Doctors Coaching Doctors – Helane Fronek, MD Coaching and Consulting | love being a doctor again

Medicine by Committee – physicians and patients creating solutions together

Posted on June 21, 2014 by Helane Fronek

I recently filled in for a friend who teaches at a medical school. The curriculum that day focused on professional ethics and the power differential that usually exists between us and our patients. One student asked if physicians needed to maintain the relative power in order to be most effective.

After all, she reasoned, we have information that we want our patients to accept and recommendations that we want them to follow. Doesn’t that happen more efficiently when we are perceived as more learned, or more powerful than our patients?

Physicians are considered to be experts. And in many ways, we are. We usually know more about our patients’ conditions and proven ways to treat them effectively than patients do. But there are things that our patients are more expert at – their bodies, their minds and their lives. Medical care is actually best delivered not by an “expert” who sits on a pedestal, but by a committee or a partnership in which each of us, including our patient, brings what we know to be true in order to fashion a plan that incorporates medical advances and the realities of our patients’ lives.

Most of my patients with symptomatic varicose veins will feel better if they wear compression stockings and exercise regularly. If I simply tell them that, my success rate in getting patients to use these two interventions is less than 10%. Very few patients are excited to wear compression stockings – they are hot and hard to put on. And many people associate exercise with discomfort, inconvenience, and yet another thing to fit into their already-too-busy lives. By briefly explaining why these two interventions will help and then asking why they might not want to implement them or what challenges they might experience, I can facilitate a discussion that will allow my patients to find ways of incorporating my recommendations.

The solutions are frequently simple and engage people in taking greater control over their lives. Sometimes, they even offer additional benefits. One patient realized the only convenient time she had to exercise was at lunch. She invited a co-worker to walk with her and not only got some exercise but built a close relationship as well. Another patient was reluctant to wear compression stockings because she found them hard to take off. She asked her husband, whose health was waning, to help her pull them off every day. By doing that, she gave her husband a role in caring for her that helped balance his increasing dependence.

We frequently feel as if delivering our knowledge fulfills our responsibility to our patients. But if our patient is already thinking, “There’s no way I’m going to do that!” we haven’t really accomplished anything, have we? So, take a moment to ask the other expert in the room – “Why might this be hard for you? What do you think will get in the way of your doing this?” You will be rewarded with important information that will change the way you practice, the way your patient sees you, and the outcomes you observe. Medicine by committee will offer you a richer, more satisfying and more effective experience.

Posted in building relationship with patients, effective communication in healthcare, physician coach, physician coaching, physician communication, physician fulfillment | Tagged Building relationship with patients, communication in healthcare, patient satisfaction, Physician coaching | Leave a comment

The examined life – happier and less stressful! A physician coach takes the seat of observer

Posted on June 7, 2014 by Helane Fronek

Mounds of dirt. Beeping trucks. Parking blocks away from our house. No water.
This was our reality for months as our street was torn up, day after day, in order to replace the sewer line. When I turned on the water and nothing came out – again – I went outside to find out when we might expect the water to be turned back on. We were having guests for dinner and they wouldn’t appreciate not having a toilet if it was needed!

As the worker casually told me that perhaps we would have water in “an hour…maybe two,” I found myself becoming irritated, argumentative and condescending. He was kind enough to listen for a minute and then simply turned away. His response wasn’t what I was looking for – and my harangue definitely wasn’t what he wanted to listen to.

As Socrates said, “The unexamined life is not worth living.”

And, as Joe Dispenza remarks in his book, Breaking the Habit of Being Yourself, “the key moment in making any change is going from being it to observing it.” So I shifted into observation mode. I was irritated by the prolonged, daily construction on our street, concerned that our guests would be inconvenienced without a bathroom and worried that I might not be able to provide dinner, as we had promised. I didn’t want to consider an alternative plan for our guests and so decided to release my anger on the man standing next to the giant ditch in the street. Blaming the person who was supervising the repair of the water line damaged by someone else wasn’t appropriate or helpful. Given what I was really concerned with, what else could I do that would actually solve the problem?

