Category Archives: Professional Well-Being

What Would YOU Do With An Extra Second….Better Decide Soon, Its the Day of the Leap Second!

In medicine, I have learned that time is a precious commodity. Too often, when life slips away and patients and families wish they had just a little more time. For physicians, a little more time may make the difference in a patient’s ultimate outcome and sometimes makes the difference between making it home in time for a family dinner. Today, we add ONE second to the international world clock at midnight. Over fifty years ago, world clocks began keeping time with atomic clocks that are governed by oscillations of an atom–which are determined in part by the rotation of the earth. The earth’s rotation is slowing over time, and in order to keep these clocks coordinated with the earth’s rotation, we must add an extra second from time to time.

What Can You Do With An Extra Second?

While a second may seem like an insignificant amount of time, when you are a careful steward of time much can be accomplished quickly. An extra second can have a substantial impact—Here is my list of possible plans for my extra second:

1.  One more chance to say “I love you”

Too often, the pace of the world gets in the way. We forget those most dear to us and allow our daily challenges—both at work and at home- to take center stage. I may use this extra moment in time to make sure that my wife and daughter know exactly how I feel. Time is unwavering and unyielding. Time rarely stops—actually almost never stops—but today we have a brief pause. We must use it wisely and take advantage of the extra “time” with loved ones and remind ourselves that time spent with those we love is precious

2. An opportunity to pause before pressing send on an angry email

In the heat of the moment, many of us have sent a note that we wish we could have back. Email and electronic communication can be unforgiving. Just think if we were able to use the extra second we are given to pause before sending an angry reply. That one second to ponder the implications of an email response may actually save even more time by preventing hurt feelings, damaged relationships and tarnished reputations.

3. A chance to pause and take a breath

Lets’ face it, today’s world moves at a very quick pace. Electronic communication, social media and instant messaging leave each of us with very little down time. Just recently I flew to Italy from New York and was amazed to have active internet service for the entire flight. Rather than unplug and enjoy the beginning of my vacation, I remained connected and engaged through the flight. Much can be gained from taking a few minutes to meditate, unplug and recharge. All of us can benefit from stepping away from the business of a hectic day—just one second may help relieve stress and recharge the mind–Maybe I should use the extra second to take a deep breath, reflect and relax. If a 5minute meditation works, why wouldn’t a 1 second mini meditation work as well?

4. Send a tweet

Social Media is an excellent example of how we can reach out to others—all over the world—in a matter of seconds. We are now more connected than ever. Twitter brings doctors and patients together and makes the world a smaller place. Twitter provides for the brief communication of ideas, exchange of information and socialization all in a moment. One second is all that is needed to send a tweet. At midnight tonight, I may decide to use my extra second to push send and publish a tweet.  Maybe I will connect with a new friend or colleague.  Maybe my tweet will reach a patient suffering with chronic disease and provide them with new hope.  Maybe my tweet will make someone laugh, or (if I am really lucky) make a lonely person smile.

Tonight, we have a rare opportunity to stop time. At midnight we are able to take back time—if only for a second. I have shared a few of my ideas. What will YOU choose to do with it? Time is ticking away–we have to decide soon how to use that extra time.  Midnight will be upon us soon.  How we use it could change a life….or result in time for one more Zzzz…

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Reflecting on Medicine in 2014: Sailing Rough Seas and Finding Uncharted Waters Ahead

As we close out on a tumultuous 2014 in healthcare, many physicians are looking forward to a better and more stable 2015. For most of us, 2014 has been marked by significant change. Many healthcare providers have seen their jobs and their patient care roles transform completely. Physician autonomy has diminished and regulation and mandated electronic paperwork has more than doubled. Many physicians find that they are spending far less time caring for patients and a greater proportion of their available clinical time is now being spent interfacing with a computer—both at work and at home on personal time.

During the last year, we have all been affected by the rollout of the Affordable Care Act (ACA), changes in reimbursement, as well as the implementation of a new billing and coding system (ICD-10). For many of us, it also marked a year of transition to system wide electronic medical record systems such as Epic and the growing pains associated with such a major upheaval in the way in which medicine is practiced.   Many practices have continued the trend of “integration” with larger healthcare systems in order to remain financially viable. The American College of Cardiology estimates that by the end of 2014, nearly 60% of all physician members have integrated with hospital systems and this number is expected to rise even further in 2015—ultimately defining the death of private practice as we know it.

