Tag Archives: relationship

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…

Gratitude, Generosity and Peace

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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

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.