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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.

Picture by MorkiRo

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?

Picture by Xava du

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

Picture by Matt Brown

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?

Picture by Zach Den Adel

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

Picture by Qwedgeonline

Do you say I’m only trying to help?

She was very earnest when I first met her.

I have these terrible headaches. Nothing has helped so far. I know you can fix it.

With all the zeal of a man on a mission I set out to establish a diagnosis for her chronic headaches. Having examined her I performed lots of tests in search of the elusive cause. When no diagnosis was forthcoming we tried a bunch of empirical treatments. After a few days on each prescription she stopped them all for reasons including ‘side effects’, the cost of the tablets or inconvenience. Each excuse was more inventive than the one before. It became apparent that whatever the cause of the headaches we were not going to ‘cure’ them. So I tried a different tack, I recognised that she was bored and unhappy. Perhaps if she dealt with her dysphoria her headaches would be less of an issue. But with each suggestion for addressing her unhappiness she would come back to:

I can’t do much with these headaches.

And yet the odd thing is that she seemed cheerful and able to function perfectly well despite headaches spanning many years. I came to the conclusion that I was the unwilling partner in a game of ‘Wooden leg‘. The lesson was to recognise the invitation to join in the game at the outset and to consider the possibility that my part in the game was I’m only trying to help you.

Picture by Kevin O’Mara

Are you aware when you are flagging?

Are you aware when you are tired? Do you look at your reaction to any situation and wonder if it came from a place of fatigue? How do you deal with that?

When we are tired, we are attacked by ideas we conquered long ago. Friedrich Nietzsche

This study aimed to evaluate the variations in mood states and empathy that occur during the internship year. Consistent with our expectations, results of the first administration of the POMS and IRI demonstrated that interns in this cohort arrived with high levels of vigor, energy, and a well-established ability to demonstrate empathic concern. However, as early as November, we found that significant mood changes were already evident among our cohort. Interns became more angry and depressed. These data support previously reported findings that internship negatively affects personal well-being. Bellini et al

Fatigue and sleep deprivation, associated with long working hours and shift work, impacts on doctors’ personal safety, increasing the likelihood of occupational accidents, road traffic crashes and needlestick injuries. It also increases risks to patient safety through clinical errors. BMA

Picture by Dominique Archambault 

Can you stand to be bored?

Ever since the invention of the smartphone boredom has been banished. But at what cost?

Our results indicate a moderate relationship between smartphone addiction and a self-reported decrease in productivity due to spending time on the smartphone during work, as well as with the number of work hours lost to smartphone use. Smartphone addiction was also related to a greater amount of leisure time spent on the smartphone and was strongly related to a negative impact of smartphone use on daily non-work related activities. These data support the idea that tendencies towards smartphone addiction and overt checking of the smartphone could result in less productivity both in the workplace and at home. Duke E

Can you give that customer, client or patient your undivided attention with one eye on your phone? Is it worth considering if you have a problem?

Picture by Graeme Paterson

Do you perform any rituals during your day?

Do you perform any rituals during your day? Why? What is the value of the ritual?

Despite the absence of a direct causal connection between the ritual and the desired outcome, performing rituals with the intention of producing a certain result appears to be sufficient for that result to come true. Francesca Gino, Michael I. Norton

Picture by Sulen Lee

How long will it take you to get to work tomorrow?

Does your journey to work impact on your performance? How? If it does as the evidence suggests, what are you going to do about it?

This paper offers a multi‐perspective examination of commuting drawing upon the literature in transport, planning, geography, economics, psychology, sociology and medicine. It examines statistical evidence on trends in commuting travel behaviour and finds that one in 25 commuters now travels to work in excess of 100 km (both ways) and one in ten commuters now spends over 2 h/day travelling to and from work. Lyons and Chatterjee

In healthcare performance is thought to be largely a factor of policy.

Looking forward, the seven countries we studied face the shared challenge of how to integrate care in an era of specialization and shortages of primary care physicians. Achieving better care coordination will likely require designs that include a mix of formally integrated organizations, co-locating or sharing services, and connecting through information systems. Schoen et al

But on closer quarters performance is highly impacted by the personal choices healthcare professionals make.

Picture by Darren Cowley