Monthly Archives: April 2014

“Thinking” About How We Lead: How We Make Better Decisions and Produce Better Outcomes

As physicians we are trained to assimilate data, analyze and interpret findings, and make the correct decision–every single time.  Often these tasks must be performed very quickly and in emergency settings.  For those who perform invasive procedures, decisions are often made “on the fly” and can have significant consequences.  In addition to our clinical duties, physicians are now thrust into executive roles as well.  Managing practices, budgets, government mandates and regulations have now become part of everyday clinical life for many practitioners.  The concept of the physician executive is now commonplace—and for many doctors and practices– a key to survival in an unstable and volatile healthcare market.  Improving skills in both decision making and communication can be critical to success in the new world of healthcare.  Learning to LEAD is critical to providing outstanding care for our patients every single day.

This week in the Wall Street Journal, author Andrew Blackman explores the inner workings of a business executive’s brain–exactly how the brain functions when making effective decisions in the world of business.  Researchers evaluated how executives make decisions under a variety of circumstances–they localized the biologic processes that occur in the brain via advanced neurologic imaging techniques.  From a biological standpoint, this research provides great insight into how successful decision makers formulate plans and solve problems.  In addition, the research provides insight into how leaders can make more effective decisions when under duress.  Using complex imaging to map the electrical connections in the brain when decisions are made, researchers are able to better quantify–biologically–what makes some leaders better than others.

By shedding light on how our brain functions when making good decisions, we may be able to one day “train” our brains to utilize particular regions during specific tasks.  For now, much of what Mr Blackman reports concerning optimal conditions for making decisions is applicable to physicians and other leaders in medicine in one way or another.

According to the Wall Street Journal, there are several things to consider when making important decisions:

(1)  Deadlines and Time Pressures may Limit Creativity and Innovation

In medicine, every day is a deadline.  Schedules of patients packed into the office or procedure list remain a reality.  Making decisions under pressure is a big part of what physicians do on a daily basis.  However, the recent neuroimaging research indicates that often the deadline pressure may stifle creativity and lead to poor decisions.  Stress induces more activity from the area of the brain associated with “task completion” and less activity in the areas responsible for new and creative idea generation.  According to Harvard researchers, one way to potentially combat this change in thought centers during times of stress may be to train workers and leaders to become more self aware and use “mini meditation” to help the mind wonder.  Although in medicine, we are trained to REACT to acute situations, it may be that while we REACT, we can also work to explore other creative centers of our brains in the process.  By combining both quick REACTION and creative thought, we may not only be able to stabilize a critically ill patient but also provide a unique treatment plan going forward.

(2)  Worry and Uncertainty can lead to bad Predictions and poor decisions

I have been accused of being “Chicken Little” on more than one occasion.   Uncertainty is something that is commonplace in medicine yet it makes most of us uncomfortable.  As physicians we rely on data to make good decisions.  However, uncertainty remains a significant part of what we do in medicine on a daily basis.  We often deal with limited data and must make a decision based on the best available evidence.  Clinical trials bring us some level of certainty  but our patients are biologic organisms, each with potential differing responses to treatments and disease.  According to researchers, the areas in the brain that are activated when you are working on problems that are cause you worry are often associated with anxiety and disgust.  Many poor decisions are made due to the “worst case scenario” line of thought.  While worry and uncertainty can never be completely avoided, psychologists argue that the way to avoid poor decisions during these times, is to learn to accept uncertainty and control the things that you can control.  No decision is ever final–even in medicine there are opportunities to act, refocus and change directions if necessary.

(3)  Good Decision Makers may look past the Facts and Incorporate “Gut Instinct”

Many decisions in medicine are made by considering the best available data and incorporating clinical judgement and instinct in order to make a determination as to the best course of action.  Interestingly, when MRI scans were performed on the brains of very successful business executives who were involved in making difficult decisions, the areas of the brain responsible for emotion and social thinking began to light up more than the purely analytical areas.  Researchers concluded that those leaders who relied not just on facts but on gut instinct and emotion tended to be more successful.  Social thinking–in simple terms–is the ability to look at a problem from numerous angles.  Seeing the potential impact of a potential decision from multiple points of view can provide invaluable insight and may lead to better decisions in the long run.  In medicine, involving other team members–nurses, technicians, and support personnel–in the care and formulation of the patient’s treatment plan may actually help a physician leader to make better decisions.