I asked the city worker if he could be sure when the water would come on. “No,” he replied.
So I went inside and made reservations at a nearby restaurant for dinner.

While not as happy as if I could have cooked dinner for our friends, this solution satisfied my real concerns. The restaurant would be able to supply both the dinner and the restroom that we couldn’t.

We have a choice whenever we become angry or frustrated. We can continue our self-righteous stance or we can become an observer. Why is this making us so angry? Is it worth fighting? What can we change? By taking a moment to examine these moments of our lives, we can bring them into greater alignment with what’s really important and make our life not only worth living, but happier and less stressful.

Posted in effective communication in healthcare, mindfulness, physician coach, physician coaching, physician communication, physician fulfillment, work life balance | Tagged communication in healthcare, Joe Dispenza, Physician coaching, Physician fulfillment, relationships, work life balance | Leave a comment

Don’t quit: advice from a physician coach

Posted on June 1, 2014 by Helane Fronek

A friend recently shared with me a story from her karate days. As she and her cohort began to feel frustrated that they remained brown belts, their black belt still elusive, their instructor gathered them together in a somewhat conspiratorial cluster. “Do you want to know the secret to getting a black belt?” he asked. They all eagerly nodded their heads, waiting to receive this important information, perhaps a new skill they had yet to learn.
“Don’t quit,” the instructor replied.

There’s a lot of wisdom in that.

Many years ago, The San Diego news carried an informative article about “hell week,” part of the training that all Navy Seals go through. I still remember feeling sympathetic pain as I read of the many grueling days that the men had to run through varying terrain and water, at times developing sores on their feet but continuing to press on, and the torturous hours they had to lie in the sand with the surf pounding against them. Almost no sleep, little food or water, and continuous exertion wore even the strongest and determined men down. And as they weakened, their commanders would tell them that it was okay to quit – that all they had to do was quit and they would get food and rest. Clearly, a Seal cannot quit.

Today I had the pleasure of watching a very bright and capable first year medical student perform his first complete history and physical exam. It was part of the testing that assesses what he’s learned during the year and he was nervous. When asked how he felt the experience went, he admitted to feeling awkward and to being disappointed that he hadn’t performed perfectly. As the writer and philosopher G.K. Chesterton, the “prince of paradox,” once remarked, “anything worth doing is worth doing badly.” If we want to succeed at anything, we usually have to tolerate a period of incompetence and awkwardness if we want to get better at it. Malcolm Gladwell advises that it actually takes 10,000 hours of practice to become masterful. In fact, many skills can be learned in far less time but rarely can we acquire them without work, discomfort, or frustration.

As we work toward a new goal or competence, it can be daunting and discouraging if we only focus on what we still don’t know or have yet to master. When we’re climbing a hill, if we only look up to where we are going the peak always seems so far away. Periodically it helps to turn around and look back at where we came from. Acknowledge how far we’ve already come. What have we learned so far – about the task, the obstacles, and ourselves? What resources or personal strengths have helped us get as far as we’ve already gotten? What do we need to continue doing? What might we do differently?

And then turn back and just don’t quit.

I work with doctors who are stressed, overworked or who feel that their life is out of balance. Through our work together they find perspective and strategies to gain more power in their lives and by doing that they create lives of greater joy. If you would like to see if coaching can help you, I would love to speak with you.

Posted in mindfulness, physician coach, physician coaching, physician communication, physician fulfillment, physician work life balance, work life balance | Tagged leadership, medical career, perfectionism, Physician coaching, Physician fulfillment, Physician work life balance, success, work life balance | Leave a comment

Which me is needed here?

Posted on May 27, 2014 by Helane Fronek

As a physician, I’m often asked by family and friends to advise them, or at least to explain what might be happening with their health or in their interactions with medical professionals. It usually feels good to use my experience to help those I most care about. When a niece related the persistently condescending behavior of her primary care physician, I was happy to empower her by suggesting she seek out another physician who would appreciate her intelligence and involvement in her healthcare decisions. Most recently, a cousin called, concerned that her husband was ill but was refusing to go to the hospital. While her stated request was for advice, what she really wanted was to enlist the authority of my opinion as a physician in convincing her husband to follow her own request. Upon hearing that I agreed with his wife, he acquiesced, was admitted, and possibly avoided a life-threatening complication.

