Category: Physician Mindset

The “Difficult” Patient

A simple thought for the day. Check this out. What you will see is a brief but fascinating little piece. The point? With 15-60% of patients being considered by their physicians to be “difficult,” the underlying problem just might not be one of psychiatric pathology in the patient. Maybe the problem needs to be reconceived as resulting from a damaged interaction between the patient and the “health care delivery” she has encountered.

Bottom Line. It always amazes me how often “reconceiving” a problem can be a powerful first step towards its resolution.  

Doctors Don’t “Communicate” About Medications

Check this out. What you will see is a simple but important thought. Our old friend, The Country Doctor, suggesting that while businesses spend a disproportionately large percentage of their time and effort focused on how to sell something rather than on how to produce it, physicians take the opposite approach. Especially given the increasingly tight limitations on their time, doctors simply cut to the chase, tersely telling patients what medications they need to take and how, and failing to “sell” the drugs and their benefits with anywhere near the same level of intensity that the drugs had been sold to them.  

Bottom Line. So what? So plenty! Consider the impact of all of this on patient adherence. And, perforce, on the doctor-patient relationship.  

Maybe we, as an industry, need to help doctors to become better salespeople. I am thinking that this could result in a triple win. For the doctor, for the patient, and for us!

Hospital CEO “Cut!” After Participating In Surgery

Yes, you read that title correctly! And no, the CEO was not an MD!!! Check this out.  What you will see is one of the more bizarre stories you will encounter this week. Guaranteed!

Here’s the deal. For some inexplicable reason, the CEO of a hospital in Bristol, TN entered an operating room to “observe” a surgical procedure. What he expected to learn from this observation process remains unclear. What is clear is that, for some other inexplicable reason, the surgeon in charge of the case asked the CEO if he would like to make the first incision on the anesthetized patient. He did!  

As tends to happen in 2020, word of this “got out.” First to the hospital’s compliance program, and then through the press. What happened next?  Exactly what you would think. The CEO and the surgeon are no longer employed at that institution.  

Is that all? Perhaps not. This blog post contains mention of possible criminal actions against the CEO, and the possibility of civil lawsuits as well!

Bottom Line. But wait. Maybe there is more going on here than meets the eye. I’m thinking that this is really a story about an “In the heat of the moment” fantasy.

Ask 5,000 surgeons on Twitter if they would let their hospital CEO’s make an incision in their patients. The answer? A resounding “Hell, NO!” Good rational thinking in response to a survey question.  

BUT. What MBA hospital administrator has not fantasized about being a doctor, you know, one of the guys who really make the hospital work? And what surgeon has not wanted to show his CEO who is really boss by letting him play with his toys, unfortunately in this case a patient’s body? 

In a world where habits, heuristics and emotions account for the vast majority of human behavior, consider this just one more reminder of how imperfectly survey responses predict actual behavior! The kind that occurs “In the heat of the moment.” 

Frankly, I Don’t Care What Your Cardiologist Says!!!

Check this out.  What you will see is a riff by a Cardiothoracic Anesthesiologist on “stuff” he doesn’t want to hear from a patient prior to surgery. For example, this doctor believes that he is more than capable of evaluating a patient’s operative and postoperative “risk.”  He doesn’t need a warning, or a clearance, from your Cardiologist. Similarly, he doesn’t want your Pulmonologist’s opinion thrown into the hopper either. And God forbid you would request a specific anesthetic!!!  

As an aside, he includes a great quote about one of the key aspects of being an Anesthesiologist. Time is usually of the essence for this specialty, since they must “diagnose and treat at the same time.” 

Bottom Line. What do we learn from this riff? In the decades that I have used my Ph.D. in psychology to study physicians, I’ve noticed three important and related trends. First, physicians have become increasingly specialized, one could even say hyperspecialized, during this time period. AND. These specialized physicians have become increasingly sensitive about other specialists treading on their turf. Finally, armed with “information” drawn down from the Internet, patients attempts to direct their own medical care are increasingly fraught with risk as they attempt to enter into the specialized world described above.  

Yup, that all makes sense!

What A Female Physician Has Learned About Being A Female Physician

Check this out. What you will see is a list of 10 key lessons this doctor has learned about how to survive as a female attending physician. Probably the most significant of these is “Lesson 4. Female resentment is real.” So how does she deal with that? By remembering to “Pick your battles” and realizing that “You must develop coping mechanisms.” 

Bottom Line. And the other key lesson here? Remembering that “Change is slow.” Female physicians are not the statistical oddity that they once were, but that does NOT mean that they have been fully accepted into the profession.

Transformation-Take Two

Yesterday, we discussed the fact that one of the states a hospitalist reported going through as he deals with treating COVID patients is “transformation.” Over the course of the last two months, he has come to understand that the “scrubs” have let the “suits” take over and ruin medicine. He is now vowing to stand up and be counted in the fight for good healthcare and for better physician quality of life.  

Here’s another one.  A self-proclaimed one minute read that implores doctors to “wake up” and start living the lives that they want to be living, rather than continue to be abused into living someone else’s.

Bottom Line. “Wake up.” I am betting that as we come out of the pandemic, you are going to hear expressions of that theme a lot. Doctors and Nurses have doubtless been jerked around enough, with 15 hour shifts, lack of PPE, etc., that they are indeed likely to want to seek out a better lot in life. AND. Being used as political footballs and being yelled at by gun toting demonstrators demanding to be “liberated” so that they can crowd the ICU’s will likely fan the flame.  

