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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

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

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

Does your performance at work depend on coffee?

Does the time of day determine how you respond at work? Are you tired by mid afternoon? Are you slow to get going in the morning? How does that impact on the decisions you make at that time?

Decision fatigue is the concept that as we make more decisions during the day, they become less and less good quality… I know that I would much rather be one of my first five patient contacts of the day than my last five. Rachel Ali

Remedies for decision fatigue might include time-dependent decision support, modified schedules, shorter sessions, mandatory breaks, or snacks. Further studies could clarify the sources of the problem and test corresponding solutions. Linder et al

Does this resonate with you? What are you doing about it?

Picture by Albert Drobin

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…..

Picture by lagaleriade arcotangente  

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

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

Why do you keep me waiting?

We often have to wait in line to be served. In healthcare that happens a lot. If you had to wait an hour or more every time you needed something from somewhere would you continue going there? Why or why not? Does queuing have to be  fact of life in healthcare? How long before someone works out it isn’t necessary and offers an alternative? What will happen to those places that fail to keep up?

Although appointment systems are often designed to avoid doctor idle time (without considering patient waiting time), it is possible to reduce patient wait time without significantly increasing doctor idle time.

Picture by Michael Dales

Could you do better?

Do you think your work could be better? How? If you think it could be improved what are you waiting for?

The intense debate about how to move forward is a sign that overtreatment matters,” Brownlee says. “We want everyone involved and sharing their expertise on potential solutions. There is room for many political ideologies and beliefs about how to pay for healthcare. The crucial step right now is to get the medical community mobilized around the idea that overtreatment harms patients

BMJ Jeanne Lenzer

Picture by Carlos Ebert