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What did you expect yesterday?

As you walked through the front doors at work yesterday what were your expectations? Were you hoping:

  1. To serve to the best of your ability
  2. To learn something new
  3. To enjoy good company doing something meaningful
  4. To make a difference to someone
  5. To earn a big pay cheque
  6. To pass the time before home time
  7. Something else?

Which was it? How did you feel at the end of the day? How do you think those who interacted with you felt at the end of the day?

Picture by Gotcredit

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

How do you contribute on the journey?

It is unlikely that you will be part of every encounter with the customer, client or patient whatever you do and wherever you work. A barista is not at the table with the customer is presented with their breakfast; a dressmaker isn’t at the checkout when the customer makes their purchase at a department store. Sooner or later you won’t be there in person. However it is likely that whatever you’ve contributed will have an impact. How do you define your role from this perspective in healthcare?

The participants—21 family physicians (fps), 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 general practitioners in oncology—were asked to describe both the role that fps currently play and the role that, in their opinion, fps should play in the future care of cancer patients across the cancer continuum. Participants identified 3 key roles: coordinating cancer care, managing comorbidities, and providing psychosocial care to patients and their families. However, fps and specialists discussed many challenges that prevent fps from fully performing those roles:

  • The fps described communication problems resulting from not being kept “in the loop” because they weren’t copied on patient reports and also the lack of clearly defined roles for all the various health care providers involved in providing care to cancer patients.

  • The specialists expressed concerns about a lack of patient access to fp care, leaving specialists to fill the care gaps. Easley et al

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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

Do you advise or dictate?

What do you advise most people who seek your help? What will solve most of their problems? It was interesting to read an article this week suggesting that junk food may be associated with depression. In her commentary Megan Lee notes:

Depression has long been treated with medication and talking therapies – and they’re not going anywhere just yet. But we’re beginning to understand that increasing how much exercise we get and switching to a healthy diet can also play an important role in treating – and even preventing – depression.

For many of the most coveted outcomes in healthcare three things are paramount:

  1. Eat less
  2. Exercise more
  3. Don’t smoke

Simple focus. Not easily translated in practice because selling a healthy lifestyle is tricky:

Interviews with 130 mothers of lower social class provided the basis for studying their views on the desirability of general practitioner intervention in their lifestyle habits; the study used both quantitative (questionnaire) and qualitative (interview) techniques. The majority of women were in favour of counselling on specific topics by the general practitioner but the qualitative data also revealed that most respondents expected the issues to be relevant to their presenting problem. Moreover they were keen to assert their right to accept or reject the advice given. Stott and Pill

Picture by Fit Approach

Who leads the way down the corridor?

It may seem a tiny detail but as you walk your client, customer or patient through your clinic, shop or premises who walks ahead? Specifically when you get to where you both need to be who takes the first step into the room? Does it matter? Have you tried to do it differently? What does your guest think? How do you know? Could it be part of the ritual of welcoming someone to your office? Here’s a perspective from Workopolis:

Hold the door. When you go through a door, always look behind you and see if anyone else is coming. If someone is, hold the door open for them for Pete’s sake. The same goes for when you are getting into the elevator and you see someone coming. Hold the elevator. It’s what separates us from the animals.

Picture by Carol Van Canon

I am Joe and I get what I want

As I surveyed the new intake of medical students one student found his way to the front of the room.

Are you the associate dean?

When I confirmed he went on:

My name is Joe ( Not his real name- to spare his blushes). You need to know that I get what I want.

Now two years later here was Dr. Joe graduating, resplendent in his academic gown. He has his wish which I hope is for a lifetime of selfless service to people in distress. So when he is called to the patient in bed 9, on the wards tonight and he is told:

I’m Mr. Smith, and you need to know I get what I want. Tell your boss to come to my room at 11am, I’ll be ready for him then and by the way I’m not happy taking those pill, please take them away.

Joe will know he has got his wish.

Picture by KC

Who taught you how to complain?

When during your training or your induction did anyone teach you how and when to express yourself when something did not meet with your expectations? Your parent might have said:

I know you’re angry darling but we don’t scratch and bite

How do your customers, clients, patients know how to complain? How did you learn to respond? Who models that behaviour for you? What is the approach to giving or receiving negative feedback where you work?

Picture by Paco Trinidad Photo

What do people see on your desk?

Okay so you might not have chosen the wall paper, the carpet or the size of your office but what’s on display on your desk? What impression is created at a glance? Do you look organised? Do you look like you’ve got the time to give your visitors some attention?

There are six reasons to clean off your desk and as Catherine Conlan suggests:

Remember, your workspace speaks for you even when you’re not there.

Picture by Andrew Tarvin

How do you explain?

In any meeting where you are the expert how do you explain technical details? As a doctor how do you explain viral illness? Warts? Heart disease? Cancer? How do you know the other person ‘gets it’? Do you say the same thing every time? Do you use pictures? Sounds? Have you practiced the script as much as you practice other aspects of your art? Why or why not?

Andrew McDonald wrote in the BMJ:

The development of such a language, securely founded in shared meanings, would be a good first step towards better communication between professionals and patients. It would not, of course, deliver the goal of full participation in decision making, but that goal will remain elusive unless we begin by understanding one another.

Picture by Marco Verch