(Full disclosure: The interaction didn’t actually proceed that smoothly. I first suggested some other tactics, which only caused my cousin to become confused. It took a few minutes before I stumbled upon a more direct and authoritative approach, which was exactly what she was seeking.)

We each play a variety of roles in the hundreds of interactions we have every day. How can we be insightful and agile enough to play the right role? How do we maintain a sense of ourself as we shape shift between these various roles?

An often cited difference between men and women is women’s need to talk about problems and men’s proclivity to fix them. I have to admit that when it comes to my family, I often break this gender-based stereotype and switch into “fixit mode” when they want to discuss some issue that is troubling them. Fortunately, our very insightful daughter has adopted the tactic of simply saying, “I don’t want your suggestions – I just want you to listen.”

In the absence of the comfort that comes from a trusting, lifelong relationship, how are we to know what role might be most helpful? Is the person just wanting you to listen to him, is she asking for a solution, or is he looking for commiseration? While it may at first feel awkward, one simple question will cut through to what is really being asked of you and allow you to make the conversation more constructive and helpful.
Try asking, “What are you needing from me?”

Posted in effective communication in healthcare, first impressions, mindfulness, physician coach, physician coaching, physician communication, physician fulfillment | Tagged Building relationship with patients, communication in healthcare, Physician coaching, relationships | 1 Comment

What do you really want? The most important question a physician coach can ask

Posted on May 9, 2014 by Helane Fronek

I often remember one particular conversation with a medical school classmate. It was early in our training and we were all trying to get to know each other better so he asked, “What do you like to do?” The answer that innocently and honestly slipped out of my mouth was: “I used to like to read, and I used to like to play music, and I used to like to run…” For most of us in the medical profession (and many other professions as well), studying and working had to come before playing. There was no other way to learn all that we had to learn in order to become the professional we dreamed of becoming. Unfortunately, in the process, we became estranged from what we really wanted. For so many years it just didn’t matter what we wanted, and acknowledging what we really desired was more painful and frustrating than simply going along with what we thought we had to do.

Often when I’m coaching clients, I’ll simply ask, “What do you want?” Almost every time, the response is, “That’s a great question!” My reply is always the same – It’s THE question.

That part of us that knows what we want has been buried for so long that many of us feel disconnected from the knowledge of what would make us happy or fulfilled. But as the amusing and wise Yogi Berra once said, “If you don’t know where you are going, you might wind up someplace else.” This makes it crucial for each of us to spend some time asking ourselves the question, “What do I really want?” And then listening for the answer.

Journaling is one way of opening the conversation with ourselves. In The Artist’s Way, Julia Cameron suggests that we write 3 pages each morning, before our day begins. Dreams from the night before, thoughts that may have filtered through our unconscious during the night, as well as leftover concerns and ideas from the days before all have an opportunity to rise to the page and be acknowledged. As busy professionals, many of us don’t have time for three pages – but perhaps we do have time for one. A regular practice of writing can help us discover many of our wantings with just one page per day.

During a recent presentation on Balancing Your Interests Inside and Outside of Medicine at the meeting of the Association of American Medical Colleges, I asked the medical student attendees to imagine their perfect life. The room became quiet as they closed their eyes and visualized themselves fifteen years in the future. There were many surprises, as some students realized that they valued a traditional, stable family life and others felt the excitement of a career filled with cutting edge research. What fills your own vision of your perfect life – in 5, 10, or 15 years?

We spend many hours trying to save the lives of some of our patients and improve the quality of others. Shouldn’t we also dedicate some time to our own life? To making sure we are living the life that we want to be living? A life filled with activities we enjoy, relationships that nurture us, and work that is meaningful and fulfilling? The first step is to ask one question – “What do I really want?” And then listen for the answer.

