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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

Picture by Drew Leavy

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?

Picture by Melanie Hayes

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

What price do you pay?

Looking back it was the right decision for me. I decided to choose a different career the day I wiped mayonnaise off my tie. I didn’t want to have my meals on the run. The job wasn’t for me if the price was regularly having to eat out of a paper bag rushing around from place to place or sitting at my desk. Others felt differently. I had to make a choice that worked for me.

While 62 percent of doctors who were normal or underweight reported eating a healthy diet rich in fruits and vegetables, the survey revealed that 44 percent of heavier doctors eat a diet high in carbs, meat and fat, or “on the go” meals. Just 16 percent of doctors who were considered overweight or obese were on a diet meant to help them lose weight or restrict calories. Life

Picture by Chris Blakeley.

Small details matter

It’s a small detail. If you are accompanying someone down a corridor as a healthcare professional- don’t stride ahead. Ideally walk alongside the person or let them lead the way if they know where you are headed. If they are wheeling a buggy and carrying a bag offer to help by wheeling the buggy.  Just try it. You might like how they respond. Apart from that you can learn so much about the person even before the consultation begins:

So instead of a doctor assessing a patient’s blood pressure, body mass index, chronic conditions, hospitalization and smoking history and use of mobility aids to estimate survival, a lab assistant could simply time the patient walking a few meters and predict just as accurately the person’s likelihood of living five or 10 more years—as well as a median life expectancy. Scientific American

Picture by Salman Qadir

Do you monitor your dashboard?

It is unlikely that you will arrive at work every morning energized, rested and looking forward to the day ahead. Last night the neighbour’s dog may have disturbed your sleep. You might spill your coffee as you rush to catch the train. You miss the train and as you run to the bus stop the rain starts and you realise you’ve have forgotten your umbrella. En route you might receive bad news or have an argument with your partner. Nonetheless you will have to get through the day and in healthcare that will mean giving those who seek your help your full attention notwithstanding how you feel. How do you prepare for that?

Jonathan has been refusing medication for diabetes for several months. His weight continues to climb. His blood pressure also warrants treatment as you have advised several times. Today he arrives unannounced to seek a prescription for steroids just in case his asthma becomes a problem over the weekend. He has a loud argument with the receptionist insisting that he has an appointment and besides he thinks his problem is urgent and he needs to see you now. He now looks sullen because he feels he has been spoken to disrespectfully.

It’s close to lunchtime and you are hungry. You have a headache and you are hoping to receive a text from your partner who finds out if his job interview was successful. What now?

Picture by Monja

Is this something for today?

How your customer, client or patient responds to your advice, offer or recommendation will depend on factors that may have nothing to do with how these are presented to them.

Susan sat bolt upright glancing at her watch. Although she had only been waiting for ten minutes she was becoming irritated as she was keen to get away as soon as possible. It would be a long day ahead. The staff meeting was likely to be challenging. There was talk of redundancies. She wasn’t sure if her department would survive the purge. It had been a bad start to the year, the sales figures were down at least thirty percent and the company had appointed an external consultant to determine what should be done urgently. She was interviewed last week and she wasn’t sure if the consultant would recommend keeping her section open. Over the past six months she had been drinking more, the glass of wine with dinner was now two glasses. She was also snacking more during the day and the doughnut on the way home which had been a Friday afternoon treat were a daily habit. She was aware that her weight was becoming a problem but right now she just wanted to get through this nightmare. She didn’t come to the doctor often but she needed a script. She had argued with the pharmacist but he was adamant that he would not supply the steroid inhaler without a prescription. Finally the doctor summoned her through and noted that she was much heavier than he remembered. 

What happened next ……your call.

Picture by Neil Moralee

Let’s do it my way this time

Occasionally your customer, client or patient will come with their mind made up. Nothing you will say will make a difference to what they feel they need. In healthcare if what they want is going to harm them you will be duty bound to refuse just as you might refuse to serve alcohol to a drunk. But occasionally it may be difficult to argue.

Just one other thing, doctor, I need this wart burnt off.

Her doctor noticed the simple wart on her finger.

How about we try something that might be just as good? How about you try taping banana peel on this every night for a week. It will be far less uncomfortable and you might be surprised that the wart will just fall off.

Sure doctor. But today can we just burn it off and then if it comes back we might try the banana?

Picture by Marco Verch

Not all solutions are linear

We mistakenly believe that the path to solving some of our customer, client or patient’s problems is linear. Want to improve your liver function? Stop drinking alcohol. Want to lose weight? Go on a diet. Want to have more energy? Stop smoking. The ‘solution’ is simple. But it doesn’t usually work that way.

Sophie sat looking glazed as her doctor suggested a strict diet that might help her shed the kilos. It didn’t end well. She never lost any weight and eventually stopped attending that clinic. Her life was complicated. She had always been overweight and after the babies were born she got steadily heavier until she was obese. She lives in a modest two bedroom rented home with three children and partner. He works as a bus driver. Sophie does shifts at a laundry when her friend needs help covering the roster. The family buy their clothes second hand and just about pay their bills. At the weekend they go to the mall and have a takeaway meal from the food court. Sophie enjoys the day at the mall where she meets her friends and spend the afternoon gossiping while the children are in the play area. She didn’t learn to cook and her small kitchen is barely equipped to turn out the simplest meal. She never enjoyed school and can’t read. In quiet moments Sophie admits she doesn’t like the way life turned out but she has dreams that she might win the lottery and then life will be so much better.

With this as her back story the diet and exercise program wasn’t appealing. She may decide she wants to reduce the risk of developing diabetes, a condition that impacted her father. It may be a meandering journey but the best coach will stick with her.

Picture by jurek d.