Why have these changes occurred?

Ultimately, I believe that the changes to the way in which healthcare is delivered has come about due to 3 distinct reasons:

 1. Declining Reimbursement

Currently reimbursement continues to fall. Multiple government budgetary “fixes” have led to much uncertainty and instability in medical practices (much like seen in any small business with financial and market instability). In addition, the implementation of the ACA has resulted in the expansion of the Medicaid population in the US—now nearly 1 in 5 Americans is covered under a Medicaid plan. Traditionally, Medicaid plans reimburse at levels 45% less than Medicare (which is already much lower than private insurance payments). While the Obama administration did provide a payment incentive for physicians to accept Medicaid, this incentive expires this week. Many practices are becoming financially non viable as overhead costs are risking to more than 60%. As for the ACA, many exchanges have set prices and negotiated contracts with hospital systems—leaving many practices out of network. Both patients and doctors suffer—longtime relationships are severed due to lack of access to particular physicians.

2. Increasing Administrative/Regulatory Demands

With the implementation of the ICD-10 coding system, now physicians are confronted with more than 85, 000 codes (previously the number of codes was approximately 15,000). In addition, “meaningful use” mandates for payment have resulted in increasing documentation requirements and even more electronic paperwork. In addition, the implementation of new billing and coding systems has required increasing staff (more overhead) as well as intensive physician training. Sadly, the new coding system that has been mandated by the Federal government includes thousands of absurdities such as a code for an “Orca bite” as well as a code for an “injury suffered while water skiing with skis on fire”.

3. Electronic Medical Record Mandates

Federal requirements for the implementation of Electronic Medical Records and electronic prescribing have resulted in several negative impacts on practices. While in theory, the idea of a universal medical record that is portable and accessible to all providers is a noble goal, the current reality in of EMR in the US is troubling. There are several different EMR systems and none of them are standardized—none of them allow for cross talk and communication. Many small practices cannot afford the up front expenditures associated with the purchase and implementation of the EMR (often in the hundreds of thousands of dollars).   In addition, the EMR has slowed productivity for many providers and resulted in more work that must be taken home to complete—not a good thing for physician morale. Finally, and most importantly, the EMR often serves to separate doctor and patient and hinders the development of a doctor-patient relationship. Rather than focusing on the patient and having a conversation during an office visit, many physicians are glued to a computer screen during the encounter.

So, What is next in 2015?

While I have probably painted a bleak picture for Medicine in 2014, it is my hope that we are able to move forward in a more positive way in 2015. I think that there are several very exciting developments that are gaining momentum within medicine and healthcare in general.  Innovation and medical entrepreneurship will be critical in moving healthcare forward in 2015.  Physicians must continue to lobby for the tools and freedoms to provide better patient care experiences for all stakeholders in the healthcare space.

2015 begins with much promise. I am excited to see what we as healthcare professionals will be able to accomplish in the coming year. We must continue to put patients first and strive to provide outstanding care in spite of the obstacles put before us. While 2014 provided challenges, we must rise above the fray and continue to advocate for a better healthcare system in the US today and in the future.

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More (or less) Hope and Change (for the worse) In Healthcare: Are Doctor Shortages Really All Due To Training Bottlenecks?

There is no doubt that Affordable Care Act has changed the landscape of medicine in the US.  Now, private practice is becoming a thing of the past. Financial pressures, increasing regulatory requirements, electronic medical records and outrageously complex coding systems are forcing long time private physicians to enter into agreements with academic centers and large hospital systems in order to survive.  As a result, medicine today is more about increasing patient volumes, completing reams of paperwork and administrative duties than it is about interacting with patients and providing superior care.  The American Academy of Family Practice (AAFP) estimates that there will be a significant shortage of primary care physicians in the next several years unless we increase the number of primary care trainees by more than 25% over the same time period.  In fact, the AAFP suggests that the primary care workforce must increase to 260K physicians by the year 2025–which translates to an additional 52K primary care doctors.

