Let’s ASCEND to a more effective flow of communication with our patients. A physician coach shares a useful mnemonic

Communication, as they say, is a two-way street.  For several years, we have taught Male doctor discussing reports with patient in medical officemedical students the art of communication.  They learn to develop rapport with patients through eye contact, body language that conveys interest in what the patient is saying, and by demonstrating an interest in the patient as a person .  They learn to signpost their
way through the encounter to let the patient know what to expect next, reducing the patient’s anxiety.  They learn to deliver “bad news” with the SPIKES protocol.  Strategies to help patients remember what we tell them are taught and practiced.  Although doctors are often criticized for their communication style, our profession is working to improve our skill set.  That’s one side of the communication street.

But what are we doing to enhance our patients’ ability to communicate with us?

Many times, patients leave our offices more confused than when they came, their real questions unanswered, even though we offered our best care.  In order to change this, it’s time for us to assist our partners in communication – our patients.  Karen Knops MD, an experienced palliative care specialist in Washington, along with the Gold Foundation, dedicated to Keeping Healthcare Human, provide us with an excellent tool for this purpose.  ASCEND is a simple mnemonic that provides six principles and practices to assist patients in becoming strong and effective partners in their care.

Dr. Knops suggests that patients develop the habit of Anticipating their doctors’ appointments by thinking about the purpose of the visit and considering what questions they want to be answered and who should accompany them.  After her experience as a teenager with scoliosis, she shares that, “I’ve never lost my awareness that commonsense can easily go on hiatus when we are gowned and vulnerable.  Taking notes should have occurred to me as a straight-A student, but never once did I try that.  I would log hours practicing for a youth symphony audition, but preparing for a doctor visit never crossed my mind.”  Once in the room, patients can ask their physician for a Summary of the big picture before details are discussed.  They can share their Concerns, Explore the risks and benefits of planned tests or treatments and ask for Explanations, including what the Next steps will be.  And they should be sure to Document the important information and instructions.

We provide patients with all sorts of assistance – why not suggest a simple mnemonic that will help to ensure the smooth flow of communication in both directions?

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The Art and Power of Saying “NO” -Physician coaching clears the path for fulfillment and impact

It’s a common experience- someone asks us to do something and, while our heart and gut are screaming, “NO!” we hear the word “yes” come out of our mouth.

Woman Scientist: Stop SymbolWhy and how does that happen? And, more importantly, how can we change that behavior so our response reflects our true desire?

When we find ourselves saying yes, it may be for a variety of reasons. Unfortunately, we rarely take time in the moment to examine our priorities so we can come up with the most appropriate response. Instead, old patterns, such as wanting to please others, not believing we have the right to say no, a fear of missing out, or a variety of other worries hijack our response system.

One protective approach is to invoke an automatic response. “That sounds like an interesting idea – let me think about it and get back to you,” buys some time so we can consider the pros and cons in a safe environment, without the pressure to please.

Then, we can sort through our values and decide whether the opportunity aligns with them or not. This alone may help us decide to say yes or no.

Another important step is to imagine how much time the new project will take. By consulting our calendar, we can see if we have time for this. If not, our answer may be simple. And if we still want to say yes, what might we have to say no to in order to fit this new commitment in?   Conversely, if we say no, what might be possible instead? Often, when we hold one option up next to the other, we see clearly which is the wiser use of our time. If we truly don’t have time to do a good job, it’s always better to decline. Otherwise, we’ll end up disappointing others with poor quality or late work. Our reputation is built on the integrity we show and the product we produce, rather than on our willingness to say yes if we end up turning in poor quality or late work.

Many of us feel guilty if we refuse various offers, as we don’t want to appear selfish or not a team player. Yet, if we decline an offer, it may create an opportunity for someone else to step up. Who might be good at this besides us? Who might appreciate the chance to learn or receive some recognition?