Posted in mindfulness, physician coach, physician coaching, physician communication, physician fulfillment, physician work life balance, work life balance | Tagged medical career, Physician coaching, Physician fulfillment, Physician work life balance, work life balance | 1 Comment

How can I make this easy? Physician coaching for the overburdened!

Posted on April 19, 2014 by Helane Fronek

There is a great story (I don’t know if it’s true, but it’s still a good story) that the early astronauts found that pens didn’t work well in outer space. Just like when we hold a pen with the tip higher than the column of ink, pens wouldn’t write in the absence of gravity. NASA spent millions of dollars researching and designing a pen that would write well in space. The Russian astronauts simply used a pencil.

The point is that we often make things unduly hard for ourselves. Sometimes we insist on doing everything ourselves when we could easily delegate some tasks to others (see my post, Advice from a Recovering Control Freak, for an easy and effective method for successful delegation: >https://helanefronekmd.wordpress.com/2011/09/17/advice-from-a-recovering-control-freak/). At other times, we allow movable obstacles to make our path more costly in terms of time, energy, or frustration.

Whenever we feel that sense of frustration, we can stop, hit the imaginary “easy” button and ask ourselves, “How can I make this easier?”

It might be as simple as finding someone who has done this particular thing before and asking for their advice. We can also pinpoint the limiting step and find a way to bypass it. One of the most effective methods is to ask ourselves, “Why do I think I need to do it this way?” That will uncover some rules, usually arbitrarily imposed, that we feel we need to live by – even though they create significant and unnecessary hardship for us.

A busy and extremely competent client was used to excelling in every area of her life. Not surprisingly, she was overwhelmed when she had to move, adjust to a new, multi-faceted job, furnish the family’s new home, assist out of town family and continue to parent three children, one of whom was applying to college. Anyone who has tried to help a child go through that process knows how challenging it can be, even in the best of circumstances! Although she was more than capable of assisting her child and had always been a hands-on mom, she enlisted the help of a professional college counselor. This allowed her greater flexibility for the many other demands on her time and eliminated much of the conflict that parents and children frequently experience during this stressful time.

Is there something in your life that is weighing you down? That you don’t know how to begin to approach? That seems so difficult? Hit that button…

How can you make it easy?

Posted in control freak, physician coach, physician coaching, physician communication, physician fulfillment, physician work life balance, work life balance | Tagged medical career, perfectionism, Physician coaching, Physician work life balance, work life balance | Leave a comment

Tetris

Posted on April 2, 2014 by Helane Fronek

Have you ever played the game tetris? My husband and kids love this game and are quite good at it. Unfortunately, I don’t like it. I get very anxious as I try to quickly move the shapes around so they fit into the available spaces before I run out of time. I don’t like to make decisions without the time to carefully consider all the options. And yet, it’s become painfully clear to me that I live my life like a tetris game.

By that, I mean that I constantly try to make everything in my life fit neatly together. If I do this today, it will free up time to do that tomorrow. And if I make arrangements for something this week, it will be ready next week when I need it. While you might argue that this is organized and smart, there is something quite limiting about living one’s life this way. As I began to notice this, life came along to show me that I am – absolutely – not in control in the way I try to be. I just cannot make everything fit.

After living in Virginia for five years, our daughter decided to return to California for graduate school. We carefully planned a cross country trip to drive her car back home. Each day and evening were planned with great care and excitement – mileage, interesting places to stop, parks to hike, people to visit. I flew to Virginia and we planned to leave the next day. And then she received an offer for a wonderful opportunity in Philadelphia. All of our plans had to be cancelled – in the blink of an eye.

My mind immediately switched into tetris mode – the blocks had changed shape and I felt that I needed to quickly fit them into the new spaces. And then I stopped. Why not just live each of the days, suddenly vacant of plans, according to what presented itself? Clearly, all of our planning had not created the trip we had imagined, so why not keep our minds and imaginations open and decide each day, based on what was available to us, what we preferred to do?

