Loving Yourself IS Loving Your Neighbor

Posted on October 13, 2013 by Helane Fronek

Many of us grew up in a spiritual tradition based on the biblical Ten Commandments. Thou shall love the lord your god…Thou shall honor thy father and thy mother…and one of the most often repeated commandments: thou shall love thy neighbor as thyself. This implies that we do love ourselves – that we provide for ourselves and go out of our way to do kind things for ourselves.
Is that true?
Unfortunately, in our culture we often deny ourselves what is most important. We pack our life so tightly that we have little time with family and friends. We pollute the air we breathe and add toxic and cancer-causing ingredients to our food in the name of expediency or profit. We over eat, under exercise, ignore dangerous levels of stress, and look to pharmaceuticals with their own set of side effects to calm the symptoms of illness or our unhealthy lifestyle. If I “love” my neighbor as myself, I will probably not be very kind to my neighbor!
As Eric Hoffer wisely remarked: “The remarkable thing is that we really love our neighbor as ourselves: we do unto others as we do unto ourselves. We hate others when we hate ourselves. We are tolerant toward others when we tolerate ourselves. We forgive others when we forgive ourselves. We are prone to sacrifice others when we are ready to sacrifice ourselves.”
Now that is true.
When we take time to nurture our soul – by being in nature, spending time with the people we love, engaging in activities we enjoy, getting enough sleep, we tend to bring our best selves to our work and to our interactions with others. But when we eat unhealthy foods, don’t take time to exercise, and drive ourselves so hard that we forego the people and activities that we love, we bring resentment, fatigue or apathy into our lives. So, if we want to treat others in a kind and loving manner, we need to direct our attentions to ourselves first.
While caring for ourselves at the expense of others might be considered selfish, caring for ourselves so we can continue to bring a loving and caring nature to our interactions with others is what Stephen Covey calls, “sharpening the saw” in The 7 Habits of Highly Effective People. By providing ourselves with the time and activities we need to be our best, we enhance the quality of our lives and provide a model for others to do the same.
Recently, I met a lovely patient whose life has been spent in service – a kindergarten teacher with seven children, she frequently cooks and cares for members of her community. After discussing her condition and suggesting that she needed a series of treatments that would take time and attention, she exclaimed, “That would be so selfish!” As I considered how I might help her see that caring for herself is not selfish, I recalled a conversation I had many years ago. A fellow woman physician and I were discussing the difficulties of maintaining balance in our lives and we realized that, if we wanted our daughters to have more fun and freedom in their lives than we were allowing ourselves in ours, we needed to model that lifestyle better. So I asked my patient what she would tell her own daughter in a situation like this. True to Eric Hoffer’s remarks, she replied that she would tell her own daughter to stop complaining and ignore her problems.
We each have a choice in our lives – whether we want lives that focus on achievement without giving ourselves the time and attention we need, or whether we want to provide the outlets and activities that are truly loving to ourselves.
So my question is, what kind of life do YOU want? What will you do today to make that kind of life a reality for you?

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Nipping it in the bud

Posted on September 23, 2013 by Helane Fronek

Over the weekend I attended a terrific workshop on EFT, the “tapping technique” that has helped millions of people decrease pain and anxiety, change negative thought patterns, get over traumas, etc. In the beginning of the workshop, one attendee announced to all of us that she had “written 86 books” about EFT. It made me wonder why she had signed up for an introductory workshop. As the days progressed, it became clear that she was undermining the presenter and attempting to “teach” her own approach to EFT. The skillful presenter directly and professionally addressed the situation and we were all able to continue to acquire the technique we had come to learn. I’m sure it wasn’t easy for the presenter to step up and confront this person. Fortunately, her commitment to her field, and to each of us who had paid for the program, was greater than her fear or discomfort.

Many years ago, in my own private practice, I tolerated employees who were unsuitable for our group. For some, their attitude created conflict within the office. For others, their competence was subpar. I used all of the communication skills I knew – and then I used them again. Just like Einstein would have warned, insanity is “doing the same thing over and over again and expecting different results.” While I’m not sure I would characterize myself as insane, I clearly was ineffective.

Fortunately, there are many communication strategies that are extremely effective in confronting poor behavior in the home and workplace.

