Bring on the Emotions! A physician coach values all emotions for the wisdom they offer

Posted on July 14, 2015 by Helane Fronek

The Hollywood blockbuster, Inside Out, is a cute, entertaining collaboration of talented animators and storytellers at Disney and Pixar.  I love when something is new and innovative – and this movie is just that.  Although the movie is aimed at kids, the audience is packed with people of all ages.  A friend took her sons to a matinee and was surprised that she was the only person with children in the theater.  So what’s the appeal?

The story focuses on the inner experience of Riley, an 11 year old girl who moves with her Screen Shot 2015-07-12 at 11.31.56 AMparents from Minnesota to San Francisco.  In Minnesota, she had great friends, loved the outdoors, enjoyed lots of time with her parents, and was an avid hockey player. They move for her father’s new, very stressful job, which takes him away from the family.  Feeling the stress, Riley’s mom suggests they need to act happy so they don’t put more pressure on Dad.  The movie cleverly personifies Riley’s emotions as they run her life from “Headquarters.”  Joy, Riley’s dominant emotion, is the quarterback of the operation and tries to keep the other emotions from ruining Riley’s day.  Joy believes that if Riley can stay happy, everything will go well for her. Unfortunately, the inevitable sadness and difficulties of leaving a life she loved and trying to fit into a new culture catch up with Riley and she becomes sad.  Joy does her best to keep things positive, but Riley’s entire emotional world begins to fall apart.  With all hope gone, Joy finally realizes that each time Riley has faced a difficult situation, it was her sadness that rallied people to her side to love and support her.  By feeling and then expressing her sadness, she found the encouragement and strength to go on.

We live in a culture of oppressive positivity.  When people ask how we are, we’re expected to reply, “Great!” or at least, “Fine.”  As Patrick Lencioni discusses in his brilliant parable, The Five Dysfunctions of a Team, we are so uncomfortable expressing displeasure that we tolerate poor behavior, unfair practices and ineffective procedures, rather than make someone, or ourselves, uncomfortable.  Just as Riley needed to feel and express her sadness in order to move through it, we never change anything we don’t like unless we are willing to feel our discomfort and share it.

Mindfulness practices show us that our thoughts are transient.  Thoughts come and go, sometimes within seconds.  Similarly, emotions are transient – they are feelings based on the thoughts that we hold.  While some emotions are more comfortable than others, they each provide a window into our beliefs, desires and needs.  We are wise to allow ourselves to feel the emotion and uncover what it reflects.  Only then will we be able to develop a life that feels whole, meaningful and satisfying.

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Good communication – simpler than we think: Coaching Physicians to enhance their relationship with patients

Posted on July 2, 2015 by Helane Fronek

Last week I had the opportunity to speak about communication to a large group of family physicians.  Given that primary care doctors are pushed to see patients in ridiculously Screen Shot 2015-07-02 at 12.59.25 AMshort visits, I titled my talk, “Communication Skills to Make a 10 Minute Visit Seem like 30.”  As a physician coach, I work with doctors who are frustrated by the limited time we’re given to see patients and with the increasing demands we need to satisfy during those short times.  My aim was to present quick ways of developing rapport and gaining a patient’s trust, managing patients’  concerns within the context of a short visit, and explaining a patient’s condition and treatment plan in a way he or she can understand and remember. The skills are simple to implement, such as introducing yourself to everyone in the room whenever you see a patient.  “You can be sure that anyone in the room is important to your patient –  by acknowledging them, introducing yourself, and including them in the discussion, you show respect to your patient,” I suggested.  At the end of the talk, several people told me it was “the best talk of the day.”  I was happy and flattered.  It always feels good to accomplish your goals and contribute to your profession.  But what was striking was that many of the people told the same story – they appreciated what I said precisely because, as family members accompanying their loved one to a medical visit, they had been ignored by the doctor.

It reminded me of the time I took my father-in-law to the emergency room.  A man walked in, pushing a large piece of equipment.  He asked me how old my father-in-law was.  Then he asked my father-in-law what his name was.  Without a word of introduction or explanation, he began to attach ECG leads and run an ECG.  As physicians, we  understood the benign nature of the test.  If we had been laypeople, we might have been terrified.

