Monthly Archives: November 2013

Charisma In Medicine: Inspiring Others To Improve Patient Care

By its very nature, Medicine involves close personal contact with others.  Communication with patients, families, staff and colleagues is essential to success.  All physicians have different ways in which they communicate–some more effective than others.  The best communicators are able to inspire, engage, and cultivate trust.  Everyone is born with different skill sets and communication styles may vary widely.

Recently, I came across an article in Inc.com that discussed the importance of charisma and how it can improve the success of leaders in the business world.  Author Jeff Hayden goes on to describe 10 habits of very charismatic leaders.  As I read the piece, I began to reflect on ways in which these tips could make me and my physician colleagues better communicators and better leaders in the world of medicine…

As we always do when tackling an issue in medicine, lets start with the available data….

Websters defines charisma as :

1. A personal magic of leadership arousing special popular loyalty or enthusiasm for a public figure

2. A special magnetic charm or appeal 

So, how can this help us take better care of our patients?  If we are able to inspire and produce excitement amongst our team–from nurses, to physician extenders, to support staff–both our patients and our employees will have a better experience when working with us.  If we are able to appeal to our patients and their families we are able to provide much needed trust and are more likely to be able to partner with our patients in an effective way. 

As we examine Mr Hayden’s Tips for Charismatic Leaderships more carefully, we can find insight into ways in which we can improve our own communication with patients, colleagues and staff:  (In each case below, I have listed Mr Hayden’s Tips from his Inc.com article and then applied them to our space as physician leaders)

1. Listen more than you talk–This one is tough for many physicians.  In training we are taught to speak up when you know the answer.  We are often motivated to provide quick results and to communicate them readily.  We strive to quickly assimilate facts and produce a plan.  However, much can be learned by listening–to patients, to families and to other healthcare team members.  When team members see that their ideas are considered by the leader, the tend to be more engaged and more productive.  It matters not who gets credit for the individual pieces of the puzzle–it is more important that the puzzle is completed successfully and the credit becomes a group effort.

2. Do not practice selective hearing–It is essential that physician leaders treat all team members with respect.  Everyone has a role to play and it matters not what title or status a particular individual may hold in the team heirarchy.  By including everyone (and making each person feel like a contributor) we inspire hard work and more participation. Ultimately the patient receives much better care. 

3. Put your stuff away–In the age of mobile phones, ipads and computers on the hospital wards distractions abound.  However, when leading a team and listening to others express opinions and ideas, it is essential to leave the digital media in its holster–nothing makes others feel more unimportant than a disinterested leader.  Take time to engage each person on the team and avoid the distractions of a text, a phone call or a tweet.

4. Give before you receive–In medicine it goes without saying but be sure to put your patients and their families first.  Within the care team, allow others to take credit and receive praise for a job well done before any is directed your way as the leader.

5. Don’t act self important–Medicine breeds ENORMOUS egos–particularly in world-renown academic centers.  To be more effective, we must put ego aside– forget the fact that you may have published half of the manuscripts in the medline search that the medical student just performed.  Focus instead on others and what they bring to the team.  Remember, we are all human–we are all connected.

6. Realize that other people are important–As Mr Hayden states clearly–”you already know what you know..you can’t learn anything new from yourself”  Listen to what others have to say–focus on their opinions and learn from their biases.

7. Shine the spotlight on others–Everyone feels validated by praise.  There is never enough praise to go around.  As the team leader make sure that you are adept at deflecting praise from yourself to those around you.  Team members who feel that their work is recognized and appreciated as excellent tend to work harder and produce more.

8. Choose your words–How we go about asking others to perform tasks can greatly alter their perception of the task.  If a task is presented as an obligation, it is viewed very differently than if it is presented as an opportunity or a privilege.  By carefully choosing your words you inspire others and make them feel as thought their position on the team is a critical component for success.

9.  Do not discuss the failings of others–Let’s face it, the hospital is a fishbowl and people gossip.  However, nothing is more destructive to team dynamics that when a leader speaks negatively about a team member, a colleague or another physician.  This behavior undermines morale and does not inspire confidence.