Given the need for more physicians and the pending shortage (particularly in primary care), many analysts have suggested that the reason for the shortage is a lack of training slots in primary care.  The ACA will add an additional 32 million patients to the pool of insured and primary care doctors will be at a premium.  In the New York Times this week, the editorial board collectively penned an article discussing their thoughts concerning the doctor shortage.  The NYT editorial board suggests that the shortage is all about an imbalance between Residency training slots and medical school graduates and can be easily corrected by federal funding of a larger number of training positions.  However, I think that the issue is much more complex and the solution is far from simple.

Primary care is an incredibly challenging specialty and requires a broad knowledge of much of medicine.  Reimbursements for primary care work continue to lag and physicians are now spending more time with administrative duties than they are with patients.   I do not believe that the so called post graduate training “bottleneck” will come into play.  I would suggest that many primary care training slots will go unfilled over the next 5-10 years even without increasing the numbers of available positions.  Increasing training slots for primary care specialties may do nothing to alleviate shortages if there are no students who wish to train.  While medical school enrollments have increased over the last decade, much of this increased enrollment may be due to a lack of jobs available to recent college graduates.  Moreover, as the ACA continues to evolve, physicians are now realizing lower compensation rates, increased work hours, more administrative duties and LESS time spent caring for patients.  Many physicians are forced to double the number of patients seen in a clinic day–resulting in less than 10mins per patient–in order to meet overhead and practice expenses.  In a separate article in the New York Times, author and cardiologist Sandeep Jauhar discusses the increased patient loads and subsequent higher rates of diagnostic testing that is required in order to make sure that nothing is missed–ultimately increasing the cost of care.

For most of those who have entered medicine, the attraction to the profession is all about the doctor-patient interaction and the time spent caring for others.  I would argue that the primary care shortage (and likely specialist shortage) will worsen in the future.  Many bright minds will likely forego medicine in order to pursue other less government-regulated careers.  In addition, many qualified primary care physicians will opt out of the ACA system and enter into the rapidly growing concierge care practice model.  The answer to the physician shortage may be more political than not–politicians must realize that laws and mandates only work if you have citizens willing to devote their time, energy and talents to the practice of medicine.  Going forward, more consideration must be given to physician quality of life and autonomy must be maintained.  In order to make healthcare reform sustainable, those in power must work with those of us “in the trenches” and create policies that are in the best interest of the patient, physician and the nation as a whole.  Cutting costs must be approached from multiple angles–not simply reducing the size of the physician paycheck.

Medicine remains a noble profession.  Those of us that do continue to practice medicine are privileged to serve others and provide outstanding care.  In order to continue to advance, we must continue to attract bright young minds who are willing to put patients and their needs above their own–at all costs.  I think that there is still HOPE to save medicine in the US.  It is my HOPE that our government will soon realize that in order to continue to propagate a workforce of competent, caring physicians we must provide time for physicians to do what they do best–bond with patients and treat disease.  (as opposed to typing into a computer screen and filling out endless reams of electronic paperwork).  It is my HOPE that those physicians in training  that will follow in my generation’s footsteps will realize the satisfaction that comes from impacting the health and lives of patients over time.  It is my HOPE that the ART of medicine can be saved before it is too late….

 

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Communication in Medicine: Lessons Learned By Wearing A Gown

Communication is critical to success in medicine.  Our patients depend on us to help them understand their disease and the risks that it may pose.  In previous blogs I have commented on how vital effective communication can be in determining outcome–much of my writing has focused on the success associated with outpatient doctor-patient relationships.  We now know that when doctors and patients engage, patients become invested in their own healthcare and are more likely to comply with lifestyle modifications and take medications as prescribed.  However, when a patient is ill and hospitalized, a entirely new level of complexity is added to the communication mix. The role of patient places one in a difficult position–you lose control, you lose your individuality and you may often become frightened due to the uncertainty of the clinical outcome.  The dynamic of communication in the acute hospital setting may be quite different in that the patient may be interacting with a new team of healthcare providers that they have no previous relationship with.  In addition, disease related factors such as pain, fever, and sedation may play a role in a patient’s ability to comprehend what is being said to them at any given moment in the hospital setting.  I can now speak to this from personal experience–this last week I became an unexpected patient.  I spent several days navigating illness and a complex yet compassionate hospital system.  My experience as a patient has inspired this particular blog–and has inspired me to become a more effective communicator in my practice.

