Tag Archives: physican

The Soft Stuff Matters

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Blogging 101, Assignment #9: Write a post that builds on one of the comments you left yesterday.

It’s from today, but I think it still counts.

If you have not already visited Catching My Drift by Pam Kirst, I highly recommend it. This morning, when I should have been preparing more diligently for my noontime presentation, I found myself drawn into and reflecting on her story, “A Wheel That Never Squeaks.” A college administrator puts together a series of student panels to help faculty address the unique needs of certain groups, such as single moms and students with autism. An advisor asks her to arrange a session for returning veterans, and the story unfolds as she learns from three veteran students about how their military experiences influence their campus lives. One cannot stand the disrespect that a professor tolerates from a fellow student. Another feels a sense of urgency to earn his degree so he may once again serve as breadwinner for his family. The third looks more like a hippie than a soldier, with a long ponytail and body piercings.

Some lines that grabbed me:

“The message was always the same: We want to help our students succeed.  We are not going to dumb it down for anyone, but we do want to work with unique situations.”

“Lesson number one, she thought to herself.  Lose the stereotype of what I think a returning veteran looks like.”

“Did you notice they all sat facing the door?  Returning veterans find it very hard to sit with their backs to a door–it goes against all their training.”

I encourage you to read the whole story, if you haven’t already. For me, it brought multiple aspects of physicians’ work into specific relief.

My comment:  “I’m getting ready to present today on physician burnout and resilience. Continuing education at this hospital occurs every Monday around lunch. Wouldn’t it be great if every month or so, one of those sessions were devoted to some humanist aspect of practice? Who are our patients? What are they dealing with outside of their medical problems? How can we best serve them? And holy cow, what would a panel of patients say to an audience of doctors??”

I have given versions of my burnout/resilience talk three times before today, each time to a different audience. Today was in a community hospital, to about 20 or so primary care physicians and some subspecialists. It was their weekly noon conference, with hot food provided. As the doctors trickled into the basement conference room, we spoke casually about burnout—so much regulation, administrative red tape, stress. Suicide came up–one doctor mentioned that he himself knew three doctors who all took their own lives. When I asked the Continuing Medical Education coordinator how often they have a presentation on non-clinical topics, she said maybe once or twice a year. Does this surprise you?

The breadth and depth of medical knowledge grows exponentially these days. Even in subspecialties, physicians must work harder to keep up with updated guidelines, new technologies, and patient expectations. So it makes sense that ‘continuing education’ would center around the ‘hard’ stuff—clinical knowledge and practice.

But what about the ‘soft’ stuff? Do we assume that all physicians just know how to manage their relationships with patients, staff, and colleagues? With themselves? That they practice optimal strategies for maintaining their own well-being, in this complex and demanding healthcare environment?

At first I thought of practicing physicians as the faculty in the college story, in need of learning how better to connect with their diverse patients. I want to go to grand rounds and hear from a panel of patients with autism about their experience in our healthcare system. I want a case manager to show me the resources available for my patients whose insurance does not cover mental health services. I want to connect with my colleagues in other specialties, learn how I can best prepare my patients to see them in consultation, and know the rationale behind their decisions. I see my own presentation as an attempt to fill this gap, inviting my colleagues to consider ways they can take charge of their own happiness at work.

On further reflection, I see my colleagues also as the returning veteran students. In the story, they are the ‘wheels that never squeak.’ Their training and mindset preclude them from complaining, even while they feel severe discomfort in their classroom surroundings. Similarly, many physicians experience great distress at work but don’t let on. For most of us, effective self-care is never role modeled in our training, let alone explicitly taught. If we express fatigue, sadness, or feeling overwhelmed, we are often shamed as being weak, rather than encouraged and shown how to overcome these challenges. Some of us become the ‘non-squeaking wheel,’ with deadly consequences. The suicide rate for physicians is estimated to be 1.4 to 4 times greater than the general population.

“The message was always the same: We want to help our students succeed.  We are not going to dumb it down for anyone, but we do want to work with unique situations.”  When we sanction conversations and conferences around the soft stuff, we validate its importance. We want our patients to succeed by helping them understand their illnesses and treatments. We want our physicians to succeed by giving them the tools to communicate and connect effectively with patients. This serves everybody; it’s a win-win.

“Lesson number one, she thought to herself.  Lose the stereotype of what I think a returning veteran looks like.”  Let’s lose the stereotype of the bullet-proof physician, the one who helps all others and never needs help herself. Let’s lose the stereotype of the lazy patient, who cares less about his health than his doctor does. Let’s find ways to know each other’s challenges, and see one another as individuals who deserve our full attention and honest caring.

“Did you notice they all sat facing the door?  Returning veterans find it very hard to sit with their backs to a door–it goes against all their training.” What do we need to notice about one another? What details do we miss in our daily routines that, if we knew, could help us connect and heal one another?

Thank you, Pam, for giving me more to ponder. I hope I can contribute to these conversations and make our system function better for both patients and doctors.

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.