In the end, if we decide we don’t have the interest or time to accept the offer, there are a number of ways to say no that still maintain our connection to the person who asked. We can offer to do part of the project, to work on it after a certain date if time is the issue, or to work on another project if we just don’t have an interest in the current offer. And, if none of these responses fit, we can offer our encouragement and acknowledge the importance of their efforts – these are important sources of assistance as well.

By becoming more skillful at discerning where our time is best spent and learning to say no, we’ll have more time for the things that are truly a yes for us.  Only in this way can we are live our most fulfilling lives and have the most impact in the world.

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Speak Out to Heal our Divide and Get What you Want. A physician coach offers a simple, 3-step process

Physicians report increased anxiety among patients, who cite the political climate as a major source of distress. “Our country is divided,” we often hear. Preferring not to couple pointing fingers at each other, blaming each otherconsider others’ opinions, we remain in the echo chambers of shows that feature only our views. While few enjoy the tachycardia, tight muscles, and flushing that accompany confrontation, another reason we avoid potentially antagonistic conversations is that we don’t have the skills. We’re afraid to share our opinions, lest others become angry and say hurtful things or we direct those damaging outbursts toward others. This simple, three step process has the potential to open up productive dialogue and heal the divide we are feeling.

When we feel a confrontation coming, the first step is to recognize our emotion. Is it anger? Frustration? Fear? Sadness? Exposed to difficult feelings throughout training, physicians learn to ignore them as a defense against feeling overwhelmed and being unable to act appropriately. With practice, we can become adept at understanding our emotional state. We feel a strong emotion when an issue we care about is at stake, so the second step is to identify the issue. If we’re cut off during a discussion, are we angry because we feel disrespected, because it’s important to hear all viewpoints, or because the information we’re sharing may prevent something untoward from happening? Once we understand the issue, we can speak calmly and directly about that.

Let’s say you are assigned a different MA from the float pool each day of your assistant’s vacation. You are frustrated explaining your protocols to a new person every morning; any experience she gains that day is lost when she doesn’t return. You have run an hour late each day, lab results have slipped through the cracks, and you are worried that a serious issue might occur. You feel disrespected because another colleague was assigned one person for the entire duration of her assistant’s vacation. You feel your jaw clench and your fists tighten as another new MA walks into your office in the morning. You want to explode.

Instead, you recognize you are angry. The issues are patient safety, the efficiency of your practice, and the unfairness and disrespect you perceive. With that understanding, you call the administrator and say, “I’m unhappy I’ve been assigned a new assistant each day. Things have slipped through the cracks and I’m worried there may be a serious patient safety issue if this continues. In addition, the situation is unfair and disrespectful to me, as my colleague was assigned the same MA for the entire duration of her assistant’s vacation. I request that I be given the same respect and that the MA in my office today remain with me for the duration of the week.”

Using this simple 3-step approach can help us speak plainly and powerfully without risk of damaging relationships, and greater understanding between people can occur. Only then can we heal the divide we are experiencing.

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What are you tolerating?

Most physicians are hard-working, driven people.  We wouldn’t have gotten where we are without that drive, ignoring opportunities that might have been more fun so warningwe could gain knowledge and skills to care for our patients.  People are surprised when they learn that our daughter, a second year medical student, is studying over 12 hours each day in preparation for her licensing exams.  No physician would be surprised at her dedication and strict regimen.  It’s what we accepted we must do to become a doctor. Don’t misunderstand me – I’m not complaining about this investment of time and attention.  I love learning and felt happy to be gaining important information that I imagined I would use to help my patients. But along the way, I became disconnected from many things I loved.   What’s troubling is that I became so used to striving that my almost single-minded devotion to learning began to seem normal.  Several years later, I became burned out.