One such strategy, as suggested by Pamela Jett of Words Matter, is to use the BCA template.
Behavior – state the behavior you have noticed
Correction/consequence – explain the correction you want them to make and the consequence of their doing it right
Attitude – check their attitude by asking a yes or no question: “Can I count on you to do this?” This allows the person to immediately get on board with what you’re asking of them, or to explain why they might not be able to make the change.

For example:
Behavior: I’ve noticed that you’ve come in late several times this week.
Correction: We begin seeing patients at 8, so you need to arrive by 7:45.
Attitude: Can I count on you to be here every day by 7:45?

What if the person gives you a reason why they can’t comply?

If it’s a reasonable situation that is limiting their behavior, brainstorm with them to find other solutions. If you feel it’s just an excuse, respond with: “I understand that this is the situation. That being said, it’s still important that….” Again state what correction is needed and ask for their agreement.

The wealth of strategies for more effective communication continues to amaze and excite me as I realize that none of us needs to be held hostage to or accept bad behavior in our practices. We can simply follow this (or another) easy formula and courageously step up to our difficult conversations. When we keep in mind our underlying commitment – to our patients, our employees, and ourselves – we can use that commitment to spur us on past our fears. Then we can get ready to enjoy the benefits of a workplace that runs more smoothly, with greater productivity and more harmony among all who work there.

Posted in building relationship with patients, honesty in medical care, physician coach, physician coaching, physician communication, physician fulfillment, physician work life balance | Tagged , | 1 Comment

What’s in a smile?

Posted on September 17, 2013 by Helane Fronek

At a recent conference, I spoke about communication in the healthcare setting and suggested that the major premise of Malcolm Gladwell’s book, Blink, has a lot to tell us about how we interact with our patients. Gladwell provides data showing that we all make snap decisions and that we usually decide whether we like someone within the first few seconds of meeting them. For this reason, it’s important to set ourselves up to make the best first impression on our patients – even before we walk in the exam room. One thing we can do to create a positive impression and establish rapport is to smile at our patients when we greet them. Patients like seeing providers who look like they enjoy what they do, and who look happy to see them. Our pleasant demeanor feels better to our patient than when we walk into a room with a frown on our face because we’re still thinking about something unfortunate that just happened or worrying about what might happen later in our day. It’s a simple idea – but often, the most powerful concepts are the simplest.

The next day, in a cab from the airport, I found out how right this concept is.

The cab driver was a delightful 33y/o man who was married at age 19 and was working hard to support his wife and three young children. He was mostly concerned with the basic priorities of his life and shared some of his concerns about his marriage and job security. He brightened up when he talked about taking his kids to the park in the summer and seemed sad that they had returned to school, since his nighttime work hours kept him from spending much time with them since school had started. Near the end of the ride he asked what I did for work and I told him I was a physician. That put a big smile on his face as he exclaimed, “I like doctors who smile the way you do. You know, it makes you feel good when your doctor smiles.”

Our days at work are usually full and often there are many things we are worried about. But by bringing ourselves into the current moment so we can welcome each patient with a smile, we make a powerful statement. The simple act of smiling often creates the connection and begins to develop the rapport we need for our patient to trust us and partner with us. And that will make both of us feel good.

Posted in building relationship with patients, effective communication in healthcare, first impressions, mindfulness, physician coach, physician coaching, physician communication, physician fulfillment | Tagged | 4 Comments

Naming the fear – a simple way to reach our patients

Posted on August 21, 2013 by Helane Fronek

Last week I saw a patient who was concerned that his post-treatment course wasn’t what he had anticipated. The pain he had originally was gone, but now he had a new pain that was interfering with his sleep. As I attempted to explain what had happened, that he had experienced an unintended reaction, his face became drawn and he looked shocked. Thinking that he simply needed reassurance, I described why the reaction was not significant and that he should have no persistent problems because of it. I saw him become fidgety and distracted and, quickly after my explanation, he left abruptly. Unfortunately, he continued to have difficulties and returned to the office several days later.

He had graciously given me a chance at better communication.

What I had failed to do was to truly define his concerns, so while I attempted to alleviate his worry, it didn’t really sink in. What would have been more effective would have been to say that he looked concerned and then to simply ask, “what are you most concerned about, given this new information about your treatment?” Another way of beginning this conversation was to suggest what I thought might be worrying him. In fact, when he heard me identify his concern, his voice became animated and he exclaimed, “right!” I explained again, just as I had days earlier, that the unexpected reaction would not hurt him in any way. But this time, he was able to hear it.