This month in the New York Times, two articles were published that discussed different aspects of physician communication with patients.  Both pieces are important and should be read and carefully digested by both patients and physicians (as well as any other healthcare provider). In the first article, author Theresa Brown discusses the discussions that physicians and other healthcare providers commonly have with patients during a time of illness.  Particularly in the hospital, teams of providers at all levels enter a patient’s room and discuss all aspects of the case (Both with the patient and amongst one another).  It is interesting to realize just how much of what is said during these encounters is “lost in translation.”  During periods of illness, even the most educated and medically sophisticated patient can have difficulty comprehending exactly what the medical team is trying to convey.  Pain, worry, and emotional fatigue may all play a role in a patient’s inability to comprehend the clinical situation, the possible diagnoses, the testing required and the treatment plan.  In a separate article, authors Gilligan and Sekeres explore whether or not there are effective ways in which we may be able to teach better communication skills to physicians in training.  Several studies have demonstrated that no amount of training will convert an introvert to an extrovert communicator–however, communication training may open a healthcare provider’s eyes to the profound impact that their interaction with patients may have on outcome.  Once a provider is aware of the impact communication may have, they are more likely to be able to better engage patients and engage in a more effective way.

During my unexpected role as a patient this week, I often did not understand what to expect–even with my years of medical training and experience–I could only focus on my symptoms and my fear of the worst possible outcome scenarios.  During my patient experience, I interacted with many physicians, nurses and other team members–ER doctors, specialists, imaging technicians, transporters, etc.  My particular providers were very compassionate and spent a great deal of time attending to my needs and explaining their thought processes, differential diagnosis and treatment plans.  However, I was unable to process most of what was said.  I was often distracted by pain and my ability to assimilate and comprehend information was limited by the sedation I had been appropriately given.  Ultimately, emotion and fear would come to the forefront and dominate my thoughts, further limiting my ability to actively and effectively communicate with the medical team managing my hospital care.  My caregivers were dedicated and wanted only the best outcome for me and my family.  However, I was often confronted with large amounts of clinical information and I began to hear only pieces–I would latch on to particular words such as surgery and potential complications and would lose focus–no longer able to follow the conversation.  My ability to think rationally and effectively process clinical information (as I would as a physician)  was severely impaired.  I can only imagine what the experience would have been like for a non medically sophisticated person.

Fortunately, as the week progressed, my condition improved and I was ultimately discharged from the hospital.  My physicians and nurses spent time later in the week making sure that I understood what had happened to me and what the next steps would be.  My hospital stay and treatment provided me with new insights into the patient experience.   I now am able to envision ways in which I can improve my own interpersonal skills with my hospitalized patients–by actively taking time to make sure that each patient understands and truly hears what is being said to them.  From my experience, one of the keys to promoting  understanding is to provide time for questions–from both patient and family–during the inpatient hospital visit.  My caregivers did this often and it did provide comfort and some semblance of control.  (as much as one can have in an ill fitting hospital gown).  In addition, providing small, easily digestible bits of clinical information at several points throughout the day seemed to improve a patient’s ability to process and comprehend their condition, treatment and prognosis (at least it did in my case).  Although is is not practical for the physician to make multiple stops to the patient room throughout the day, phone calls for updates by the treating physician and visits by other providers such as nurses, PAs and NPs can make a difference in patient understanding and comprehension.  As Ms. Brown rightly states in her New York Times piece, hospitals and medical care are well focused machines–most providing efficient, quality life saving care.  We must remember, however, that we are treating patients–human beings with emotion and fear that can certainly impact a disease process.  We must take time to ensure that we not only provide the high quality efficient care but we also are able to care for the human being lying in the bed in the awkwardly draped hospital gown.

I am glad to be home from the hospital.  I am grateful for the wonderful care and compassion that me (and my family) received from many over the last week.  I am happy to be sitting outside in the sun writing this blog today.  I am excited about the opportunity my experience as a patient has afforded me.  I will take what I have learned and apply it to my practice–I hope to work every day to improve my communication with all of my ill and hospitalized patients.  Most of all, my experience has reminded me that although medicine is the application of science to the treatment of ailments suffered by human organisms, it is the human that really matters.  Our patients are people–they are often alone, frightened, emotionally exhausted and suffering.  We must all engage them in a way that best facilitates their understanding of their situation and focus equally on both treating a disease AND treating a frightened person lying in the bed before us.

