Latest blog postsLearn More

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

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 mind if I don’t take your advice?

Your customers, clients or patients are free to choose. Despite your most earnest desire to save them from themselves they may choose to pass on your advice today. Is that alright? They may decide never to give up on the donuts, to stop smoking or head to the gym. As a consequence they may continue on the way to chronic illness. Do people have responsibilities from the ethics point of view?

Autonomous patients do have duties most of which are left out of mainstream medical ethics. Some of these duties flow from the obligations all persons have to each other; others are the
responsibilities citizens have in a welfare state. More specifically, patients have duties corresponding to those that render doctors captive helpers. Patients have to- morally have to do their best to ensure that they minimise this captivity and enable doctors to be willing helpers. Although doctors remain captive in the face of acute or life-threatening illness, it is not unethical for doctors to free themselves from this captivity in cases that fall short of life or death. Draper and Sorell

Picture by Viv Lynch

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

What do you share about yourself that’s a safe topic?

Health warning:

As a doctor, the reality is you are never off duty and their status in the public eye demands a high standard of conduct at all times. Dr Naeem Nazem 

At some point someone will ask you where you went on holiday or why you have a model airplane on your shelf. You can choose to be very ‘private’ or have something you might find increases the connection with that person without befriending them on Facebook.

Physicians aged 40 to 59 years report that they most enjoy running or jogging (36%), bicycling (35%) and camping or hiking (24%). About 50% of physicians older than 60 years reported walking to stay healthy.  Other interests include golf, aerobics and cardio, skiing, tennis and fishing. Other leisure activities reported include reading, with many physicians describing themselves as avid readers; regular reading was reported by more than half of physicians under 40 years, 58% of those aged 40 to 59 years and more than 64% of those aged 60 years and older. Endocrinology advisor

The trick is not raising topics that should be off limits but it makes you more human if your client, customer or patient knows you are an avid reader, you play golf or sing in the choir. You can prompt the chat by having a prop for something that you are happy to share. My doctor has a picture of a civet cat in his room. I’d love to know why,  he tells me everyone asks him about the cat.

Picture by  Daniel Colovini  

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

Are you ready yet?

What do you do before you interact with your next customer, client or patient?

Gaze and body orientation communicate levels of engagement with and disengagement from courses of action. As doctors and patients accomplish regular tasks preparatory to dealing with patients’ chief complaints, doctors use gaze and body orientation to communicate that they are preparing but are not yet ready to deal with those complaints. In response, patients wait for their doctors to solicit their chief complaint. These findings have implications for research on nonverbal communication, interactional asymmetry, and power.

JD Robinson

Picture by Mad African

What problem can’t you solve?

Armed with a hammer everything looks like a nail- except it isn’t. We need to be clear what healthcare is for. Doctors cannot ‘cure’:

  • Debt
  • Workplace bullying
  • Violence
  • Illiteracy
  • Homelessness

In addition there are many other problems that may be beyond curative intervention and a few others that require people to make different choices more than the doctor to prescribe something.

The unbridled enthusiasm for guidelines, and the unrealistic expectations about what they will accomplish, frequently betrays inexperience and unfamiliarity with their limitations and potential hazards. Naive consumers of guidelines accept official recommendations on face value, especially when they carry the imprimatur of prominent professional groups or government bodies.

Woolfe et al BMJ

Picture by Bart

Are you sure they can help?

One of the key roles in healthcare is to refer people to other sources of help. The list of therapists, specialists and clinics is as long as any phone directory. However off loading someone elsewhere is hardly worthwhile if it’s a waste of time and money.

The goal should always be the initiation of a discussion about a patient’s needs and the beginning of a triaging process to address these, rather than problem identification being an end‐goal itself. Gemma Skaczkowski

Picture by nicdalic