As physicians struggling to provide care for patients in a system that seems to value “productivity” over conscientiousness, in which patients “rate” us based on the magazines in our waiting rooms and the time they spend waiting rather than on our competence, and where we must keep up with various “meaningful use” parameters and navigate computer systems designed by engineers and technicians rather than doctors, it’s easy to become disillusioned.  But these challenges make it even more important to hold onto a sense of humanity – ours and our patients’.  Simple gestures such as introducing ourselves, welcoming everyone in the room, and making sure everyone is comfortable go a long way toward establishing caring relationships that help patients trust us enough to share what’s really concerning them. And when that happens, we know that the many hours spent acquiring the necessary knowledge and skills were worth it, as we really do have an opportunity to make a difference in the lives of our patients and their families.  And that’s why most of us went to medical school in the first place.

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How Can I Help YOU? Physician coaching looks at service.

Posted on June 20, 2015 by Helane Fronek

Recently a friend interviewed a prospective employee for her practice.  “How much would you like to be paid?” my friend asked.  The woman told her and they agreed.  In their next discussion, the prospective employee remarked that she would really need a higher hourly wage. Following that, she changed the date she would be available.  When my friend rescinded her offer of employment, the woman backtracked and offered to work for less and start earlier.  It was too late.  Her true colors had shone through.

Screen Shot 2015-06-20 at 6.17.16 PMIt reminded me of an  interview in which Sheryl Sandberg, COO of Facebook and author of Lean In, discussed how she decides whom to hire.  Most people, she mused, try to convince her why they are the best applicant.  She remembered one prospective employee who said, “I could tell you all about me, but what I really want to know is what’s your biggest problem and how can I help you solve it?”  Sheryl hired the person immediately.

Master networker Keith Farrazzi, author of Never Eat Alone, stresses that when one looks for a mentor, meets a new person at a meeting, or attends an interview, it’s important to find a way to serve that person, rather than only looking for what the person can provide to you.  Is there a connection you can make for them to a likeminded person?  Is there a paper you can send their way that discusses a subject you two spoke about?  Any healthy relationship needs to have give and take – when we sense that concern is only going in one direction, we are less likely to offer any more.  And truly, one of the easiest ways to find fulfillment and make ourselves feel better about our lives is to do something for someone else.

When seeing patients in the office, most physicians start the encounter by asking an opening question.  My favorite is, “How can I help you today?”  It starts the interaction by making it clear that I want to help my patient.  Although it’s implied and often assumed, by stating my intention, I immediately convey that I want to care for them in a way that would be meaningful to them.  It also helps focus the patient on the concern that brought them in.

I often hear people lamenting the fact that we live in a “me society.”  Social media, with its ease of broadcasting each moment of our lives, and smartphones that allow us to take “selfies” (and immediately put them on social media) have enhanced the sense that we are the center of our, and many other people’s worlds.  Why not spend the next day asking yourself how you can help each person you interact with?  My guess is your life will feel even more fun and fulfilling.  You might deepen a friendship.  And maybe even get the job you’re looking for.

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Got joy? A physician coach suggests we have a choice in each moment

Posted on June 12, 2015 by Helane Fronek

Last night we saw a young couple we hadn’t seen for several years. While Screen Shot 2015-05-19 at 10.28.08 PMdiscussing their desire to start a family, I repeated something I’ve often shared: once you decide to have a baby, you never stop worrying. You worry that you won’t be able to conceive, or that something will happen to the baby.  After that are complications of childbirth, childhood injuries, the list goes on. I’ve known many parents who spent more time worrying than experiencing the pleasure of parenthood.

Why do we often drown our joy or satisfaction with thoughts of loss or failure?

Years ago I shared with my father my excitement about visiting Manhattan again.  I had loved living in the city and made great friends who  said,  “Come and stay with us anytime.”   I finally had a chance to visit.  “How do you know it’s all right?” my father warned.  “What if they’ve changed their mind or moved?”  As a young adult who didn’t want her dreams squashed, I felt irritated and resentful.  Then it occurred to me that this was how my sweet, kind father lived his life,  reluctant to get too excited about anything lest he be disappointed.  He once told me how happy he was upon making his high school basketball team. Unfortunately, his father wanted him to work in the family business after school.  As my dad proudly showed off his new uniform, his father gruffly said, “take it back.”  My father decided at that moment that it was dangerous to become excited about anything.

