Angry patients? Don’t run and don’t hide.

Posted on January 9, 2012 by Helane Fronek

During the holidays (aside from the crowds at the malls), most people are filled with generosity and kindness for those around them. But the reality is that anger is a frequent expression of fear and pain in our society. As medical providers, all of us have had to deal with angry patients and family members. While we may be tempted to respond with anger, as Dr. Lawrence J. Peters commented, “Speak when you are angry – and you’ll make the best speech you’ll ever regret.”

The first step is to understand our own feelings about the situation so we are able to interact in a calm and rational manner. Then, it is always best to speak honestly and respectfully with angry patients. If the situation is complicated, schedule a meeting and involve additional people (family members, colleagues, etc.) as indicated. Take the time to listen to the patient’s and family’s concerns and validate their feelings first. Many times, just knowing they have been heard will defuse their anger. If action is indicated, let them know how you plan to respond to their complaints. Many people just want to know that others will not have the same experience, and explaining what we plan to do differently will let them know that we value their concerns.

When complications occur, attorneys frequently advise us not to apologize. However, it can be appropriate to state that we are sorry for our patient’s situation. One way of saying this is: “Just like you, I wish the outcome would have been different.” In the case of an unintended outcome, clearly explaining the rationale behind our decisions as well as our plans for their future management is sometimes all that is necessary. Involving the patient in the decision-making helps to enhance a sense of partnership. When outcomes do not match expectations, most patients are forgiving if they see that the doctor has a plan and does not intend to abandon them. Although it is often uncomfortable to interact with an angry patient, the best way of demonstrating our concern and commitment to their best outcome is through regular communication.

In situations that don’t relate to medical issues, it’s crucial to assess the specific issue and deal with it directly and clearly. Patients may be angry about interactions with our staff, scheduling appointments, wait times, charges, or a variety of other issues. We are often tempted to ignore the situation, hoping that it will just go away. Unfortunately, these problems can cause other difficulties within our office, so it is worth taking the time to address them. Again, listening to what patients are angry about, clarifying our policies or stance on the issue and then taking deliberate action is important and will keep the anger from spreading to other aspects of our practice.

As most medical malpractice attorneys will confirm, patients don’t initiate lawsuits simply because of malpractice. In over 70% of suits, communication issues are cited as a major factor. So it pays, in many ways, for us to take the time to speak clearly and honestly with our patients when they are angry.

Posted in building relationship with patients, effective communication in healthcare, honesty in medical care, physician communication, Uncategorized | Comments Off on Angry patients? Don’t run and don’t hide.

“Begin with the end in mind”

Posted on January 1, 2012 by Helane Fronek

Many years ago, a friend suggested that I read Stephen Covey’s The 7 Habits of Highly Effective People. I thought it was going to be another time management book – boy, was I wrong.

Covey defines a habit as “the intersection of knowledge, skill, and desire.” On this first day of a new year, the 2nd habit seems particularly useful.

Begin with the end in mind.

While at times it seems like a luxury, living our lives with intention is increasingly important. The years fly by quickly (doesn’t it seem as if we just celebrated the end of 2010?), and at times we can feel as though we are at the mercy of the circumstances of our lives. So take a few minutes at this juncture and run the film of your life ahead to one year from now, the end of 2012. What do you really want your life to be like? What is important to you about this? What would it mean to you if you could change your life in this way?

Would you like to learn about a new subject? Volunteer with your family at a soup kitchen or another local charity? Cultivate new friendships? At the end of 2012, what change would make you feel more satisfied with your life?

Take a few minutes right now to brainstorm ways in which you can make the new activity a reality. Did you know that reading five minutes a day will add up to 30 hours over the course of the year? Or perhaps setting aside 1-2 hours a week to read would be more enjoyable. Each new idea can be accomplished in many ways, so decide what would work best for you. Then, take out your calendar and schedule the time to make it happen.

Intentionally include what is important to you in your schedule. Keep your desired “end” in mind. After all, it is your life.

Posted in physician coaching, physician fulfillment, physician work life balance, Uncategorized | Comments Off on “Begin with the end in mind”

Looking for the perfect gift?

Posted on December 22, 2011 by Helane Fronek

What most people really want in life is to be seen – really seen for who they are, the impacts they make, and the importance they have in our lives. Unfortunately, we live in a busy world in which our minds are filled with many concerns and the minutes and hours of our days seem to fly by at an astonishing pace. This leaves little time to really notice who other people are or to appreciate them for these qualities.

So, if you’re looking for the perfect gift for that special someone, a colleague, an employee, a child, or anyone else in your life, take a moment to acknowledge them for who they are.