There’s only one question. Will medical professionals be able to get organized enough to get changes made? Banding together has never been their strong suit, which is how they find themselves in their current situation. 

We shall see!

Love During the Time of Covid-19

Take a long look at the photo, above. Two doctors. He a Urologist, she a Family Physician educator. And they are married. To each other.

Now check this out. Here you will see the story of them trying to maintain their marriage during the pandemic. It has never been easy. He is completing his residency in NYC. She teaches at a medical school in Miami. Many flights up and down the East Coast each month have worked. Until now. Flying is not too smart, and the stress level at both ends has been ratcheted up significantly.  

To emphasize the feeling of loneliness, she describes Match-Day 2020. What is usually a time of hugging and jubilation was literally transformed into a drive by. Students lined up in their cars, driving up to the Dean one by one and receiving the news as to what residency they were bound for through the car window. At the end of a 10’ pole!!!

Bottom Line. Ponder for a minute the impact all of this is going to have, after Lord knows how many months of “Social Distancing,” on relationships.  

All kinds of relationships!

This Is Not About Physician Burnout!!!

In fact, it is about the reverse thereof. The woman you see at the podium is my doctor. Dr. Patricia North. An Internist universally respected on Hilton Head Island as the best damn doctor in town. Patients have typically been on a waiting list for two years to join her concierge practice.  

The event? Dr. North’s recent “retirement reception.” After 35 years of clinical practice, she is hanging up her stethoscope and heading off to cruise the waterways in a trawler captained by her husband. She is leaving medicine with a smile on her face, just as she always did when I saw her in the office, having found an appropriate Internist to take her place. Of the 800 patients in her practice, 275 patients lined up at this event to say “thank you.” A genuine feel good event. 

AND. A few days later, I had the opportunity to have lunch with two of my fellow Board members of HHI’s Volunteers in Medicine. A great group of retired doctors, nurses, pharmacists, etc. who provide free medical care for the underprivileged on our generally overprivileged island in South Carolina. One of the topics we discussed was how often our volunteer physicians describe their time at VIM as the best experience of their careers. No pressure from insurance companies. Just patients who appreciate and comply.

Bottom Line. As I drove home from that lunch meeting, I thought about what I had seen in the last week. Happy doctors. At both ends of the practice socioeconomic spectrum. I then juxtaposed those observations with what I am going to be talking about, yet again, in an upcoming Intellus Webinar on April 2nd.  Physician suicide, depression and burnout. 

You know what I realized this week? The practice of medicine doesn’t have to drag doctors down. It can be a joy, regardless of the socioeconomics of the practice setting.  

How can we help to spread the joy???

Performing A Procedure Without Patient Consent

Check this out. What you will see is a continuation of yesterday’s riff on our Consent Culture and Bodily Autonomy. Yesterday’s bottom line was that in order to avoid traumatic surprise to the patient, physicians should make it a point to inform the patient about what needs to be done, and then wait for the green light. 

But today’s version is a little different. The question before the house today is whether a physician who has patient consent to do one diagnostic procedure can do another one that the first procedure revealed to be necessary. The kicker is that the patient is sedated while this decision is being made. What is the ethical thing to do? Proceed, since the second procedure is a related one, or hold off until all the paperwork is signed, meaning that the patient will need to be sedated again.

This Gastroenterologist proceeded, and found the problem the patient had authorized him to look for, although not where he was authorized to look. All’s well that ends well, although it should be noted that the medical malpractice attorneys would doubtless have had a field day if something had gone wrong during the second procedure.  

Bottom Line. SO. Yesterday’s guideline of “Always inform the patient and get permission in advance” clearly has some limitations. And that’s the way things work in medicine.  

And in life!

Don’t Touch Me! At Least Not Without Asking Me!!!

Check this out.  What you will see is an interesting discussion by a Pediatric Nurse Practitioner on the topics of “Consent Culture” and “Bodily Autonomy.” Frankly, I had to think about both of those terms for a few minutes, and read the referenced post, in order to understand what each of these terms means and why I should care.   

Let’s take them one at a time. We are indeed in a Consent Culture. Want to put cookies in my computer? I have to consent. Want to have me comply with your rules and regulations? I have to consent.  Etc.  And the rallying cry of the Consent Culture? Very appropriately, #MeToo. BUT. How do we get a child to consent to medical care being provided? Sure, the legal onus here falls on the parent or guardian, but children can be traumatized if they have not bought into a procedure, even a benign one, before it is performed on theirbodies.

Bodily Autonomy? Related issue. This is my body, don’t mess with it. 

All of this got me to thinking. How about medical practitioners who are treating adults? Shouldn’t they have the same considerations and concerns? 

Bottom Line. At the end of this post, we are provided with five simple guidelines on how to manage these concerns constructively. My favorite, without a doubt, is that pediatric practitioners should announce what they are about to do and wait for an “ok,” even a tacit one.  

I’m thinking that the same thing is true for practitioners taking care of adult patients. This doesn’t take a lot of extra time and, in an era where office visits are increasingly rushed, might be right up there with warming the stethoscope in terms of providing patients with the feeling that they are being “cared for,” not just “treated.”