In The Tao of Poo, Winnie the Poo is asked about his favorite moment.  “My favorite moment is when I’m opening up a new jar of honey,” he answers.   Then he pauses and corrects himself.  “No, it’s when I’m thinking about opening up a new jar of honey.”  The anticipation of wonderful things ahead is almost as exciting and pleasurable as actually living through them.  When we dream of a vacation, recall the delight of being with people who live far away or who have passed away, or imagine what it might be like to do something wild and exciting, we are having an experience.  We can see ourselves in those circumstances, we’re reminded of what we love or strengths we have, we see possibilities where they didn’t exist before.  If they never actually occur, we still benefit from anticipating them.

For others, a sense of unworthiness stands in the way of experiencing joy.  Especially true for survivors of tragedies, it can result from any sense of guilt or shame we feel.  We  feel we don’t deserve to be happy – so we don’t let ourselves feel the joy that’s all around us.

Our daughter is visiting this weekend.  I know she’ll only be here for a day and that I’ll feel sad when she drives off.  I can’t wait to give her a big hug, see that beautiful smile on her face, and watch her joke around with her dad.  It makes me smile just to think about it.  In this moment I have a choice.  Should I feel sad that she lives far away?  Or should I choose to focus on the joy of that anticipation and on enjoying her company for the day?

In what ways will you choose joy today? 

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Do you feel like an impostor? Physician coaching helps us tell ourselves a different story

Posted on June 5, 2015 by Helane Fronek

Sitting on a plane bound for the American Medical Women’s Association meeting, I struck up a wonderful conversation with the man next to me.  A PhD in English and master’s degree in counseling preceded his law degree, which led to an impressive career Screen Shot 2015-06-05 at 3.20.32 PM– he was on his way to meet a prominent journalist to discuss humanitarian crises.  When asked why I was traveling, I mentioned that I would be speaking on the Impostor Syndrome.  “What’s that?” he asked.  I explained it’s the belief many successful people have that they’re a fraud and are just faking their competence.  His eyes widened. With a sense of shock, he replied that he has felt that way himself.  I wasn’t surprised, as up to 70% of successful people admit to feeling like an impostor at some time in their life.

Many physicians and other professionals spend each day thinking, “I’ve fooled them this long, but one day they’re going to find out I’m not as smart as they think.”

If we’re so accomplished, why do so many of us feel like a fraud?

There are many reasons why successful people don’t “own” their success and attribute it to luck, charm, or their ability to fool others.  Messages during childhood can contribute. If you were labeled “the smart one” by your parents, you may believe you’re not the person your parents thought you were – you’re a fake – if you make a mistake or don’t master every subject.  Gender, race and nationality stereotypes can play a role in diminishing a person’s sense of belonging and competence.  Certain environments feed self-doubt.  Upon returning to academia, we were asked for feedback on a session in which  we were to facilitate discussion of multiple videos about communication difficulties. I explained that I found it challenging to decide whether to limit the discussion on each video in order to play them all, or let the discussion go to deeper levels of understanding and skip some videos.  Another instructor wrote back, “I managed my time perfectly.”  With messages like that, it’s easy to feel we’re not as good as our peers.

Among the most important factors in creating impostor feelings is our own definition of competence.  Some people feel they must be perfect in order to feel competent.  As Julia Cameron, author of The Artist’s Way, explains, “Perfectionism is not a quest for the best.  It is a pursuit of the worst in ourselves, the part that tells us that nothing we do will ever be good enough.”  In her wonderful book on the impostor syndrome, The Secret Thoughts of Successful Women, Dr. Valerie Young suggests we seek GEQ – good enough quality – not perfection. Other “impostors” feel that competence requires that we succeed effortlessly and do it all on our own.  Most things in life require effort and assistance.  Better to appreciate ourselves for what we’re learning and our ability to enlist others to get a job done.

Knowing how common these feelings are can help us neutralize them when they occur.  “There I am having those impostor feelings again!” we can remind ourselves.  Challenging our definition of competence and finding a more realistic one is another good strategy.  Finally, when we do succeed at something, we can consider what qualities in ourselves contributed.  By acknowledging our skills and abilities, we can accept that it is us and not an impostor that creates our successes.