Did a colleague cover for you when you needed to attend to a family matter? That was kindness in action. Did an employee admit making a mistake, even when he could have swept it under the rug? That took a lot of courage and integrity. How about a child who took it upon herself to clean her room. Impressive responsibility!

In dealing with patients, a simple acknowledgement of their effort and dedication to their good health in bringing down their blood sugar, wearing compression stockings, or exercising regularly means so much and goes a long way towards building partnership and trust.

In the middle of this holiday season, when we are bombarded by messages about all those “things” that we can buy for the special people in our lives, consider giving something that will live on long past the time when the coffeemaker breaks down, the sweater is no longer in fashion, or the movie tickets have been used.

Acknowledgement – a simple and profound gift that comes from the heart and will truly show that person that you value who they are and what they mean to you.

Posted in building relationship with patients, effective communication in healthcare, physician fulfillment, Uncategorized | Comments Off on Looking for the perfect gift?

The potency of hope

Posted on December 12, 2011 by Helane Fronek

The holiday season brings many reminders of the power of belief, faith and hope. Unfortunately, we in the medical profession often focus so much on science that we forget how important these other factors can be in our patients’ healing. On a recent plane trip I sat next to a Brad, a 50 year old engineer who painfully recounted the experience of listening as his mother was told that she had pancreatic cancer and only months to live. Brad realized that the physician was attempting to be compassionate by quickly jumping from announcing the diagnosis to explaining medicine’s ability to make Brad’s mother comfortable as the cancer progressed. Clearly, the physician had forgotten that a whole lot of living could occur between those two points – life events that would give meaning to the rest of her time; provide strength for her to face treatment, uncertainty, and discomfort; and create memories to live on after she was gone.

Fortunately, the family understood this.

As the months passed and her illness progressed, her family helped her live fully by focusing on a granddaughter’s graduation, then a friend’s daughter’s wedding, next a family trip and, finally, Thanksgiving. Each event was something to look forward to – something to hope she would live to see. Her presence made each event even more special to everyone there. A similar interaction was described by Rachel Remen, MD, the founder of the Institute for the Study of Health and Illness and author of Kitchen Table Wisdom. Rachel was told at 15 that she had Crohn’s disease, that she would have a difficult life and probably wouldn’t live past the age of 40. She often wonders how differently she would have approached her life if she had instead been told that she would have a difficult life, but that it could still be a good life.

None of us knows how long our patients will live, what challenges they will face, and what their future will hold. Medicine is not an exact science and we each have experienced the mystery of patients becoming ill or recovering unexpectedly. By admitting our uncertainty and allowing our patients to have hope – of fully recovering or living to the next event or of being engaged with their loved ones and life itself until the time comes to let go – we give them a very powerful tool that will help them meet whatever life does bring. We demonstrate that we believe in the importance of living their life to the fullest – for as long as they possibly can. That is the essence of partnership and it can offer our patients an important and compelling source of healing.

With warm wishes that your holiday season will be filled with the promise of hope.

Posted in building relationship with patients, effective communication in healthcare, honesty in medical care, physician communication, Uncategorized | Comments Off on The potency of hope

Doctors are teachers

Posted on November 19, 2011 by Helane Fronek

The word doctor originates from the Latin verb, docēre, which means “to teach.” Much of our time is, in fact, spent teaching our patients about their condition, the treatments we offer, and how to stay healthy. Joanne Desmond, in Communicating with Today’s Patient, states that 25% of our time is devoted to explaining things to patients. For this reason, one of the most important factors that patients consider in selecting a doctor is the doctor’s skill in communication (84% of patients say it’s the most important factor in choosing a doctor).

Several communication skills have been shown to impact how well our patients understand and retain what we tell them.

1. Sit side by side, which is less intimidating than facing our patient and creates a sense of shared planning and experience.

2. Use visuals whenever possible. People remember 20% of what they hear, 40% of what they see, and 70% of what they both hear and see.

3. Employ the “ask-tell-ask” technique. Start by asking your patient what he knows about his condition. Then tell him something about it, and follow with a question to assess his understanding. Then, ask what else the patient would like to know and repeat the steps.

4. Divide your explanation into “chunks” and check with your patient after you explain each chunk to make sure she understood. Frequently, patients have questions about what we say and either don’t understand or may not even listen to what comes after that.

5. Be sure to use language that your patient will understand. If you want to introduce medical terminology, use the common English description first and then add the medical term.

We all become frustrated when we spend time explaining and our patient seems to forget or ignore what we have said. With these easy tips, you will markedly improve your patients’ comprehension, improve your clinical outcomes, and become a more effective teacher – and therefore, a more effective doctor.

