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Your fists stop swinging where my nose starts

You complain when people are rude, late, unreasonable, inconsiderate or selfish. However to what extent does this reflect your messages to them? Might you be suggesting:

It’s Okay. I’m easy. My feelings don’t matter. I can cope. I’ve got broad shoulders. I don’t really expect much. It’s okay to vent.

But could it be that you are actually saying:

Please like me. You can hurt me. I’m scared of you. I need you to be nice to me. I’m weak. I have no confidence. I am disposable.

What Amy Morin suggests writing in Forbes magazine makes sense:

Encourage employees to speak up when they’re frustrated, confused, or nervous. Invite them to share their opinions through the correct forums, however. Airing their grievances to any co-worker who is willing to lend an ear does more harm than good.

Address rude behavior when you see it. Ignoring sarcasm in an email or allowing disrespectful comments to be exchanged in an email chain sends the wrong message. Make it clear that you value direct communication.

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Are drugs always needed?

There is some evidence that housework helps anxiety and depression.

So if you are a healthcare professional would you suggest that doing simple chores at home might help more than drugs? How do you bring that up in the conversation?

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Is there such a thing as simple administrative task?

Jane was invited back to have a repeat colonoscopy ( examination of the bowel). Her specialist wasn’t happy that he had a clear view through her bowel last year and he couldn’t be completely reassuring. Meantime Jane had noticed a change in her bowel habit and was now worried.

So she made an appointment with her doctor who practiced several suburbs away. It is a vagary of the system that although the specialist invited her back she had to get a letter from her family doctor to accept the invitation. Her doctor didn’t ask whether she was worried about it or why she had made an appointment that particular day given that the specialists note to her was a month ago. He simply wrote:

This lady needs a repeat colonoscopy as per your previous records. Thank you for seeing her again.

Two minutes later she was handing her credit card to the receptionist and walking out of the building.

Lost opportunity. Is there such a thing as a simple administrative chore or what we choose to make of an opportunity presented to practice our art?

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What was the journey like?

Do you know what your customer, client or patient’s journey to your office, clinic or shop was like? How did they get there? How long did it take? Who travelled with them? What did it cost? If they drove where did they park? Did you take any of that into account in your dealings with them today? Does it matter?

If you’re lying on a table waiting for radiation, you can’t just jump up and plug your meter,” she wrote to the city. “As someone who has gone through and survived cancer, I can’t tell you the anxiety experienced at finding a parking ticket on my vehicle. Nancy Piling

That patient’s experience was impacted by factors that had nothing to do with the professional care she was receiving. But…..

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What would happen if you didn’t show up at work today?

What would happen if you didn’t show up to work unexpectedly today? Would the show go on? Who would provide continuity for the what you have been working on? Is there a contingency plan for that possibility?

Data from the Office for National Statistics (ONS) for 2016 recorded an absence rate across all workers in the health sector of 3.5%. This compares with an average rate of 2.9% across the public sector and 1.7% in the private sector. In its analysis of these data, the ONS says, “It is possible that the exposure of health workers to infections and diseases contributes to their higher sickness absence rate.” BMJ May 2018

….any policy that mandates strict back-to-work rules must also ensure adequate staffing and coverage of health care personnel to limit feelings of personal responsibility that encourage presenteeism. Despite the best efforts of education and mandatory exclusion rules, health care providers will likely continue to come to work if they feel that their absence would burden their colleagues or affect delivery of patient care. Policies that maximize efficiency at work can therefore be detrimental to public health. Furthermore, a policy that ensures adequate coverage may be cost-effective for health care institutions by mitigating the negative financial impact associated with large nosocomial outbreaks. Widera et al

Meanwhile what do you do to ensure someone at work knows where to find that crucial document? Who knows what you are working on? Who is  on standby if something unexpected happens? What is the risk to the team if you can’t be there tomorrow?

Picture by  Ben Seidelman 

Do you use stories?