 10.  Admit your own failings–It is essential for teams and leaders to feel connected.  Nothing promotes connection more than when a leader admits his or her own mistakes and failings to the group.  However, when admitting a mistake it is essential that the leader set an important example–when admitting a failing also admit what was learned through the event and what corrective actions you plan to take to avoid the mistake in the future. This sets a wonderful example for self improvement for the team and at the same time promotes connectedness within the care team.

What’s the Bottom Line?

Effective communication and inspiring leadership are essential to the success of any medical team.  When teams are engaged and focused on the ultimate goal–the care of the patient–outcomes improve.  It is the job of the physician and other team leaders to motivate people and form cohesive, effective teams.  As leaders, we can learn a great deal from the business and political world–charisma is a characteristic that can move markets and change the course of entire nations.  Charisma allows a leader with a vision to effect change.  Charisma can be the difference in connecting with patients, families and co-workers.  Charisma can ultimately improve care and improve the delivery of care–the key is to learn to focus on them….not on me…..

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The High Cost of Terminal Illness: Big Pharma Cashes In on Hope

As Obamacare continues to implode, issues with our healthcare system continue to expand.  We are fortunate in the United States to have access to the best technologies in the world.  We also spend more of our GDP on healthcare than any other industrialized nation in the world.  Although the ACA does address insurance costs (by passing on high prices to the young and healthy) as well as access (by providing access to care for all Americans even with pre existing conditions) it does NOT address the escalating cost of drugs and medical devices.  I believe that the lack of regulation of the pharmaceutical industry and the prices that they are allowed to set on newly developed drugs is yet another (in the very long list) of major flaws in the legislation.

This week in the New York Times, I was troubled by a story touting the release and FDA approval of a new drug for the treatment of a particular type of aggressive blood cancer known as mantle cell lymphoma.  Mantle cell carcinoma has a very poor prognosis and is very difficult to treat.  This new drug has been shown to help treat the disease but offers no cure.  Most patient who start therapy with the drug see 1.5 years of good results but then no longer respond.  For cancer patients time is everything–however the issue with this particular drug is the shiny new price tag–$120K annually.  According to analysts the drug could be worth nearly 6 billion in annual sales for Johnson & Johnson and their drug-making partners Pharmacyclics Inc.  The drug is expected to also be approved to treat a common cancer in elderly people known as CLL or chronic lymphocytic leukemia which will expand its indications to an even more common and larger group of patients.

 Doctors who specialize in the treatment of cancers are concerned about the astronomical prices.  Certainly, they are excited to have another treatment option (especially a new one that comes in pill form) but they are surprised at the cost of therapy.  The new therapy has been shown to be superior to current therapy in clinical trials–however the new drug does not offer a cure.  The company supplying the product argues that the cost of the new therapy “is in line with other new drugs for cancer”.  It seems to me that for pharmaceutical makers the cost is based on what the market will bear–given no limits for cost, they are free to charge whatever they like.  It is disturbing that those that make potentially life changing (and potentially life extending) therapies profit from the hopelessness and desperation of those suffering with a terminal illness such as rare and advanced cancers.  To me, it is reminiscent of the carpetbaggers after the Civil War. 

Why is it that physician payments are dictated by bureaucrats–Medicare, Medicaid, CMS and the insurance companies?  Why is it that hospital reimbursement  is dictated by the same?   In the same breath, politicians and others allow pharmaceutical makers to dictate their own terms as to the cost of their product.  Are there hands reaching into deep pockets?

At some point as providers of healthcare we must step in and advocate for our patients and loudly exclaim… “ENOUGH”.

As evidenced by a recent change in the law in the state of Maine, medical consumers are beginning to take matters into their own hands.  In landmark legislation, Maine recently legalized the import of prescription drugs from pharmacies outside the US.  As I discussed on Fox Business recently with Melissa Francis, there are inherent risks with obtaining prescription drugs from pharmacies outside of the FDA’s jurisdiction–there may be impurities and the quantities of the active compound may vary.  However, I believe that competition from outside the US is the only thing that will ultimately bring drug prices in the US back within sight.  Big pharma will argue that the cost of research and development requires a high price tag–however, I do not believe that the US consumer must foot the entire bill.