When our patients are worried, they need to know that we understand their fears. Once we name the fear, our explanations become more trustworthy and powerful. What a simple technique – that I hope I remember next time!

Posted in effective communication in healthcare, honesty in medical care, physician coach, physician coaching, physician communication | Tagged | 2 Comments

Being Stuck

Posted on July 14, 2013 by Helane Fronek

It’s been two months since I wrote in this blog. In that time, we decided to “downsize,” so we sold the house we lived in for 27 years, sorted through our belongings and the precious mementos of our lives, and moved to a house half the size of our old home. I can tell you that this cut-and-dried explanation ignores the heartbreak of leaving the comfort of our old neighborhood, the grief of separating from the house we designed and loved, the harshness and shock of acknowledging that the phase of our lives filled with the joyfulness and wonder of small children is over, and the fear of what life in our new house and this next phase of our life would be like. Although it looked from the outside like a lot of activity, on the inside I felt stuck. When I sat down to write, my thoughts were jumbled and wouldn’t coalesce into a coherent idea. There seemed to be something physically in the way of my moving forward with life. I realized that our possessions were not the only things we had packed away. All of those feelings and more were packed up in those boxes, leaving me with a feeling that I don’t like to have.

Whether it’s the decision to have another child, which job opportunity to select, if we want to add another activity to our already busy lives, or just a vague unease, “stuck” is a frequent feeling. And not a very pleasant feeling, as Rilke describes in his poem, Pushing Through:
It’s possible I am pushing through solid rock
in flintlike layers, as the ore lies, alone;
I am such a long way in I see no way through,
and no space: everything is close to my face,
and everything close to my face is stone.
Most of us enjoy the periods of vibrant activity in our lives – we delight in the knowledge that we know where we’re going and how to get there and in the confidence we experience as we move toward our goals. In that stuck place, we squirm and contort ourselves – making lists of pros and cons, rehashing our dilemma with our friends and advisors, keeping busy with anything that will distract us from the discomfort we feel and hoping that we will suddenly realize the “right” decision.

But as Byron Katie says in A Thousand Names for Joy: Living in Harmony with the Way Things Are, “Decisions make themselves…they come when the time is right.” As we remain in our stuck place, those decisions gradually take shape and are exposed, as proteins open and expose their binding sites when the right cofactor floats by.

So what are we to do while we’re waiting for our decision to “make itself?”

We can do what Julia Cameron suggests in her wonderful book, The Artist’s Way, and we can journal. Simply putting our unedited thoughts down on paper allows us to remove the debris – those “fallen branches and stones” that Mary Oliver speaks about in The Journey (see my page, Poems That Will Inspire You!) and examine feelings and thoughts that were previously buried. What fears are there? What hurts? What hopes? What passions?

We might also examine the ideas that confidently tell us which path is best. These messages often begin with, “you should” or “you shouldn’t.” Our next question should be, “whose voice is that?” Frequently we are guided (sometimes harassed or intimidated) by voices that belong to our past or to people who have other agendas than our values and our benefit. (To find your values, see my post on October 24, 2011.) If we find that the voice is not ours, we can gently move it aside and return to our stuckness. Sometimes, we find that our decision has already been made but was being obscured by that voice.

Too often, we find that we are simply stuck. But “stuck” isn’t the stagnant place it might seem to be. There is usually something of great value to be found and investigated, so sometimes just sitting with the discomfort is the best thing we can do. We can feel the sadness of what we might be losing. We can feel the fear of the unknown. What else is there for us to feel? Explore? Understand? Most of the time, a catharsis occurs as we feel the feeling and let it pass through us. We are often left with a greater calmness. Not necessarily a decision, but certainly more confidence that we can withstand the not knowing until the time is right for our decision to make itself or our path to become clear. So that is where I am, and I’m wondering…what are your experiences with being stuck? What has helped you through those times? How have you loved yourself while you remain in the place of not knowing? I hope you will share your experiences in the comments section below.

