Physicians Make Mistakes, Correct Them The Right Way

“If they will hand me the instruments when I need them, then they won’t get yelled at. This is my OR and my rules.”

“Well, I’ve always prescribed Cipro for strep throat. In my experience, it always works. No one can tell me how to practice medicine.”

We’ve all heard stuff like that before. Try to offer a correction or suggestion to a colleague and the walls go up immediately. It can be very uncomfortable, especially for non-physician staff, when a physician shuts down a conversation. Physicians often implicitly hold the most power in conversations or interactions that they have with staff and patients. If they refuse to discuss something further, then there is little recourse, but the long-lasting impact on relationships can be irreparable.

So how do we deal with this? As a supervisor, how do I hold staff accountable? As a colleague, how do you approach someone and speak up when you see a problem? It will always be uncomfortable to criticize someone, but if structured correctly, criticism can lead to growth.

If structured incorrectly, then these conversations can lead to worsening distrust within healthcare organizations. If administrators thought their job was hard now, try to lead a cadre of physicians that refuse any attempts you make at change or improvement. It can get ugly fast.

Peer To Peer Conversations

Physicians correct other physicians. That is the practice in my organization, and it is essential. Due to the extensive amount of training that the average physician undergoes, it is very difficult for non-physicians to grasp the knowledge base and unique experience that most physicians have.

This is similar to many other highly specialized fields. I wouldn’t dream of micromanaging the daily tasks of a nuclear physicist. I have no clue what he does on a daily basis. In the same way, physicians are much more apt to listen to a fellow colleague than a non-physician.

My first thought when an MBA tells me I’m not seeing enough patients? Who does this bean-counter think he is (no offense!)?

My first thought when a fellow internist tells me I’m not seeing enough patients? Holy crap, am I not pulling my weight?

Establish the Standards

If you’re going to hold someone accountable, then you need to define what the standards are. Decide the standards up front and include physicians in the decisions regarding this. As I always say, the mission is the answer, and you have to very clearly delineate what you expect your staff to accomplish when they show up at work.

These standards can get as specific or as broad as you like. I personally prefer to keep them broad so we hold each other to the spirit of the law rather than the letter of the law.

I may receive hate mail for this as well, but I think you should define what the standards are not only when it comes to behavior, but also clinical practice. Civility and respect should be a common expectation in all interactions, and most will not have a problem with this. ZdoggMD has an excellent video below demonstrating how to appropriately talk to patients:

OK, maybe not, but I think you get what I’m going for here.

There are numerous benefits to establishing clinical practice standards as well. If all physicians practice in a similar way, then it is much easier for staff to effectively do their jobs. We use published clinical practice guidelines as our starting point and have established methods for deviating from them if there is a compelling clinical reason that the physician staff can agree on.

If a situation is outside of established guidelines, then physicians need a formal venue for peer assistance. This can be through interdisciplinary rounds, tumor boards, etc. The purpose of clinical practice standards is not to cram every patient into the same box. The purpose is to practice in an evidence based manner where evidence is clear, and allow for reasonable judgement when the evidence is not clear.

Public Praise, Private Correction

Do you enjoy being called out in public? Didn’t think so. Then don’t do it to other people! Physicians are no different. Nobody responds well when called out in a meeting of their peers. A justified critique will easily be interpreted as a personal attack because of the venue.

Despite what some may think, adding the extra humiliation of public critique doesn’t “add emphasis” to what you say or “make them remember.” It just builds resentment. The average physician is a driven, hard working individual that will have no trouble remembering any criticism they receive.

In contrast, everyone wants their accolades to be publicly broadcasted. Even folks that shy away from the limelight enjoy being congratulated in front of their peers, whether they admit it or not.

Again, physicians, on average, amplify this even more. Physicians pride themselves on the quality of their work and enjoy seeing that work recognized. Remember you are talking to a group of people that earned a lot of A’s during their school years! Feed the ego a bit and let everyone know when someone performs well.