(4) Effective Leaders must stay positive and Inspire Teams

When leaders begin to inspire teams of people and lead with passion, certain other areas are activated in the brain–particularly those areas associated with positive emotions and social thinking.  Along with involving other team members in the care of the patient, it is essential for an effective leader and decision maker to incorporate “praise, encouragement and rewards” when motivating teams to perform at a high level.  Creating an emotional bond among members of a medical team can be as simple as asking for input from all involved parties and recognizing outstanding contributions to patient care.

The Bottom Line…

Business executives are adept at making determinations that affect millions (if not billions) of dollars and these decisions can move markets.  In medicine, we must make decisions every single day. While some decisions may be trivial, others may permanently impact the lives of our patients and their families.  Moreover, from a business standpoint, the management of a medical practice in today’s market requires impassioned leadership and great skill in order to remain viable. The work that is done with neurologic mapping in decision making may have provide us with guidance in the future as we develop new leaders.  It may be that through practice and coaching, we will one day be able to activate specific areas of the brain when we are working to make tough decisions.  The strategies and skills that we are able to glean from these types of research activity will allow us to be more effective physicians, leaders and executives in the years to come.

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Personalized Technology in Medicine & Building Steve Austin: Better, Stronger, Faster

As a child, I often watched science fiction movies and television shows wondering how much would become reality in my lifetime.  From space travel in Buck Rogers and Star Trek to time travel in Back to the Future, I often imagined growing up in a world where the impossible became probable.  Bionics and the repair of human tissues was captivating and the Six Million Dollar Man (and its spin-offs)  became a hit series.  (we never missed an episode on Friday nights in my house!) Now, much of what was thought to be science fiction is becoming a reality in today’s world.  No other discipline has seen science fiction become reality and produce human impact as readily as the medicine and the treatment of human disease.

Medicine is becoming increasingly “electronic” and patients of all ages are more consistently “wired” through the use of the internet, mobile devices and mobile applications for health.  Patients are able to track health status, blood pressure, blood glucose and other indicators via their smartphones.  This ability to track and transmit data is important to streamlining care and improving the efficiency of the doctor patient interaction.  Hospitalizations are prevented through early intervention when physicians and patients have access to data while the patient is still an outpatient.  For example, many implantable cardioverter defibrillators (ICDs) and pacemakers have diagnostic sensors that can transmit important information to clinicians and allow for the outpatient adjustments of medication before the patient reaches the point where hospitalization is necessary for congestive heart failure and other cardiovascular diseases.

Now, researchers are beginning to develop small, unobtrusive diagnostic tools that have the potential to not only transmit health status but also deliver therapy.  In Monday’s Wall Street Journal, author Robert Lee Holtz reports on implants that are as thin as tattoos that are able to collect, process and respond to health data.  Even more impressive is the fact that in early clinical trials, some of these sensors are able to deliver medications and therapies in response to the collected biologic information. The biophysics of personalized medicine is upon us–experiments are being conducted in laboratories all over the country in order to design miniature, accurate, responsive sensors that can easily integrate with the body and dissolve when no longer needed.  In fact, as reported in the Journal, current experiments include using digital technology sensors on eyes for glaucoma, wrapping around hearts in need of a pacemaker and implants that control pain after surgery.  These types of technologies, while potentially years away from routine human use, represent a major shift in the way in which doctors are able to care for patients.  We are becoming increasingly web savvy–at all ages and in all demographics.  As a society, we must accept more individual accountability and responsibility for our own healthcare in order to help contain costs.  New developments such as implantable sensors and drug delivery systems may help doctors treat more diseases remotely and avoid costly hospitalizations.  For patients, increased education, increased self awareness and the ability to receive real time feedback from therapies may improve their ability to make lifestyle adjustments and improve their own health status.