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What do we really need? A physician coach learns a lesson in simplicity

Posted on May 23, 2015 by Helane Fronek

At the recent American Medical Women’s Association meeting, I had the pleasure of Screen Shot 2015-05-23 at 3.51.40 PMcoordinating the judges who evaluated over 100 posters created by medical students and residents who attended. The students are particularly excited as they stand by their poster and discuss their research or case study with physicians who pass by. They’re all dressed professionally, eager to impress and gain the experience afforded by the situation. One enthusiastic first year student shared with me how excited and nervous she was as she considered what to pack for the trip. Her down-to-earth boyfriend shared his opinion of her situation: “When I’m going hunting, I need a gun and a jacket. To present a poster, you need a poster and a suit.”

In our commercialized society, it’s easy to get hooked by the pressure to always have more. And with the array of activities to choose from and the ease of access, it’s tempting to overfill our plate with more things to do. That’s been an ongoing struggle for me – so many interesting things to do, so little time.  It often leaves me overwhelmed and not able to enjoy what I do or appreciate what I have.

In her yearlong attempt to discover what makes us happy, Gretchen Rubin began by de-cluttering her home. Systematically, she excavated each drawer and closet, giving away duplicates or items she didn’t use. She found she felt happier in her less cluttered home.  Since we’re living out of our home with most of our possessions in storage, I decided I would purchase nothing new until we moved back into our home, unpacked the many boxes, and rediscovered what we have.  I’m enjoying finding new and creative ways to use the things we brought along and a sense of freedom with my shopping-mall-free life. Increasingly, people are opting for small-scale living spaces – it’s amazing how much life they smartly and neatly pack into 200-400 square feet.

For our children’s first years, I saw toys, books and games as opportunities for their learning and growth. “They would develop manual dexterity with this toy,” I reasoned. “They’ll learn numbers with this book,” I decided. While many of the toys and books that filled our home were enjoyed and useful, one of our kids’ favorite pastimes was opening a box of plastic spoons, scattering them on the floor, and putting them back in the box, one by one. Manual dexterity and numbers could also be learned from an ordinary box from the grocery store.

From now on, I’m planning to ask myself, “What do I really need?” whenever I’m considering a new purchase, packing for a trip, restocking our home or considering a new activity.  I want each choice to reflect what’s truly important and necessary. I’m looking forward to a less cluttered and more spacious home and life.

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Preparing yourself for each day by opening your mind and heart: a physician coach takes a lesson from a travel expert

Posted on May 16, 2015 by Helane Fronek

Yesterday I heard a discussion between Rick Steves and Pico Iyer, two travel experts Screen Shot 2015-04-11 at 12.53.15 PMsharing their love of world exploration.  Having taken many travelers around the world, they agreed that two people can visit the same country and have very different experiences.  One comes away inspired by the music, culture and people, while the other “complains about the food.”  The difference is that the people who enjoy the trips had taken time to “open their hearts and minds” to the possibilities they might experience.

That same type of mindset can make all the difference in our daily lives.

Too often we awaken with a sense of worry or dread about what we anticipate might happen today.  If we allow our worry to hijack our intentions for the day, it’s hard to even get out of bed.  Mindfulness, the practice of bringing our attention to what is actually happening right here and right now, helps us escape from the illusion our very busy mind creates for us and brings us back to the present.  After all, none of those things we’re worrying about is actually happening – and it’s very possible they will never happen!  It’s wise for us to remember the adage, “Don’t believe everything you think.” People who have a mindfulness practice such as meditation know that our thoughts aren’t to be believed.

When I first began to meditate, I was frustrated – I couldn’t clear my mind and achieve that desired goal of peacefulness.  No matter how many times I brought my attention back to my breath,  another thought quickly seized my attention.  But when I simply noticed the presence of the thought without allowing it to capture my attention, it effortlessly floated away, to be replaced by another thought and then another.  It was clear these thoughts were simply illusory and represented my mind’s activity rather than something real.  Try it!  Sit in a quiet spot and practice keeping your attention on only your breath (or on anything – the feeling of your body sitting on the floor or chair, the expansion of your chest as you breathe in and out…).  Notice how your thoughts come in and then float away.  This simple practice, even for a few minutes a day, can help to disentangle you from the cords that your mind uses to keep you captive in its thoughts, and help you see more clearly what is real in your life.  One physician coaching client of mine told me about her meditation experience – usually less than 15 minutes and sometimes as short as 1 minute a day.  She’s noticed she is more centered and has found significant improvement in both her patience and ability to respond more effectively in times of stress and conflict at work.  What a great investment of time each day!