Posted in honesty in medical care, physician coaching, physician fulfillment, physician work life balance | Tagged | 4 Comments

Do-overs in the same barn

Posted on May 16, 2013 by Helane Fronek

In, Blink, Malcolm Gladwell explains that we often make decisions in the blink of an eye. In fact, Gladwell shows us, we frequently form an opinion of people we meet within the first few seconds. This makes it important for us to prepare before walking into an exam room– we want to know our patient’s name (and how to pronounce it), why they have come to see us, and what we hope to accomplish. Acknowledging that we are about to make a difference in the life of another person (we have that opportunity each time we interact with a patient) gives us a sense of purpose that our patient will pick up on immediately.

But sometimes we aren’t at our best. We may be distracted, irritable, or overcome with an emotion that we just can’t shake at the moment.

So if we fail to make our best impression, do we get another chance?

Yes! But it helps to employ a few simple skills.

First, we can acknowledge that we got off to a less-than-optimal start. The next time we see our patient, we can explain what was going on at the time (if appropriate) and state what we want instead: to have a strong partnership, to provide the best care, to listen – whatever we feel we missed the first time around. Years ago, I was practicing Internal Medicine in an HMO setting with 15 minute appointments, frequently running behind schedule. I didn’t know how to care for patients in such a short time when their medical conditions were complicated or they were emotional. The clinic I worked in asked new patients to arrive one hour before their appointment to fill out paperwork that usually took 10-15 minutes. On one particular day I was running an hour late, so my new patient, a busy executive, waited 2 hours to see me before I walked into the room. After apologizing to her for keeping her waiting, I was hit with an angry tirade that centered on the concept that her time was just as important as mine. Since I had been working hard and without a break all day, I felt unjustly accused. Pointing that out, however, would have gotten us nowhere. So I repeated my apology and explained that if I could have prevented this situation I would have, but that now that we were together I would like to spend our time on the concern that brought her in rather than have her continue to yell at me. She instantly dropped her anger and we used our time to discuss her concern, ending the visit with a solid relationship and a plan that we both felt good about.

Another great skill for building relationship after a rocky start is to use a fact that Gladwell alludes to – our tendency to make quick associations between current situations and past experiences. Yesterday I saw a 50-year-old professional who came in with his wife. It quickly became apparent through her many questions that she was a very detail-oriented person. My patient obviously valued this and deferred to her assessment many times. Coincidentally, I happened to mention that I was a very detail-oriented physician and we shared a laugh that, “being ‘a bit OCD’ is a good thing for a doctor,” as my patient put it. His sense of comfort on making this association was palpable, as he seemed to feel more comfortable with the idea that his physician was like his wife, also someone he could trust and rely on. While we never want to misrepresent ourselves, when we point out shared values or perspectives we help our patients feel more secure being cared for by us.

Years ago, a horse trainer explained to me that when you move a horse to a new barn, you get a “do-over.” The horse perceives that he is now in a new place and easily accepts any change in routine or rules. Although our patients do make an immediate judgment about us based on their first visit, even in the same “barn” we can often create a “do-over” with these simple yet effective steps.

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Lessons from a 5th grade history teacher

Posted on May 12, 2013 by Helane Fronek

Yesterday I missed an opportunity to partner with my patient and engage her in the decision making for her treatment. I did what our kids’ 5th grade teacher warned them never to do – I assumed. I assumed that I knew what my patient would prefer. And, as that very wise, witty (and a bit risqué for 5th grade!) teacher explained, “When you assume, you make an ass out of u and me.” My patient had described her considerable anxiety over having a procedure done, so I decided she would tolerate it better if we staged her procedure, dividing it up into several shorter sessions, rather than performing one or two longer procedures. Fortunately, her kind husband stopped me and turned to his wife to ask her what her preference would be. To my surprise, she said she would rather have fewer but longer procedures. While there were medical reasons to adopt my plan, the important point of the interaction was that I failed to include my patient in deciding the best way to treat her. This one question, “What would you prefer?” could have strengthened our relationship, provided me with important information, and allowed her to feel engaged rather than powerless and, it turned out, even more anxious. I definitely felt exactly as our children’s teacher warned I would! It made me wonder how many times in other areas of my life I continue to operate as if I know what others think.

It took only seconds before that wondering led me to another poignant example.