Professional Courtesy

I hear this phrase thrown around a lot in break rooms. Several physicians have told me before they should be “given the benefit of the doubt” or shown a little “professional courtesy.” Unfortunately, they don’t seem to know what that really means when they say it.

I think our professional athlete colleagues can assist us with an example. Here is Peyton Manning and Jeff Saturday, formerly of the Indianopolis Colts, giving a wonderful example of professional courtesy (note there is some language in the video courtesy of Youtube):

See, professional courtesy means you just sweep problems under the rug, right? Ha! Professional courtesy means I do you the courtesy of coming to you, peer to peer, to ask about what happened rather than simply acting on the information I receive (or calling a press conference in Peyton’s case), under the assumption that we are both on the same page regarding our common mission and goals.

There are many vocations where someone reporting your misdeeds leads directly to termination or other bad consequences. Try working at McDonald’s and have one of your co-workers report that you stole something. Your manager will have a conversation with you, but it will be very brief and will likely end with you handing in your name tag.

Professional courtesy means if someone reports a potential problem to me about a physician, then I do not pass judgement during that initial conversation. I will promise to investigate, but I will not promise to punish or even agree. This can be frustrating for other staff at times, but to me, innocent until proven guilty is an essential part of professional courtesy.

Second, I will review the facts surrounding the case myself and come to you, physician to physician, to discuss the matter (hopefully with fewer bleeps than Peyton). I will not pass judgement before talking to you, and I am open to hearing your reasoning for your actions. This may or may not change my mind, but I will speak directly to you and not to anyone else.

As I said before, professional courtesy never means that I will ignore problems. Our standards are our standards and everyone must be accountable to them. However, I will absolutely promise to come to you, and no one else, to discuss the issue. That is professional courtesy.

Address Problems Now

If there is any final piece of advice I can give, it is to address problems immediately. Don’t ignore them. Don’t say you’ll “address it next time.” Address it now. Show your colleagues that you really think accountability and performance standards matter. Demonstrate urgency with your actions.

The single greatest problem I see amongst physicians and physician supervisors is lack of urgency when it comes to accountability. We get caught in this every man is an island mode of thinking where we simply throw up our hands and say “he’s responsible for his own actions.”

We have to acknowledge that our fates as physicians are tied together and act accordingly. It is always better for physicians to collectively improve. Always. No improvement happens without accountability.

Remember that, at the end of the day, we are going to be accountable to someone. We can either be accountable to ourselves or to someone else. We’ve tried the someone else route in medicine. Time to do something different, wouldn’t you say?

Have you ever tried to correct a colleague or bring up a problem? Did it blow up in your face and turn out well? Tell me about your experience in the comments!

The Position Paper 9/8/17

Welcome to The Position Paper! The Position Paper is my series featuring my quick take on a particular topic to help you manage your position. I will often feature one outside article as well that will allow you to dig in deeper if you desire. Read this while you drink your coffee in the morning and start your day off right!

Today’s Position: Professional Position

Featured Article: None

My Take

No featured article today, as I thought I’d give my brief thoughts about physician accountability. As many of you know, I am a physician that supervises other physicians. As such, I am the guardian of our organization’s mission and values within our clinic.

I take this job very seriously, as I view this as just another way to ensure that our patients receive first class medical care. My role sometimes requires me to have tough, direct conversations with colleagues, and I don’t shy away from it.

I have marveled, however, that some others in similar positions refuse to speak up when noticing their employees delivering substandard work or behaving in an an unacceptable way. Often, they will tell me something along the lines of “I’m not going to tell another doctor how to practice medicine” or “They are responsible for their own actions.”

On the surface, I agree with these sentiments. I don’t go to work every day and tell my physicians how to practice medicine, and they most certainly are responsible for their actions on a daily basis, just like anyone else. However, professional courtesy requires that you act like a professional.

I am not going to sit by and watch one of my physicians treat a patient with disrespect. I’m also not going to watch any of them give out narcotics to every patient with back pain that walks in the door. There are standards of behavior and quality that we all must adhere to. Enforcing these standards does not diminish our profession; it enhances it.