And for all of us (meditators and not) there is a simple thing we can do to “open our hearts and minds” to the possibilities of each day. Instead of buying into the dreary and fearful thoughts that flood our minds when we awaken – we can wonder, “what might happen today?”  What interesting, fun, stimulating, growth-enhancing, inspiring things might come our way?  We’ll only notice, and thus reap the benefits of, the ones we open our hearts and minds to.  This simple question will help us do just that.

I wonder…what will happen today for you?

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What’s your style? It’s a good one! A physician coach suggests that we each bring who we are – with confidence

Posted on May 9, 2015 by Helane Fronek

Recently I watched a class of first year medical students practice communication skills with a “standardized patient,” an actor playing the part of a newly diagnosed diabetic.   Screen Shot 2015-04-11 at 2.31.54 PMThe students were tasked with explaining diabetes and negotiating a plan for further testing and lifestyle modifications.   Blood testing, exercise, and dietary choices were broached and each question posed by the patient was answered.  Each student took a turn, picking up where the last student left off. What was striking was how differently each student carried the discussion – some were quieter and listened intently, validating the concerns that the patient was experiencing; others were more animated, their contagious enthusiasm infusing the patient with hope that she could manage all that was before her.  The actor provided each student with feedback and reflected the fact that each approach was effective and helpful in understanding her condition and gaining confidence that she could face what was ahead. The Myers-Briggs personality assessment provides a description of the preferences we each have for what we pay attention to, how we like to take in information, the methods we use to process that information, and how we prefer to deal with the outside world.  When I ask a physician coaching client to take the Myers-Briggs, I’m careful to emphasize that there are no good or bad answers, and no good or bad personality types.  What’s important is to understand who we are and what we bring to our relationships, groups, and interactions.  Each of us has something special to offer.  It’s crucial that we recognize and acknowledge that.  Otherwise, we risk withholding skills, talents and information, thinking that our way is not as valuable as someone else’s.  Or, we aggressively try to dominate, believing that our way is the only relevant way to approach a situation.

It’s taken me years to understand and accept my own preferences. A strong introvert, I opted for a wonderful conversation over a quiet dinner with a friend rather than the boisterous gala at a recent meeting. An extroverted colleague later shared her delight with the evening of laughter and dancing. We each chose appropriately and emerged energized and ready for the morning sessions. I prefer to plan and follow an uninterrupted path toward my goals. My husband is happy to divert his attention to various interesting things along his path. Because of my focus, most of our arrangements flow smoothly. But it’s his willingness to shift his attention that makes our life more interesting and fun.

In what ways are your preferences important in your relationships, activities and work? How do those of others complement what you bring? By appreciating and contributing each person’s ideas and strengths, we make our own lives more enjoyable and enrich our workplaces and homes.

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Motivating Patients – a Physician Coach Brings Neuroscience to the Rescue!

Posted on May 2, 2015 by Helane Fronek

As healthcare providers, we need to communicate with and motivate many different types of people each day. With some, we feel as if our communication is seamless. We say what Screen Shot 2015-05-02 at 10.22.16 AMwe mean, and they understand and respond appropriately. With others, our words are misinterpreted. Where we meant to reassure, we instead provoke anxiety. As we try to motivate, we instead discourage. As a physician coach, I work with physicians to help them communicate more skillfully.  One of our current challenges is that we’re asked to do more in each patient visit, while being given less time to do it.  That means that we need better tools than simply sitting across from a patient and leisurely explaining what they need to do.  The exploding field of neuroscience can provide us with better ways to engage with people who might have different ways of seeing the world than we do so we can be more effective and efficient in caring for them.