Years ago, when our daughter was about to enter kindergarten, I took her to a furniture shop to pick out a desk. She was going to school and would soon have homework, and a desk seemed like an important symbol of this new, more grownup status. After I had pointed out several white melamine desks (which seemed very practical to me, as they would go with any décor), she settled on a desk in which the table top was bright blue, the drawers were bright red and yellow and the sides were bright green. I was horrified. This was not my idea of a smart choice. Patiently, I explained that she might like this brightly colored desk now, but my fear was that in a few years, she wouldn’t like it anymore. Her reply is one I have never forgotten: “But if I pick the one you want me to get, I won’t like it from the beginning.” There is no argument to such clear logic, even from a 5 year old. We bought the brightly colored desk, which she happily used for many years.

We all have preferences. A powerful and concise way to tell our patients that we see them as unique individuals and value their input into their care is to simply ask, “what would you prefer?” It’s a new discipline that I’m excited about putting to use in my life.

Posted in building relationship with patients, effective communication in healthcare, honesty in medical care, patient agendas, physician coach, physician coaching, physician communication | Tagged | 1 Comment

How do we want to play the game?

Posted on April 8, 2013 by Helane Fronek

I recently had the opportunity to attend the World Baseball Classic in Tokyo – part of the international baseball tournament in which teams are made up of players who all have ties to a particular country. While some players grew up and continue to live in the country of the team they play for (like the teams from the USA or Japan), some of the players on the Netherlands team grew up in the Dutch islands of Curacao, Aruba and Bonaire. Still other players simply have ancestors from the country of the team they play for (such as when Mike Piazza played for team Italy). It makes for some great competition and a lot of national pride.

In its first game, Chinese Tai-pei led Japan for the entire game – until the end, when they lost 4-3. The game was exciting throughout, and the fans cheered constantly. The game was close, so the spirit that the teams demonstrated wasn’t surprising. In its second game, Chinese Tai-pei was beaten by the Cubans, 14-0. In spite of the shutout, the Chinese Tai-pei team and fans never gave up. They played and cheered hard through each play, all the way to the end, as if each play was the bottom of the ninth and they were only behind by one run. They certainly made their country proud and set a great example for all the other players in the tournament.

And for all of us, as we go about the moments of our lives.

It made me think about all the times when I give up on things I’m passionate about, just because they don’t seem to be going the way I wanted or expected them to go. Or the times I’ll go, grudgingly, to a social event, already having decided that I don’t want to be there and probably won’t enjoy myself. What would it be like, instead, to live each moment with the passion that the Chinese Tai-pei team showed, even while knowing that they were losing the game?

During a conversation this morning with a wonderful coach friend, we agreed that with each activity or interaction in our lives, we DECIDE how we want to play the game. Will we sit on the sidelines and wish we were somewhere else? Or will we jump into the activity and find the fun/connection/learning that is waiting for us? Recently, a client shared a story about her recent vacation that illustrated this beautifully. As she sat, watching her daughter play in the ocean waves and regretting that the vacation hadn’t included as many fun activities as she had hoped, she realized that fun was right in front of her. All she had to do was decide to join in. She ran into the water and before she knew it she was jumping and laughing with her daughter. She just had to decide to make that moment what she wanted it to be.

We each have the opportunity and power to make our lives more fun, meaningful, alive. We just need to keep making the decision, moment by moment, to have the life that we want.

Posted in mindfulness, physician coach, physician coaching, physician fulfillment | Tagged | 1 Comment

The only helpful comparison is the one we find inside

Posted on March 29, 2013 by Helane Fronek

In a women’s group that I attend, our facilitator asked us to write down one word that represented each individual in the group. One of the women wrote that I was “together.” My immediate reaction was, “What? Who me?” I can assure you that this morning, when I was awake until 3AM worrying about things going on in my life (most of which I have absolutely no control over), I was certainly not feeling “together.” How often does someone else arrive at a conclusion about our value, competence, or kindness when we feel that we are anything but that? What do they see that we seem to miss about ourselves?

Often, we look around and judge ourselves in comparison to what we see others doing. Other people seem so “together,” smart, accomplished, confident, or funny when we feel out of control, silly, insecure, or boring. But as someone wisely remarked, we frequently judge our inside by comparing it to someone else’s outside.

Many years ago our daughter and I participated in a mother-daughter philanthropic organization. One of the women appeared to be living a wonderful life – she, her husband, and her two daughters lived in a beautiful home in the wealthiest part of town, she drove an expensive car, her children attended private school. In fact, it turned out that she was accused of embezzling money from a nonprofit group and had to pack up and leave town abruptly. Her “inside” was certainly not the perfect family life that I saw on the “outside.”