Similarly, people in failed relationships often look back and recall behavior of their partner that foreshadowed what was to come.  Refusals to help when asked, unwillingness to spend time together, and hurtful, dismissive comments were ignored or overlooked.  “She’s tired, stressed, preoccupied,” were excuses given to explain the behavior.   We often tolerate unpleasant or unhealthy behaviors or situations for fear of imagined repercussions, hoping that the behavior will change.  Unfortunately, this is magical thinking. When we tolerate undesirable behavior, from others or ourselves, what we usually get is more of the same, or worse.

What are YOU tolerating?

Are you tolerating intimidating or unfair treatment by others in your office?  Are you tolerating a poor diet or lack of exercise, believing you don’t have time to do better? Are you tolerating being left out of plans made by your partner or friends, even though you feel ignored and hurt?  Or perhaps rude responses from your kids?

While your current level of distress or disappointment may not have reached its boiling point, imagine that this situation has continued for the next 10 years.  How will you feel then?  What will you have given up?  How much better would your life be if you had corrected this situation now?

Stepping up to a conversation in which you honestly share what you have noticed and the impact it is having affords the other person an opportunity to change.  And if the behavior continues, you can make a conscious choice between continuing to tolerate it or changing the situation. Either way, you take greater control of your life, so that in 10 years, you will have given yourself the opportunity to have the life that you truly want to be living, and not one that you are simply tolerating.  How great would that be?

 

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We’re all in transition: physician coaching can help us navigate ours

Several months ago I received a phone call from my cousin Steve, who I’ve spoken with only intermittently over the years.  I’ve admired Steve as the stay-at-home-dad Hand and butterfly hand painting, tattoo, over a blue skyfor his two daughters, who grew into successful, dynamic and authentic women.  Steve is a talented writer with a great sense of humor.  I always wondered why he never pursued a career as a writer, or anything else, even after his daughters went to college and moved out of the house.  Steve and I grew up in the same city, almost like brother and sister, playing together often and having a joyful time whenever we were together.  At least, I thought so.

In our call, he reminded me of a conversation we had when we were young, when I asked him if he had ever wished he weren’t a boy.  I was quite the tomboy, who loved to climb trees, run and play sports – all things that boys did – and I frequently wished I had been a boy.  Steve recalls fearing he had been “found out” during that conversation, as he did wish he had been a girl, and now knows he’s transgender.

We’ve had several long conversations since that first call when Steve revealed this news.  We share the challenges we are having as we move into our new phase of life.  She, as a woman, shedding her identity as a man named Steve and discovering a new identity as a woman named Eve.  Me, as a physician coach, exploring what it will be like without my identity as a clinician.  While the depth and reach of our change is quite different, as Eve says, “We are all in transition.  Mine is just more obvious.”

It saddens me to think of all the years Eve spent feeling invisible and unable to be who she was.  It explains why she never developed her talents and created a separate career. As she  begins to explore life as a transgender woman, Eve is becoming more outgoing, is meeting and sharing her story and beliefs with others,  and feels a sense of relief at being able to be herself.  She says it feels like she’s broken out of a prison and is finally free.

How can we each become more of who we are so we can live with greater freedom and bring our gifts and passions to the world?

Eve’s lesson for all of us is…where do we feel we aren’t being ourselves?  What is the cost in terms of withholding our talents, depriving ourselves of the joy of self-expression? What steps can we take towards being more authentic and honest about who we are and what we believe in?  As we each transition into a fuller version of ourselves, greater possibilities unfold and we become a beacon for others to discover and contribute who they are as well.  The world will reap tremendous benefit as we live a more joyful, exhilarating life.

 

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Let’s Dust off our Ethical Compass – and map our way back from burnout

Physicians have long felt the pull between our natural desire to please our patients and our professional and ethical commitment to provide care that’s in our patient’s best interest.

When a patient requests an antibiotic and we know their viral illness won’t respond to one, we feel torn.  When a patient who can walk without much trouble asks for a disabled placard, we feel conflicted.  The angst of these decisions has intensified with the pressure of online reviews and the arrival of patient satisfaction scores. Honestly and compassionately explaining why we’re refusing a request, in a way that maintains a trusting relationship, requires time – and that’s something we have less of as the years pass.