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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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Finding Success AND Happiness in Medicine? Where Is The Holy Grail?

Medicine is a very rewarding career.  However, recent changes in the healthcare system have made the practice of business much more cumbersome and job satisfaction rates among physicians is at an all time low.  Fear over the unknown and how Obamacare may affect our ability to effectively and efficiently care for out patients has significantly contributed to the general unease in the medical community.  Most physicians are highly driven, highly successful individuals.  Much of my professional happiness (and I expect other healthcare providers feel the same way) is derived from developing relationships with my patients and achieving excellent clinical outcomes.  However, balancing success and happiness in medicine is now more challenging than ever.  More time is now devoted to additional government mandated paperwork, arguing with insurers and managing escalating overhead costs.  All told, these tasks begin to take away time normally devoted to patient care.

This week, in the online magazine Inc.com, I read an article discussing tips for ensuring BOTH happiness and success.  As I read through the piece, I began to reflect on my own balance of success and happiness–How can these two goals can be readily achieved TOGETHER?  Although primarily directed at the executive/business professional, much of the content is very applicable to medicine.  In today’s medical landscape, the most successful physicians have embraced the concept of the Physician Executive–developing a business skill set that allows one to be fastidious with a spreadsheet while also providing exceptional patient care.  I have addressed this concept in several previous blogs–now more than ever, it is critical for physicians to think like business people in order to navigate the changes that are being implemented on a daily basis.  Although much of our new executive-like tasks certainly take time away from patients, if we are able to find the right balance we can still find happiness and fulfillment in our jobs.  As stated in the Inc.com piece, in order to achieve both goals we must think in unique ways–try to do things differently and find out work works best for YOU.

In the article, author Steve Tobak explores six unique ways that one can develop BOTH a successful career and enjoy a happy life–believe it or not, they do not have to be mutually exclusive.  Here is my take on how each of these suggestions (that were created by Mr Tobak) can apply to those of us who have made our careers in medicine and healthcare:

1. Develop real relationships:  In the end, relationships matter.  In medicine, the most important relationship is that with our patients.  Understanding patients feelings, their families and their preferences improves our ability to care for them.  Celebrating their successes and their family milestones provides me with great happiness.

2. Groom yourself:  No, I don’t mean comb your hair–Try new things.  Engage in other activities as time allows.  Make sure that you make time for family outings and that you try skydiving–or horseback riding–whatever it is that interests you–give it a whirl.  It may change the way you look at your work and your life.  Ultimately, exposure to new things can make us all better leaders and provide more opportunities for success at work.

3. Do Nothing:  Medicine can be incredibly hectic.  Running between hospitals and clinics.  Hustling to see a new consult or dictate another note–all of this “noise” can take away from happiness.  Every single day, just take a few minutes to do nothing.  Sit quietly and listen to your own thoughts…meditate.  Even a brief respite can make you more effective and ultimately improve your mood.

4. Work for a great company:  Whether you own your own practice (a rarity in today’s medical world) or work for a university or hospital, make sure you believe in the mission of the organization.  Be involved and try to influence policy.  If you work in an organization that recognizes and appreciates your efforts, your job satisfaction will improve.  If you do not, you may need to consider taking a risk and making a change.

5. Do one thing at a time:  This seems like an impossibility for physicians today (guilty as charged).  However, if you are able to make a list and prioritize–focus on one or two tasks at a time–you will see the fruits of your labor.  Crossing a task off the list gives us a feeling of accomplishment and completion which can add to overall happiness and satisfaction.  Trying to chip away at several things at once can often result in no task done well.  In medicine, it may be that you spend a half day a week on administrative work–take time to separate yourself from clinical work and catch up on the rest.

6.  Be good to yourself:  As physicians we expect nothing but the best out of ourselves–we are often very critical of our own decisions and clinical outcomes.  In the current healthcare market  (world of Obamacare reform) there is much we cannot control.  We must remember to remain centered and remain “in the present” in order to achieve happiness.  Although providing perfect care is a noble goal–it is not attainable.  Be reasonable with expectations–always provide the very best of yourself to your patients and be satisfied with the fact that you do.

