ll need to know your own needs and limits, and those of your partner.  And wouldn’t it be great if you had a map and a plan?

I have just described the ideal physician-patient relationship.  How can we do all of this?  With tools, I say!  We would never enter a forest to camp at night without the appropriate gear.  So why do we so often enter the physician-patient relationship in this way?  Until very recently, physicians received almost no formal training on effective communication and interpersonal skills.  I think we were expected either to be thusly gifted by virtue of being smart enough to get into medical school, or to ‘pick it up’ along the way.  I also think patients’ expectations today vary so widely based on personal experience and circumstances, that sometimes it’s a miracle that we understand each other at all.

The tools I explore in this blog–mindfulness, compassion, empathy, reflective listening, patience, self-awareness, stress-management, collaboration, and others—are intended for patient and physician campers alike, but only the ones truly interested in achieving the objective above—finding one another, walking together, and finding the best place for both parties to set up camp and stay a while.

I seek fellow campers! Tell me your stories! Show me the tools that work for you! What have you learned? What advice have you for our frightened novices or frustrated (disillusioned, burned out, cynical) elders? Let us find one another, clear our own authentic spaces in the dark forest, and build our campsites intentionally, deliberately, with respect for one another and the forest ecosystem. Once we have our eco-friendly doctor-patient camps firmly established, maybe we can start to clean up the litter and pollution in the forest, too—but that might be another blog…

Closing the Satisfaction Gap

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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.