Outcomes in healthcare can be assessed using measures, meters and monitors. The art of healthcare is to ‘sell’ health because most of what promotes health are the choices of autonomous individuals. Healthcare can choose to present facts and figures:

Your BMI is 27, your blood pressure is 150/95mmHg, your lipids are in the higher range, your K score ( measure of depression) is 26

So if this is you you’ll be advised to lose weight, exercise more, eat less and relax. Even as you hear these numbers you will glaze over. In other industries they use stories to avoid ‘push-back’. The typical story has a setting, a hero, a complication a turning point and a resolution. Story teller’s say:

He must enter the hearts of his listeners, where their emotions live, even as the information he seeks to convey rents space in their brains. Our minds are relatively open, but we guard our hearts with zeal, knowing their power to move us. So although the mind may be part of your target, the heart is the bull’s-eye. To reach it, the visionary manager crafting his story must first display his own open heart. Peter Guber

The story might be:

You know you remind me of another 45 year old chap I knew. He was a very successful and worked long hours. While he loved his job he also wanted to retire early so he didn’t pay much attention to his lifestyle. Then one night he went to the Emergency department because he had terrible chest pain. He was due to go to an important meeting in the morning but that evening he was sweating, vomiting and clutching his chest. He was lucky because it turned out he didn’t have any serious illness but he needed to change his habits. Two years later people didn’t recognize him, he put all of his skills to reinvent himself, lost weight, started exercising and having regular breaks. So although he, or should I say I, won’t retire soon I plan to live long enough to enjoy it when it does happen.

Bernadette Jiwa’s new book the Right Story might help.

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What is the last minute in your company like?

According to the ‘Peak End Rule’ people, including patients will rate an experience much more positively if the final moments of the experience are good or at the very least not horrible. So how you close a meeting warrants as much attention as how you greet the person and the thought you put into the interaction generally.

…. companies cause experiences as opposed to creating them, because customer experiences are created from everything perceived, felt and remembered by the customer…..In layman’s terms, design customer journeys that go out with a bang. Deliver a grand finale, even if staged, to make sure your company is causing experiences that make your customers feel emotion and remember. Mary Drumond

So what is the last minute in your shop, office or clinic like for your customer, client or patient? Doctors might want to reflect on the research evidence.

Experts have proposed four main skills which may contribute to a satisfactory ending of the consultation.

  • Summarising: summarises session briefly and clarifies details of care.
  • Contracting: contracts with patient regarding next steps for patient and physician.
  • Safety-netting: safety nets appropriately – explains possible unexpected outcomes, what to do if plan is not working, when and how to seek help.
  • Final checking: checks that patient agrees and is comfortable with plan and asks if any corrections, questions or other items to discuss.

But beyond that do you perform any ritual? Do you get off your chair as the patient stands up to leave? Do you accompany them out? Do you wait at the door until they move off down the corridor? What? Why?

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Are you a do-gooder?

Are there limits beyond which you would not go? What are they at work? Who knows about it?

  1. Will you do extra shifts?
  2. Will you see more customers, clients or patients?
  3. Will you take phone calls outside of work hours?
  4. Will you agree to stay late?
  5. Give up your lunch break?
  6. Will you tolerate interruptions when you are doing something?
  7. Will you check your emails tonight?
  8. Will you use the word ‘ No’?

If you don’t set those limits what can’t you do?

  1. Exercise?
  2. Attend a family function?
  3. Sleep?
  4. Eat well?
  5. Be present for those who love you?
  6. Generate solutions?
  7. Create opportunities?

Why are the items on the second list not a priority? Who pays the price? How long before you feel the consequences? What is the quality of your ‘doing’? Will the world end if you set limits? Will you be missed if you were to be fired today or would you be replaced within hours? (OK may be days.) What worries you about setting limits? Is that logical? Really?

If you rate yourself as a people pleaser here’s some advice from  Dr. Pamela Wible

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What do you do to unwind?

As a health care professional you are encouraged to have some down time. According to research:

Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout. Shanafelt TD et al

In the UK, NHS

More than half of salaried and locum GPs suffer from stress as a result of their work. BMA

So if you are in healthcare how and when do you unwind? How do you know it’s working? Are you too busy chopping the wood to think about sharpening the saw?

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Does your confidence get you into trouble?


Confidence– it’s just a decoy– it’s the dog that barks because he doesn’t bite.Tomas Chamorro-Premuzic, professor at University College London

As a healthcare professional you’re supposed to have the answers. But how often are you blind sided by your confidence? How often do you test your ideas?

In reality however, there is a very big difference between confidence and competence. Competent people are generally confident, but confident people are generally not competent. There are just good at hiding their incompetence and their insecurities– mostly because they are self-deceived themselves, so they generally think that they are much better than they actually are.Tomas Chamorro-Premuzic, professor at University College London

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