Christine Comaford, serial entrepreneur/venture capitalist/former Microsoft engineer/executive coach, explains that there are 4 meta-programs that we each use to process the information coming to us. Two of them are particularly useful in dealing with patients. The first, “toward-away,” proposes that some people move toward rewards and others away from pain. We can ask, “What do you want in your work/your home/your life?” If the person describes what they want to achieve or attain, they are likely “toward” processors. They will resonate more with words and concepts that focus on what they will get from an intervention. If they speak more about wanting to prevent a disaster or “hold the fort down,” we might want to emphasize what they will avoid. Knowing what motivates each patient allows us to select appropriate language and examples. A toward person may be energized to stop smoking if he thinks he will have the energy to play with his grandchildren. Describing the debilitation and suffering that results from smoking may pack more of a punch for the away person.

The second dichotomy is “active-reflective.” Active people like to take immediate action and move ahead. Reflective people prefer instead to analyze the situation, obtain data and opinions, and then decide. If we ask, “How do you solve problems at work?” we’ll hear the active people say, “I like to make a decision and move on.” The reflective people will share that they like to weigh all their options before moving ahead. While we need to fully explain the procedure and complications of any treatment, the active person will be satisfied with less detailed information and may feel more comfortable with a plan to “get it done” and “not wait.” The reflective person may need more information to make a decision to undergo treatment and will be reassured by words such as “could” or “consider.”

During our medical training, we learn a new language – the language of medicine. We begin to use words derived from Greek and Latin that end in –itis or –ectomy. As we learn to skillfully communicate with patients, we learn to translate these words back into English so our patients understand. Neuroscience now provides us yet another language – a simple language that holds enormous power for influencing and motivating our patients to make choices that support their better health. While it does take some time and attention to incorporate into our daily practice, I guarantee that it’s easier and less complicated than memorizing all of those mnemonics during medical school!

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The mysterious effects of what we say – a physician coach considers our intention and our patients’ experience

Posted on April 25, 2015 by Helane Fronek

On a recent plane ride, I sat next to a man who told me his harrowing, near death story of remaining in a coma for weeks after suffering a catastrophic medical condition.  Screen Shot 2015-04-23 at 8.37.10 PMFortunately, due to excellent care and a dose of luck, he recovered enough to be enjoying life again.  One of his clearest memories of the ordeal is when the physicians came into his room after he had awakened and was lucid again. They shook their heads and remarked, “We thought we had lost you.”  As a physician, I understood that the doctors were struck by the mystery of his recovery and were grateful that their fears for him had not materialized. Interestingly, the patient found their comment extremely unsettling.  It underscored the chasm that frequently exists between our intentions and what our patients actually experience.

Many years ago, I treated a patient’s varicose veins.  While our modern treatments are usually successful, a small number of patients don’t respond perfectly to one treatment. At his followup visit, my patient remarked that he was happy with the treatment and felt that things had gone well.  After examining him, I felt that things had not gone very well.   “Actually,” I informed him, “this result is not as good as I had hoped, and not as good as I think we can accomplish for you.”  I explained what we would need to do to obtain a better response.  To my surprise, he never returned.

During physician coaching sessions, my clients and I engage in deep and life changing conversation.  There are many times I say something that provokes sadness, confusion, excitement or a variety of other intense emotions.  I’ve learned to ask, “what do you notice when I say that?”  It’s a simple question that allows them to identify what emotion, image or other memory has been stirred up.  And it affords me a window into their experience that bridges this gap between what I may have intended and what my client is actually experiencing.

In a recent medical school class about delivering bad news, a colleague wisely remarked that we never know what our patients perceive to be “bad news.”  Learning they need to be in a cast or take a particular medicine may feel catastrophic to patients.  Perhaps my travel companion, awakened from his coma, was unsettled by the realization that life is so fragile.  It’s possible that my patient lost confidence in me or couldn’t accept that another treatment was needed.  In both situations, our communication was lacking two important ingredients – an expression of our intention and an inquiry into the patient’s experience. Facial expressions or body language may tip us off to the fact that our patients are struggling with our message and we might be prompted to ask what they’re feeling. Even in their absence, our relationship will be stronger and we will be wiser if we explain what we hoped to accomplish and ask how they feel about what we’ve just said.  It tells our patient that we want to know them and it provides the foundation for clear communication.  And that’s good medicine.

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