These types of decisions leave us feeling increasingly burned out.

We’re frustrated that we’re not given the time to fully use the knowledge and skills we worked so hard to acquire. We’re angry that we’re expected to satisfy the conflicting demands of our patients, medical group, the pool of medical resources, and our own sense of professionalism and ethics.   We resent outside interests – insurers, administrators – that interfere with care we feel is necessary. And we feel despair when our dreams of having a satisfying career feel like they’re evaporating.

Doing what pleases patients or administrators if it conflicts with our ethical convictions doesn’t lift our feeling of unease. But when we insist on following our own beliefs, we worry about losing our job or facing a dwindling practice. We feel stuck.

Finding our way out of this will take some thought and courage, but we can regain the sense of authority and integrity we’re so painfully missing.

Take a moment and consider the conflicts you feel in your practice. For those that constitute a simple difference of opinion,  you might decide to take the path of least resistance. But with those issues that are rooted in your sense of ethics, a different tactic is required. Because the person you live with, day in and day out, the one you most need to please – is YOU.

As a physician coach, I’ve seen physicians courageously stand up for what they believe. This act has caused some to leave their positions. Others sparked an uprising that spurred important change. None of these physicians regretted their decision to follow their ethical compass. Those who continued to do what they felt was unethical continued to suffer and became increasingly disillusioned.

With all the changes in medicine, many of us find ourselves straying from the path of service and fulfillment that we thought would define our career. But we each have an ethical compass that advises us when we’re getting off track. If we want to be healthy, engaged, satisfied physicians who provide good care to our patients, we need to dust off our compasses and find our way back to the inspiring path we signed up for.

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Reconnecting with yourself – the antidote to physician burnout

In the first weeks of  medical school, a colleague asked, “What do you like to do?”  My response still saddens me: “I used to like to cook, and I used to like to read and I used to like to run.”  It had taken only a few short weeks for me to give up many things I loved, activities that brought me joy, interests that made me feel like me. As we travel further in our training, we feel other pressures – not to show or even feel our emotions, to feign interest in things that don’t excite us – that cause us to forget what is meaningful or inspiring to us.  As we become increasingly disconnected from who we are, we begin to even feel estranged from our own lives.  This isn’t the life I dreamed I’d be living…whose life is this anyway?  These are important steps along the road to dissatisfaction and burnout.

hands-on-heartHow can we reconnect with ourselves and find the joy of living and practicing medicine?

Given the circumstances of practicing medicine, it may seem like this is an impossible task.  Fortunately, even small shifts can make a big difference.

Clients have reported that beginning a meditation regimen – a mere 10 minutes a day – helped them feel more present in their life and almost immediately resulted in greater calm, better sleep, and less irritability.  Others found that understanding their core values and planning one activity a month that reflected those values gradually changed the experience of their life.  Their life suddenly felt more fun and they felt more alive.   For exercises to help you find your values, click here.

Recognizing their strengths and seeking ways to use them at work allowed physicians to experience greater meaning in their work.  We often downplay our strengths. Since they come easily to us, we believe that everyone must have those same abilities.  This leads us to undervalue their importance and usefulness. Tom Rath’s Strengths Finder 2.0 is a simple and effective way to gain clarity on our strengths.  One of my strengths is “Developer,” which means that I instinctively see others’ strengths and enjoy helping them develop their talents and abilities (a good quality for a physician coach!).  I derive tremendous satisfaction and joy from mentoring medical students that I didn’t find in other aspects of my work.

So let 2017 be a year in which you grow to know and really connect with YOU.  Allow yourself the joy of rediscovering what you love to do and the strengths you can contribute to your work, your family, the world. The world needs each of us to do that.  Because the more we know and love ourselves, the more healthy and loving the world will be.  And as you reconnect with yourself, your life will become more fulfilling, meaningful and joyful.  A certain antidote to burnout.

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