In all fairness, most of us don’t have a lot of experience with this way of living. Medical training is a prolonged and prescribed journey – there is little choice and our days are determined not by our preferences, but by the requirements and expectations placed on us by our position. Once out of training, we lead busy lives in which fitting in work, family, service and other activities we enjoy requires us to schedule ourselves tightly. When was the last time that you woke up and said, “What do I feel like doing today?” When I ask clients what they like about being on vacation, they nearly always say that it’s the lack of structure – being able to do whatever they want to do, when they want to do it.

How can we give ourselves that sense of freedom in the midst of our busy lives?

Is there a day, or part of a day – maybe this coming weekend – when you can just stop and ask yourself, “What do I want to do for the next few hours?” And then just do that. Suspend the tetris blocks, see what your heart and imagination suggest, and enjoy the excitement and wonder of spontaneity. What possibilities await you?

Posted in mindfulness, physician coach, physician coaching, physician fulfillment, physician work life balance, work life balance | Tagged medical career, perfectionism, Physician coaching, Physician fulfillment, Physician work life balance, work life balance | Leave a comment

A Powerful RX

Posted on March 22, 2014 by Helane Fronek

Recently I had the pleasure of hearing Mark Tercek, CEO of The Nature Conservancy, speak at the meeting of the American Medical Women’s Association (check it out http://www.amwa-doc.org). He laughed as he explained that people often find his career path – from Goldman-Sachs to the Nature Conservancy – somewhat surprising. In fact, he argued that his stint in investment banking was the perfect segue to his current position. The connection, he believes, is that we need to “invest in nature.” He cited the many benefits to our health, economy, and well being when we spend money to support or revitalize the environment. Definitely an interesting and important perspective. He went further by encouraging the physicians in the room to “prescribe nature.” That is something I can definitely get behind.

I have to admit that when I go to a meeting, I rarely see much besides the meeting rooms and my hotel room. If I’m lucky I make it to the fitness center a couple of times. Between meetings, lectures, conversations and the time it takes to make sure I’m ready for the next day, there aren’t many free moments and I find myself increasingly exhausted as the meeting goes on. So after listening to Mr. Tercek, I scrapped my plan to go to the gym and instead decided to take a walk. I’m really glad that I did. The sun was warm, the breeze was balmy, and the air was definitely fresher than any I had breathed in days. I immediately felt more awake and recharged.

Whether we are treating our patients’ hypertension, stress, diabetes or varicose veins, by suggesting they spend some time in nature, we add an extremely therapeutic complement to their regimen. Being in nature can get us away from our stressful thoughts and environment, slow our heart rate and lower our blood pressure. As we look around and take in the trees, sky, water, wildlife, or whatever now surrounds us, the sense of wonder and appreciation widens our perspective, calms the immediacy of our perceived demands and puts gratitude in our heart.

As healthcare providers, our suggestions have power. Simply by prescribing nature, we can help our patients live happier and healthier lives. And they, in turn, may go on to protect our natural world. It’s a simple, yet very effective way for us to make an important difference in the lives of our patients and the world.

Posted in building relationship with patients, mindfulness, physician coach, physician coaching, physician communication, physician fulfillment, physician work life balance, work life balance | Tagged Building relationship with patients, communication in healthcare, Physician fulfillment, Physician work life balance, work life balance | 1 Comment

How are you a genius?

Posted on March 7, 2014 by Helane Fronek

After 12 years practicing in a large, multispecialty clinic, I opened my own practice in August 1997. Laughingly, I told everyone that I spent the summer learning about all sorts of things I never had any interest in: OSHA regulations, how to create an employee handbook, which computer scheduling and billing system would be best, accounting – the list was long but I was excited to open my new practice and dove in with great enthusiasm. After spending several hours setting up the accounts in my new QuickBooks program, I realized that I needed help. I found a young accountant who advertised his skills with the program and hired him to finish setting it up for my business. Initially impressed with what I seemed to have done, he later told me that he rapidly found out how badly I needed his skills. The accounts I set up made no sense and it took him many hours to correct what I had done. So much for omnipotence.

In the course of a medical career, we gain many competencies. We learn to diagnose and treat many conditions, perform a variety of procedures, communicate effectively with different types of people, and sometimes even manage employees and colleagues. This often gives us the idea that there is nothing we cannot do, or learn to do. And sometimes we feel as if we NEED to do everything, and that no one should be doing anything for us. But as Albert Einstein wisely remarked, “Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.”