Posted in building relationship with patients, effective communication in healthcare, physician communication, Uncategorized | Comments Off on Doctors are teachers

What moved me today

Posted on November 7, 2011 by Helane Fronek

In The Healer’s Art medical school elective (http://www.ishiprograms.org/programs/medical-educators-students/), we discuss the “3 question journal” in which we look back at our day and ask, “What surprised me today?” “What touched me today?” and “What moved me today?” As I contemplated my day, spent at the American College of Phlebology’s annual Congress, I realized how moved I was by the final session, entitled simply “M&M.”

We physicians, sometimes accused of being arrogant or aloof, routinely hold these morbidity and mortality conferences in which we open our wounds for inspection and critique by our colleagues, hoping for some revelation of what we did that caused an unwanted result, or what we might have done differently to avoid it. I know of no other profession that ritualizes this type of intentional vulnerability and inspection of our mistakes, ignorance, or misjudgments. We do this, as we all know, because we constantly strive to be better. We want to offer our patients the very best. We wish to prevent every complication, even though we know that complications are not only possible but even expected. To discuss our failings requires a certain sense of safety. In this era of increasing litigation, evaluation of our decisions by insurance administrators, and repeated patient satisfaction evaluations, how does this sense of safety still persist?

As my colleagues bravely stood up to discuss their less-than-optimal results, they were joined by other physicians who had experienced the same difficulties. Everyone added his or her experience, opinion, and suggestions. I watched as the entire group struggled to understand and formulate a better path for the treatment of our patients. There was a sense of shared experience, of shared risk, and of shared commitment to a solution. The nobility of this endeavor, in which honesty and vulnerability are intentionally placed above ego, and in which people generously contribute to the safety that makes it possible, made me very proud to be a physician.

Posted in effective communication in healthcare, honesty in medical care, physician communication | Comments Off on What moved me today

Your Own Personal Secret to Work-Life Balance

Posted on October 24, 2011 by Helane Fronek

Physicians (as part of a societal trend) are increasingly focusing on trying to balance the many demanding aspects of their lives. Below is a recent column I wrote for Vein Magazine; the link to the pdf is at the bottom. My wish is that you will take a few minutes to discover YOUR values – that short investment of time might be the starting point to achieving your true personal work-life balance.

Google “Work Life Balance,” and up pop 20,600,000 entries, many of which have tempting titles like “The 5 tips to Work Life Balance.” The way I see it, if it were as easy as 5 tips, we would have figured it out by now. So, what exactly is the secret to that elusive work life balance that we all strive for? During a recent workshop, I asked a group of physician leaders to experiment with the physical act of balance. Go ahead – try this yourself. When we stand on one leg and attempt to balance, we find that it is not a rigid or static state. It involves constant movement and continuous rebalancing. If someone hands us a five-pound weight (or our secretary suddenly quits or a child or parent becomes ill), we get thrown off balance and need to shift in order to feel balanced again. Another thing we notice while standing on one leg is that when we contract our core muscles, balance is easier to maintain. Similarly, when we live according to our core — when we view our life and make decisions through the lens of our core values — balance is easier to achieve and maintain.

Values are those principles or ways of being that make our life worth living. When we allow our circumstances to prevent us from honoring our values, we feel stressed, unhappy, and disconnected from the life we are living. A person with a strong value of family might feel oppressed working 80 hours a week, while the person who is extremely achievement and contribution oriented and working on a meaningful project might find those same 80 hours exhilarating. Defining some of our values is easy, since we may naturally pay more attention to them. Family, spirituality, being fit, service and learning are values that might be detected in how we spend our time. Other values such as justice, humor, connection, adventure and freedom may be discovered in what we long for. Another method of mining for values is to recall a time when we felt terrific – when life seemed great. What was going on? What values were you honoring?

Below is a partial list of values. Take a minute to circle your top 10 values.

Humor/ Family/ Integrity/ Achievement/ Excellence
Honesty/ Accuracy/ Spirituality/ Creativity/ Independence
Joy/ Beauty/ Risk taking/ Recognition/ Tradition
Freedom/ Harmony/ Success/ Contribution/ Fairness
Innovation/ Kindness/ Zest for life/ Learning/ Connection
Physical health/Service/ Adventure/ Responsibility/ Compassion
Free spirit/ Romance/ Order/Serenity/ Intimacy/ Authenticity

Now, consider how well you are living those values at home, at work, and in the rest of your life. Use your creativity to find one thing that you will do this week to bring your values into those parts of your life where you are not fully honoring them. Although this seems easy, it requires tremendous discipline and commitment. But just like that subtle shift you made when you were standing on one leg, those small adjustments may be all you need to give yourself true balance in your life.

