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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

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.

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.

What stories do you tell?

We all have stories about what we do for a living.  We tell them all the time- even if we don’t recognize that we are telling stories.  They communicate how we feel about our work. Do your stories convey the impression that you are stressed out, bored, bullied, treated unfairly and in general can’t wait to retire? You realise that this is also your self talk and that ultimately you will magnify these experiences. On the other hand if you started telling stories about experiences that energized you, made you feel valued and creative then you might notice more about your job that seems to resonate with what you want and how you want to feel.

At 9 o’clock one bright morning a 32 year of man had been waiting for an hour in a busy clinic. He was called into the doctor’s office. Covered in tattoos, he was a muscular man whose tanned skin suggested a life outdoors. He wore a high vis vest and heavy steel capped boots.

I’ve had a toothache since three o’clock this morning doctor and I need to get to work

He said rubbing his jaw. His doctor was curious, it was odd that a man who seemed very robust in every other way, was getting ready to go to work would wait for an hour in a busy clinic complaining about toothache that started a few hours ago. But of course that wasn’t the whole story. The doctor watched him rubbing his jaw and the side of his neck.

Where did the pain start?

In my chest doctor, it was like someone was sitting on my chest, I felt a bit nauseous and it seems to have settled in my jaw and the side of my neck. I think it’s going into my shoulder now.

Half an hour later the man was in hospital being treated for a heart attack. His decision to get to a doctor might just have saved his life and his doctor’s curiosity paid of.

Picture by Jonathan Moureau

What I’m taking is better than anything you can suggest

We don’t know why some people respond to some treatments.  Helen produced a bottle of cough medicine from her handbag.

This stuff is magic. It cures my cough every time.

You recall a recent paper which concluded:

Across Europe, there are large variations in the recommendations made by healthcare professionals for the treatment of acute cough. This has arisen through custom and practice based on the evidence of historical studies performed to standards well short of what would be considered legitimate today. Acute cough is particularly difficult to study in a controlled setting because of the high rate of spontaneous remission and a large placebo effect. Morice and Kardos

What do you say? Whatever you say and however you frame it is worth considering before it happens- because Helen isn’t the only one taking what might be considered a placebo.

Picture by _Val_

You can’t fix what you don’t know

Georgia has been waiting to see you for over an hour. She has been ignoring the pain in her side for days. Initially she hoped it would just go away. There is too much else to deal with. Josh her partner lost his job last week. Her mother had a stroke 3 weeks ago. Her dad is barely coping with caring for his disabled wife. The children are going to a new school this year and Emily (9) is having trouble settling into the new class. Meanwhile Georgia was hoping for a promotion at the office. With Josh out of work they need the money and it looks like she might now need to spend her weekends helping dad to manage at home. The pain in her side has got steadily worse and now it’s disturbing her at night. She mentioned it to her friend who forced her to make this appointment. Georgia doesn’t know her doctor well. She just wants this nightmare to end. She imagines this might be a urine infection but surely that wouldn’t last this long? She doesn’t want to think about the other possibilities. She especially doesn’t want to think about the lump she found in her right breast last month. She hasn’t told Josh she was coming to the clinic today and gave a vague impression that she needed to come to this end of town to collect something for work. She doesn’t want Josh to worry even though she thinks he might have noticed her holding her side while making the children’s lunch last night. Please let it be a urine infection so that a course of antibiotics will fix it. Georgia isn’t ready to handle any more bad news. A quick visit and a prescription is all she expects.

In 2 national, nonprobability online surveys of 4510 US adults, most participants reported withholding at least 1 of 7 types of medically relevant information, especially when they disagreed with the clinician’s recommendations or misunderstood the clinician’s instructions. The most commonly reported reasons for not disclosing information included not wanting to be judged or hear how harmful their behavior is. Levy et al

The outcome doctor is up to you but it all hinges on you being able to get the picture. Georgia isn’t sure she is going to tell you any of this even though she desperately needs someone to make it alright. Will you notice? Are you set up to receive the signals?

Picture by Drew Leavy

What happens next is up to you

Healthcare more than any other service warrants taking the long view. Supposing a toddler becomes feverish overnight. Mum and dad (assuming they are living together) are likely to fret about that child all night. No one will sleep well. The following day the parents will continue to worry that their baby is ill. Friends or family will be consulted. It is possible but not certain that a grandparent may be able to offer some relief with childcare.

Researchers in the United States have found that a third of children under the age of six receive up to 10 hours of care a week and that 47% of all grandparents with grandchildren (under 13 years) living nearby provide some childcare . Although more grandmothers (54%) provided child care it was found that grandfathers (38%) also made a significant contribution. In the United Kingdom it has been estimated that up to half of working parents rely on grandparent care for their children. It was also found that although grandparents were prepared to provide some child care, and at times even reduced their working hours to provide it, they did not want to give up their jobs. Australian Institute of family studies

The partner who has to go to work the next day will be distracted and anxious. The childcare arrangements, if that’s the norm will be on hold as one parent may take time off to be at home. The parents will visit a pharmacy (drug store) and acquire whatever is recommended in the hope that the child will recover quickly. That is unlikely as even a viral illness can make a child unwell for several days. Eventually they will seek medical advice. Phone calls will be made and appointments requested. Parent or parents and toddler will travel and wait in line to see a doctor. They will eventually wheel the toddler into a health practitioners room. If that person is you what happens next is up to you.  Most likely the child will have a viral illness, be teething or have some other minor illness. But to this family this will have been a stressful and worrying couple of days. How you respond will form their impression of your service and make a bad situation an opportunity to learn about caring for a sick child or add to the  drama.

Picture by Andrew Seaman