We MUST continue to innovate and produce novel, more effective therapies.  It is essential that we support our pharmaceutical industry colleagues in the research and development of new technologies through participating in clinical trials and examination of outcomes data.  However, we must stop short of providing big pharma with  a blank check to charge whatever they like for newly developed drugs.  I am opposed to big government and more regulation in general–but something must be done to control drug cost.  Maybe the answer lies in the beauty of the great state of Maine.  Maybe if we allow a little competition from the outside, prices may fall and ultimately more patients will have access to potentially life saving drug therapy and hope will not cost a life’s savings anymore.

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Evaluating Surgical Skill to Improve Outcomes: Lets Go To The Replay Booth

Just as elite athletes are born with amazing skill, elite surgeons and doctors in other procedure-based specialties are also equipped with innate abilities that others do not possess.  Surgical skill is often difficult to quantify.  Certainly, outcomes data can be obtained and reputations are formed over time.  Years of training allow the truly gifted surgeons to develop their skills and perfect their craft.  However, all surgeons are not created equal.  During training, residents and fellows learn by watching the senior staff.  As they progress in training they begin to perform procedures with guidance and as they near the end of their training they are working independently with minimal oversight.  Once training is over, most surgeons have little or no opportunity to continue to improve their skills.  So, how can we best evaluate surgeons and allow patients to make more informed decisions?

For patients, it can be difficult to choose a competent surgeon.  Last week in the New York Times, the issue of how a patient may best evaluate a particular surgeon’s skill was discussed.  Surgery can be life-saving in certain situations but every procedure has finite risks associated with it.  Complications associated with a particular procedure are issues that patients must consider when choosing a doctor.  The best physicians have learned to minimize complications and are also adept at dealing with them quickly and effectively when they do occur.   Certainly, metrics such as board certifications and memberships in professional organizations (such as the American College of Cardiology) can provide some guidance.  However, most measures of surgical ability are purely indirect–board exams containing multiple choice questions and oral exams just aren’t enough.  In residency and fellowship, a trainee can complete all of the requirements of the the ACGME and be declared graduated–even with substandard surgical skills.

Now, a new study published in New England Journal of Medicine explores a new more direct and objective way to evaluate surgical skill.  Previous studies have focused more on what surgeons may do before or after surgery in the care of their patients and very little focus was placed on what exactly was done in the Operating Room.  In the new study, researchers brought together a panel of expert surgeons to evaluate 20 other surgeons ability thru the use of videotapes of the same surgical procedure obtained from the Operating Room.  The researchers found that there was a large variance in skills–the evaluators commented that the surgeons rated the lowest had skills similar to those of trainees and that those at the highest end of the ratings were considered “masters”.  For the first time a study now shows what has been intuitive for years–the dexterity of a surgeon makes all the difference in outcome.  The surgeons rated in the lowest quartile took 40% longer to complete their procedures and had much higher complication and mortality rates.  Moreover, those in the highest rated quartile had much lower rates of readmission and re-operation rates.

In addition to evaluation of skill through video review another very reliable source of information is the opinion of the nurses and support staff that work with the surgeons on a daily basis.  Experienced OR nurses are very good at rating the talent of the operating physician.  They quickly recognize gifted hands and can easily point out those that are not.  However, there is no mechanism in place for other staff to provide feedback to a particular surgeon.

As we continue to work towards healthcare reform, assessing the skill and effectiveness of physicians will be an important part of cost containment.  Significant complications and negative outcomes are costly to both the patient as well as the healthcare system as a whole.  Objectively evaluating surgical ability may transform the way in which patients and insurers are able to choose physicians to care for themselves and their families.  As physicians we have a responsibility to provide the very best care for our patients.  We must use every tool possible to ensure that we can continue to improve our skills as we progress in our careers.  Evaluations such as video observation should be incorporated into training programs and may also play a role in continuing education for physicians throughout their careers.  Ultimately we must protect patients and improve outcomes–Primum non nocere.


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