HFronek_Summer_2011_-_v4i3_column

Posted in physician coaching, physician fulfillment, physician work life balance | Comments Off on Your Own Personal Secret to Work-Life Balance

Introductions – easy to do, profound in their impact

Posted on October 19, 2011 by Helane Fronek

Several months ago I accompanied my elderly relative to the emergency room. I sat in the room worrying as I wondered what might be causing his symptoms. Suddenly, a man entered the room and gruffly asked me, “how old is he?” After hearing my reply, the man walked over to the gurney, took hold of my relative’s wristband and asked what his name was. The man then proceeded to place ECG leads on the body of my frail and precious relative. As a physician, I knew that this man, pushing an ECG machine, was the ECG technician. I knew that he was doing a quick test to evaluate the electrical activity in the heart and that it would not hurt.

But what if I were a non-medical person? It would have been terrifying.

Too often, lost in our thoughts, thinking that what we are doing is routine, or rushing to “get everything done,” we enter a patient room and immediately begin our work. We ask questions, examine bodies, pronounce diagnoses and decree treatment plans. Our patients, while they may not admit to it, wonder who we are and what we are planning to do to them. How much better would it be for their sense of comfort, for building rapport, and for developing trust if we were to first introduce ourselves, state our role, and explain what we are there to do?

So, take a moment and let your patient and each person in the room know who you are, what credentials you have, and what you will be doing. It’s one of those things that is simple and quick – and goes a long way toward building the partnership that we want with our patients.

Posted in building relationship with patients, effective communication in healthcare, first impressions, physician communication | Comments Off on Introductions – easy to do, profound in their impact

Changing behaviors…made easier

Posted on October 8, 2011 by Helane Fronek

As physicians, we are the leaders of the healthcare team. And with medicine becoming more specialized, we depend increasingly on employees and consultants for their contributions. Unfortunately, it often seems that their vision doesn’t match ours and their behavior reflects it. We wonder why they don’t do what seems so obvious to us. If only there were a way to clearly and effectively tell people what we really need from them. I have tried wishing, hinting, modeling, and sticking my head in the sand.
Sorry to report this, but none of those strategies worked.

For several years, the One Minute Manager was the rage and we were told to sandwich critical comments between two positive ideas. Most of us tend to hear what we want to hear, so our employee often heard only the positive, last comment and nothing changed.

Another communication skill, contrasting, seems to work better. Contrasting is simply “saying what you don’t mean, followed by what you do mean,” and is described by Patterson, et al in Crucial Conversations (great book – full of helpful communication skills).

Let’s say we have an employee who does a good job – but consistently arrives 15 minutes late. We would start by telling him that there was something we wanted to talk with him about and asking if this was a good time to talk. Then we would anticipate what he might incorrectly assume if we simply corrected his behavior – that we were unhappy with him as an employee – and assure him that we didn’t mean that: I don’t mean to imply that I’m unhappy with the quality of your work here. After that, we would tell him what we do mean: I enjoy working with you and feel that you are a real asset to the practice. Finally, we would end with the change in behavior that we expect: I’ve often seen you arrive late and I need you to be in the office, ready to work, by 8:00 every morning.

This sequence first puts the employee at ease by declaring your overall approval of his work and appreciation of his contribution to the office. Then, it clearly defines the change in behavior that you are seeking. This is the last thing that he hears, increasing the chance that the message will land. Sounds simple, doesn’t it? Even better, it actually works.

Posted in effective communication in healthcare, effective delegation, physician communication | Comments Off on Changing behaviors…made easier

We’re in this together

Posted on October 1, 2011 by Helane Fronek

When I was a resident, my father suffered a severe MI – 2000 miles away from where I was training. Worried and distraught, I approached our chief resident and asked for permission to fly home to be with my parents. Her response still startles me today: “If you can find someone to take your call, you can go.” For people who are tasked with the job of caring for other people, physicians have historically been reticent to care and show compassion for each other.

As a faculty member for the Healer’s Art elective course at UC-San Diego School of Medicine, I was treated to a very different interaction during a recent class, entitled Sharing Grief and Honoring Loss. I watched in awe as first year medical students (who have known each other for only a few short and demanding weeks) supported, acknowledged and witnessed each other as each one shared their experiences of loss. I marveled as they instinctively knew to listen with generosity and kindness, creating a true community in which each person felt safe to expose their wounds and their vulnerable sides. How different would our community of physicians be if we all felt safe to share our concerns and fallibilities, knowing that we would be accepted, encouraged, and nurtured when we were hurting or in need of support?

As these medical students continue along their path and join our ranks, I hope that the culture of medicine will change and become “kinder and gentler.” But why wait? What can we each do right now to support and show compassion to our colleagues?

Posted in physician fulfillment, physician work life balance, Uncategorized | Comments Off on We’re in this together