As I have said many times in my blogs, engaged patients enjoy improved outcomes.  New technologies such as tiny implantable sensors and drug delivery systems will allow patients to connect like never before.  I look forward to a future where devices are individualized and personalized for each patient’s particular disease process and needs.  I believe that it will not only be important for physicians to be able to interact with the biologic data BUT also for patients to receive and interpret this information via a smartphone, computer, tablet or other mobile device in order to make adjustments and prevent complications or exacerbations of disease.  Although we don’t have Steve Austin or the Six Million Dollar Man with us, we do have the technology to make all of us Better, Stronger and Healthier.  The Age of Digital Medicine is here–we must embrace these new technologies and promote their development and deployment in the marketplace in order to improve the lives of our patients TODAY.

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The Cost of Childhood Obesity: Setting an Example for (Hope) & Change

Obesity and obesity related illness accounts for an enormous healthcare expenditure in the US today–approaching 150 billion dollars annually.  In an era of healthcare reform and cost containment, preventative medicine is essential to success.  Rather than rearranging networks, separating doctors from patients and limiting choice, our government may be more effective in reducing healthcare costs by focusing on slimming waistlines throughout the US.

According to a recent study in the Journal of the American Medical Association, nearly 30% of adults and 17% of children are classified as obese. According to the Centers for Disease Control, obesity in children has more than doubled in children and quadrupled in adolescents in the last 30 years.  Obesity rates in adults have remained constant–if not increased–over the study period.  In fact, in women over age 60, obesity rates have increased from 31 to 38%.   It is clear that obesity directly results in the development of diabetes, heart disease and other potentially debilitating chronic illnesses.

Data from previous studies clearly identifies habits developed in childhood as a primary determinant of obesity as an adult.  In fact, childhood obesity is almost always associated with obesity and health problems during adulthood.  This week, a study published in Pediatrics provided a specific cost analysis of childhood obesity and found that each obese child results in an individual $19,000 healthcare cost increase as compared to a child of normal weight.  Moreover, when the researchers multiplied the &19,000 figure by the number of 10 year olds who were estimated to be  obese in the US today, they calculated the total lifetime healthcare expenditure in this age group alone to be more than 14 billion dollars.

The adverse effects and negative impacts of obesity on our children stretch far beyond the staggering dollar figures that are illustrated in this most recent study.  Obese children are more likely to have risk factors for heart disease and are at increased risk for certain types of cancers.  Pre-diabetes is common in obese children and many develop Type 2 diabetes before adulthood.  Children with weight problems are more likely to suffer from depression and other mental health disorders including poor self esteem.  Development of such significant medical problems at an early age can prevent a child from truly enjoying the process of growing up and can limit choices and opportunities later in life.

Children of obese parents are far more likely to be obese themselves.  America is becoming a culture of sedentary adults (and now children)–increased calorie intake and diminished calorie output.  Our children model behaviors that they witness in adults and other mentors.  Modeling healthy habits such as regular physical activity and healthy eating can directly impact children and significantly reduce the chances of becoming obese.  Habits developed during childhood become part of our daily routine and are incorporated into our system of values and become second nature. If we, as adults, put a priority on diet and exercise early in life, we make it much easier for our children to develop and maintain a healthy lifestyle well into adulthood.

This most recent study should serve as a call to action–Americans are fat and are getting fatter.  The time to intervene is now.  We must set better examples for our children.  In a world full of fast food and calorie dense meal choices, we must do a better job demonstrating responsible lifestyle choices.  Fill the house with fruits and healthy snacks and avoid fast food meals whenever possible.  Help children learn to choose wisely.  Parents must encourage more outdoor activities, regular exercise and limit screen time.

As healthcare costs continue to rise,  we must focus on prevention.  Cardiovascular disease, diabetes, and high blood pressure are significant contributors to our overall healthcare costs and ALL of these diseases are more likely to occur in those who are obese.  As a nation, we must become more health conscious and make daily exercise and healthy eating part of our culture–only then will we be able to impact obesity and set an example for change.  Only then will we begin to reverse the obesity epidemic of the last 30 years and improve the lives of our children and the generations to come.

 

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