The only measure of our success really comes from within – and it is different for each of us. What is really important to you? Is it contribution to your field? Relationships? Accomplishing a particular goal? Taking the time to determine what your own values are and what would make your life feel successful is an important part of achieving that success. As Yogi Berra once said, “You’ve got to be very careful if you don’t know where you’re going, because you might not get there.”

There are many ways of finding “where you’re going.” Visualizing your future is often a powerful method. Imagine that it’s now 10 years later. Someone is giving a speech about you. What would you want him or her to say about you? Or picture yourself sitting on a porch after retirement. In the distance, you see a line of people coming toward you to tell you the impact you have had on their life. What would they be telling you?

Another, simpler, way is to ask those people who are important in your life. What do they think are your greatest strengths, accomplishments, and impact in their life and in the world?

By putting all of this information together, we can see what we have accomplished and where we want to focus during the next phase of our life. That direction may not be the same as for the next person, but if it reflects who we are and what we feel is important, it will set us on the path toward the most fulfilling life possible. Not someone else’s path. Ours. And that’s really the only path that matters.

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What if we just don’t know?

Posted on March 18, 2013 by Helane Fronek

Medicine is an inexact science. We diagnose two patients with the same disorder, treat them with the same therapy, and one recovers while the other one doesn’t. I’m sure we have all had that experience. Hard core “knowledge” that we learned in medical school or residency training is later determined to be false. Then, there are all of those idiopathic conditions. When I explain to my patients that their condition is idiopathic, I am always reminded of a neurosurgery professor in medical school who said, “The term idiopathic means that the doctor is an idiot and the patient is pathetic!” Funny, and sadly, true.

And yet, our patients look to us for answers, often when none exist.
So, what’s a physician to do?

There are many instances when patients are given false information about their condition. Perhaps it’s an attempt to satisfy the patient’s inquiries or maybe the practitioner doesn’t understand the pathophysiology involved. Many years ago, I saw a patient who presented for a consultation for leg pain, holding an MRI of her spine. The pain was localized over a bulging varicose vein that had obviously been affected by superficial thrombophlebitis. When I asked her why she had an MRI, she stated that her doctor told her that varicose veins don’t hurt, so her leg pain must be coming from her back. With the increasing specialization in medicine, it’s impossible for any of us to keep up with the rapid developments in other fields.

But we can be honest when we are uncertain.

As Scott Eblin, author of The Next Level, writes in his blog, Five Rules for Leading Through Uncertainty, we should share what we know, say what we don’t know, cut the crap, ask for input, and stay engaged. All great ideas.

Patients are surprisingly open to the truth that we don’t know everything. By sharing what we do know, we demonstrate what mastery we have and allow them to share in the understanding that is available. When we explain what knowledge or understanding is lacking, we give our patient the gift of trust, a very powerful component in the doctor-patient relationship. When we admit what we don’t know, it’s easier for patients to believe what we do claim to know. Our transparency and refusal to offer an explanation that we aren’t confident in makes patients more comfortable when they depend on our judgment. It also opens up the possibility that someone else may know, and allows the patient to seek out another practitioner who might know something we don’t. Then we can learn from them! Letting our patient know that we will contact them if we discover new information is a form of partnering, an effective strategy in avoiding malpractice claims.

Another important tactic is to explain our thinking process. Taking a few moments to discuss what the available information does tell us, what more we might need to know to determine the best course for our patient, and how we plan to make the decision in the absence of any further understanding gives our patient confidence that our decisions are based on careful consideration and the best data available. And if our instinct turns out to be wrong and their course isn’t optimal, our patient will understand why we made the decision we did and will usually be more forgiving.

So, when our patient asks us questions we don’t have an answer for, if they present with a constellation of symptoms that don’t add up to a clear diagnosis, or if they react in a way that we can’t explain, we can simply say, “I don’t know.” That may be the most effective thing we can do to establish our credibility and cement their trust in us. That will go a long way toward building the type of respectful and honest relationship that we all want with all our patients.

Posted in building relationship with patients, effective communication in healthcare, first impressions, honesty in medical care, physician communication | Tagged | Leave a comment