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What did you expect yesterday?

As you walked through the front doors at work yesterday what were your expectations? Were you hoping:

  1. To serve to the best of your ability
  2. To learn something new
  3. To enjoy good company doing something meaningful
  4. To make a difference to someone
  5. To earn a big pay cheque
  6. To pass the time before home time
  7. Something else?

Which was it? How did you feel at the end of the day? How do you think those who interacted with you felt at the end of the day?

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Do you see how that happened?

You may face may challenges or have an unexpected outcome following your interaction with your customer, client or patient. As a healthcare professional these are opportunities to reflect on how an event unfolded, how you were feeling at the time and how you are feeling afterwards. Consider then how those emotions play out through the course of the day. Given that most  outcomes in healthcare are moderated by an interaction with a health professional it is important to ensure that the health professional is attuned to their inner world. We can’t change many things as providers of health services but we can look within.

Know what causes your negative emotions, and which types of feelings you face most often. When those emotions begin to appear, immediately start your strategy to interrupt the cycle. The longer you wait, the harder it will be to pull yourself away from negative thinking. Mindtools

Picture by Vishweshwar Saran Singh

Is normal too thin?

Try this experiment. If you are tending to overweight ( Body Mass Index (BMI) 25 or over) then try to get to BMI 18.5 -24.9.  If you succeed people will decide you have lost ‘too much weight’  even when your BMI is in the middle of the normal range. If normal was defined as ‘what is most common’ then to have a ‘normal’ BMI is unusual and we may have become blind to normal so that what we perceive as ‘normal’ is not ideal. Rates of overweight and obesity are now at 60-70%.

In an Australian study on the public perception of body size the authors report that:

Overweight participants were also most likely to incorrectly identify themselves as a healthy weight (67 per cent, p<0.001), compared to 12 per cent of obese participants . The majority (89 per cent) of normal weight participants accurately identified themselves as being a healthy weight. Flanagan et al

Therefore it is not surprising that when people are challenged about their weight in healthcare they are reluctant to identify the issue as a problem.

Picture by Phil Gradwell

What do you notice?

Before making any changes that might improve outcomes where you work you have to notice things that don’t look quite right or that hint at a solution. I know someone who notices the tiniest details even when she is out shopping. She generates a huge number of ideas about how things could be improved sometimes with the smallest tweaks. Here’s an example. As a result she is the most successful person I know. You’d be lucky to have her on your side. I know I am. What did you notice about your office, clinic, shop or hospital today?

Picture by Marcin Wichary

Does parking stop doctoring

Imagine you have back pain. Your doctor suggests you need special scan. You have to travel an hour across town to get to the hospital where you have an appointment at 9 am. You take the morning off but hope you might get to work in the afternoon. It’s peak hour traffic as you arrive at the hospital. The queue to get into the car park stretches down the street. You join the line of cars and realise it’s now 8.45am. The X-ray department is a long walk from the car park. Just as you get to the entrance to the parking lot the attendant indicates that it is full and you have to try and get a spot on a side street. The chap in the car behind you is getting frustrated- are you waiting in the queue or trying to back out? It’s a one way street you can’t turn the car here. It’s now 9 am you are going to be late- not sure how late. You toy with the idea of just going home.

In November 2011, an editorial in the Canadian Medical Association Journal called hospital parking fees a barrier to health care, saying the charges amount to “parking-centred health care,” and recommended hospitals stop charging patients for parking. The editorial stirred up a debate in the media. The Ontario Nurses’ Association, for one, agreed with the recommendation and noted that many of its members could tell stories about patients who had avoided seeking care or had cut appointments because of high parking costs. Canadian Nurse

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Mobile phones aren’t allowed in the operating room.

Before a surgeon gets anywhere near a patient in the operating theatre he must wash his hands, put on a gown and gloves. He then drapes the patient and cleans the skin. As he makes his first incision there is no mobile phone on the table, he banishes all distractions and appreciates that the job isn’t over until he has sutured the wound. Whatever you do for a living how do you approach the job? If you adopted rituals would you perform better? Bacteria can destroy a surgeons work. What contaminates your work and how does that manifest in your results?

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Do you know their secret fear?

Do you know why your customer, client or patient chose you today? If you are his doctor John made an appointment this morning because he thinks he may have an inherited illness. His uncle recently died from this condition and it all started with weakness in his arm. John has noticed that he has pain and weakness in his right arm when he lifts heavy things at work. This morning he nearly dropped the kettle when making a cup of tea. He isn’t going to tell you what he is worried about but he expects you will tell him he doesn’t have that condition after all the tests you will perform right? His uncle had lots of blood tests and scans.

In quite a number of contacts with a new reason for an encounter (22%), the ideas, concerns, or expectations of the patient remain undisclosed. A second main finding is that the expression of concerns and/or expectations is correlated with fewer prescriptions (univariate, logistic regression analysis, and also after exclusion of patients without an ‘a priori need for medication’). Although the causal relationship remains uncertain, the observations may indicate that systematically disclosing the patients’ real expectations and concerns could lead to less medication use. Matthys et al

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How do you enjoy musac?

It’s Friday evening. Your customer, client or patient needs something. You’ve been trying to arrange it or get the necessary authorisation over the phone and now you’ve been put on hold listening to musac. You had advised this person in all good faith that what they need to make a decision will be here today. The minutes tick by and then the phone goes dead. The queue of people waiting is growing longer. A tired child is screaming somewhere nearby and you are already running late.

Over 54% of physicians report a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. The number is up 10% from just three years ago. Who is to blame? If you ask many physicians, the fault lies among leaders involved in healthcare finance, policy and clinical administration. Sachin Jain

You can choose your reaction to the trial by phone on Friday evening. This scenario is not uncommon and as a doctor it won’t be the first or last time you will experience it. Yet each time it happens it may evoke the same negative emotions until you choose otherwise.

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Doctor heal thyself

The probability that anyone will get the flu this year is one in twenty or as high as one in five. You might wake up one morning with a sore throat and headache. You’ll notice that your muscles are aching and your nose is running. It may well be at a time when the office, ward or clinic where you work is busy. Others on your team or practice may be off sick. You may be covering for an absent colleague. What happens now?

A recent survey of more than 1,000 full-time employees shows that 38 percent of people say they still head into the office even when they feel like they might be contagious.

Apart from being contagious, if you are a healthcare professional how will you do your best work in these circumstances?

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Would it be easier if I went home and skyped you?

When I am sick or worried I need you to look at me. I know you need to maintain my records doctor but while you are doing that it isn’t helping me to tell my story. Wasn’t that the point of me being here? Would it be easier if we both looked in the same place through a screen?

The non-verbal behaviour of doctors themselves is easily overlooked in communication research. Many instruments for measuring qualities such as patient centredness are designed to be applied to audio rather than video tapes, and questionnaires for patients may not be sufficiently detailed to seek their views on this area. However, an increasing body of work over the last 20 years has demonstrated the relationship between doctors’ non-verbal communication (in the form of eye-contact, head nods and gestures, position and tone of voice) with the following outcomes: patient satisfaction, patient understanding, physician detection of emotional distress, and physician malpractice claim history. Although more work needs to be done, there is now significant evidence that doctors need to pay considerable attention to their own non-verbal behavior. Silverman and Kinnersley

Picture by Robin Hastings