In what ways are YOU a genius?

A happy life includes lots of activities that make us feel competent or that honor our fundamental values. Values can be a part of your workday or you can include them in one of your outside activities. (To find out what your values are, see my blogpost (http://helanefronekmd.wordpress.com/2011/10/24/your-own-personal-secret-to-work-life-balance/.) And although most of the feedback we receive during our life focuses on improving our shortcomings, research shows that people perform best when they play to their strengths. Make sure that your strengths show up often and in high profile in your life.

Are there trees in your life that you shouldn’t or don’t need to be climbing?

Take a look at all the things you’re doing in your life. Then make a list of those things that aren’t meaningful, fun, or interesting, as well as those that are a struggle because you’re just not good at them. If there are items on that list that you want to learn about or become better at, take them off your list. But with everything that’s left, ask yourself who might do them better than you. Who might learn something from being given that job? Then delegate or hire someone to take over and cross them off your list.

Having a happy life doesn’t just happen – we have to set ourselves up by checking in to see how we are really feeling, taking some time to look critically at how we are living, and then making the choices to create the life we really want to be living. We don’t have to spend our lives struggling to climb a tree – we can happily swim in the ocean, feeling our competence and enjoying the sights, sounds, relationships and activities that bring us the most joy.

I work with doctors who are stressed, overworked or who feel that their life is out of balance because of all the changes that we’re struggling with in medicine, or just because they’re trying to live a demanding medical life. Through the work we do together they find perspective and strategies to gain more power in their lives and by doing that they create lives of greater joy. If you would like to see if coaching can help you, I would love to speak with you. You can contact me here.

Posted in physician coach, physician coaching, physician communication | Leave a comment

Calling all perfectionists!

Posted on March 2, 2014 by Helane Fronek

Physicians are known to share some strong personality traits. We are generally hardworking, skeptical, and perfectionistic. Those characteristics support us in our quest to continually add knowledge and skills, think critically, and strive to provide the best care to our patients. They also wreak havoc with our life balance, our relationships, and our confidence.

As Lee Lipsenthal MD says in Finding Balance in a Medical Life, perfectionism is excused and justified because we deal with life and death decisions. Certainly, the consequences of our mistakes can be quite grave. My sister, a successful retail executive who managed millions of dollars in transactions once remarked, “if I make a mistake, we lose thousands of dollars, but if you make a mistake, someone could die!”

Since we are human, the goal of becoming perfect is completely unattainable. The great baseball hitter, Tony Gwynn, carried a lifetime batting average of .338 and won major League Baseball’s Batting Title 8 times – by being successful 1/3 of the time. While we strive to be successful more than 1/3 of the time, accepting occasional failures, mistakes, or ignorance is an important part of our growth if we want to live a happy life. Expecting perfection makes us anxious, irritable, and extremely judgmental of ourselves and others.

Perfectionists tend to focus on whatever negative interaction we had during the day, sometimes becoming overly distracted so we function at a level lower than we might otherwise. Perfectionists can receive a multitude of compliments but remember the only negative comment we received, or become depressed by a single complication and not recall the thousands of successful treatments we provided to our many patients. Our medical education trained us to always ask, “What could I have done better?” We never think we are good enough.

So what are we perfectionists supposed to do about this?

One simple thing we can do, beginning today, is to end each day asking ourselves a different question: “What did I do well today?” This will help us bring our view of ourself into balance. Just this one short question, this one small change, gives us the opportunity to ease up on ourselves and allow greater joy in our life.
Sounds simple – what have you got to lose? I invite you to try it!

Posted in control freak, mindfulness, physician coach, physician coaching, physician communication, physician fulfillment, physician work life balance, work life balance | Tagged medical career, perfectionism, Physician coaching, Physician fulfillment, Physician work life balance, relationships, work life balance | Leave a comment

Doctors Coaching Doctors – Helane Fronek, MD Coaching and Consulting