Happiness is critical to a successful and fulfilling career.  With sweeping changes in healthcare, many physicians are finding it more difficult to balance both success and happiness.  By applying these 6 unique principles and looking at the “big picture” it is my hope that all of us can continue to serve our patients, continue productive successful careers and remain satisfied and happy throughout our professional and personal lives.  If we are able to achieve the right balance then everyone–patients, family and YOU–will ultimately reap the benefits of a long and HAPPY career in healthcare.

Nurses Show Us the Way: The Simple Beauty of Connecting in Healthcare

In today’s healthcare environment, we are all driven to see more patients in less time and do more with less support.  Obviously most of this is financially motivated–the delivery of medical care had unfortunately become more of a business than an art.  As more physician groups are now owned by hospital systems, the “bean counters” and administrators are now crafting the rules of engagement.  Physicians no longer have the luxury of time for a leisurely patient visit.  No longer do we have the time to routinely ask about the grandkids and the most recent trip that our favorite patients have taken in their retirement.  Ultimately, it is the patient who suffers.  Those who are ill and those who love them often need more than pills, blood tests, IV fluids and heart monitors–they need support and genuine caring.  These patients and families need a doctor or other healthcare provider  to sit on the edge of the bed and unhurriedly listen to their concerns –to simply chat for a bit.  Unfortunately, this is no longer the norm.  Luckily, we have dedicated caregivers on the front lines in our hospitals who can often fill the gap–nurses.

I was moved last week as I read a wonderful article in the New York Times by Sarah Horstmann.  In the essay, Ms Horstmann (a practicing Registered Nurse) describes her special connection to a few patients and their families on the orthopedic unit in which she works.  Ms Horstman chronicles her struggle with remaining objective and professional in her role as nurse when she becomes emotionally invested in her patients.  She paints a picture of an engaged and caring nurse who is able to put everything on the line for her patients.  Her internal struggles with “crossing the line” in her care for the patient is one that we all as healthcare providers have faced at one time or another.  However, she handles her feelings and her patients with absolute grace.  We can ALL learn a great deal from Ms Horstmann.  We should all strive to feel and care as deeply as she does.  Our patients and the care we will provide them will certainly benefit greatly.

In my experience in medicine, it is the nurses that often lead the way for all of us. I have particular poignant memories from my training of nurses on the hospice care unit at University of Virginia hospital   These nurses set a remarkable example of compassion and connection.  I have been forever impacted by witnessing true caring–crying, grieving and comforting dying patients and their families.

As a whole I have found that many nurses go beyond what the physician is able to do in short encounters.  Nurses spend the time required to get to know the patient–their fears, their thoughts about disease, their thoughts about their own mortality.  Nurses understand family dynamics and can help in managing difficult family situations.  Nurses make sure that above all, the patient comes first–no matter what the consequences.  The very best nurses that I have worked with over the years are ADVOCATES for those who are too scared or too debilitated to advocate for themselves.  Many times early in my career, I did not pay attention or listen to the lessons that were all around me on the hospital wards.  However, as I approach mid-career I am much more attune to these very same lessons that I may have missed earlier.  There is much gained when we watch and listen to others who are caring for the same patient–maybe in a different role–but caring for our common patient nonetheless.  I now realize that nurses have “shown me the way” many times and for that I am truly grateful.

In my opinion, emotional investment and developing patient connections can improve care and assist patients and families with acceptance and with eventual grieving and loss.  I believe developing bonds with patients is a wonderful expression of love for another human being and is completely acceptable in medicine–as long as we are able to remain objective when critical clinical decision making is required. In medicine we strive to provide excellent care for all patients but every now and again there are special patients that we develop emotional bonds with.  Just as in everyday life, there are certain people that you are able to connect with in a spiritual way–whether they are co-workers, colleagues, friends or significant others.  We must stop and appreciate the way in which nurses provide care–we can learn a great deal from them and ultimately provide more “connected” care for our patients.  So, next time you are in the hospital, find a nurse.  He or she will likely be haggard from running from room to room, and it is likely that they have not stopped to eat lunch.  Thank them for caring for our patients.  Thank them for showing us all how to provide better care for our patients.  Then, stop in and say hello to your patient–sit on the edge of the bed and take time to simply just chat.


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