As I tell my employees, we can either police ourselves or someone else will come and do it for us. As a physician, myself, I think I am the best positioned to fairly and accurately judge my staff’s performance and behavior. As long as I hold everyone accountable to a standard of excellence, then no one else will bother us.

If I fail to hold others accountable, then other people will likely start to bother us. I think we all can agree that medicine needs less outside people shaping our direction, not more. Accountability is the only way to ensure physicians remain the leaders of the healthcare system; we should embrace it.

Have a great day!

 

TheBossMD

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The Position Paper 9/6/17

Welcome to The Position Paper! The Position Paper is my series featuring my quick take on a particular topic to help you manage your position. I will often feature one outside article as well that will allow you to dig in deeper if you desire. Read this while you drink your coffee in the morning and start your day off right!

Today’s Position: Financial Position

Featured Article: Here’s The Key To Getting A Good Raise At Time Money

My Take

So, you want a raise, huh? Think you deserve to have your paycheck padded? Think you deserve a bonus for your efforts? Well, let me give you a really complex tip to get paid more at your job. Be good at your job.


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While not the most earth shattering advice, this tip is timeless. It doesn’t matter what compensation structure is en vogue at the time. It is always financially better in the long run to be a star performer.

Our article today from Time Money not only talks about the monetary value of achievement at work, it also talks about trends within the workforce today. Many workers have come to expect the periodic “raise” purely from just showing up.

For those that really do “only show up,” that is the only raise they will ever see. Rather than giving larger raises to great workers, however, the current trend is to make better use of bonus programs.

Clinical medicine is no stranger to this trend, as many hospital systems are instituting clinical quality bonus systems in line with payers’ increasing focus on quality. Interestingly, this shift in focus has led to a slightly different definition of a “star performer” within the employed physician ranks, but that is a different discussion.

I would highly encourage you to know all the details of any bonus program you participate in so you can maximize your chances of getting every dollar, and don’t forget the different tax treatment of your bonus versus a pay raise so you can plan ahead for your taxes. It’s all about what you keep when it’s all said and done. If you’ve gone through the trouble to be the best, then you might as well get the most you can!

Have a great day!

TheBossMD

Do you like The Position Paper format? Is this someone I should keep doing or trash it? Leave me a comment and let me know!

The Position Paper 9/4/17

Welcome to The Position Paper! The Position Paper is my series featuring my quick take on a particular topic to help you manage your position. I will often feature one outside article as well that will allow you to dig in deeper if you desire. Read this while you drink your coffee in the morning and start your day off right!

Today’s Position: Personal Position

Featured Article: Modern Day “Needs,” Which Really Aren’t by Money Propeller

My Take

The recent tragedy with Hurricane Harvey has really gotten me thinking about what matters in life. Many folks lost all of their material possessions in the hurricane and subsequent flooding. I think it’s only natural to think about how I would react if that happened to me as I watch all the news coverage.



Today’s article from Money Propeller doesn’t quite have this kind of focus, but it does provide some perspective about modern day things that we, sometimes falsely, consider to be “essential.”

There are several items mentioned, but I was glad to see electronics like phones and computers put on there. I have been “unplugged” a few times in my life on purpose, and honestly, I really enjoyed it. This realization has greatly changed many of my daily habits for the better as I do not consider it essential to have many electronic notifications in my life.

I don’t need to receive every email that comes in exactly when it hits my inbox. I don’t even need to receive every text message or phone call exactly when it occurs. There are plenty of things happening my real life that require my full presence, free from outside distractions. So, I really can’t call a phone “essential” to my life.

In healthcare, I think we often overstate the importance of computers. I secretly love when our computer system goes down, and I am free to just see patients with no computer. I may pay the price when they come back up, and I have to chart everything. But, there is something truly sweet about seeing patients with nothing else around.

So think about the things you consider “essential.” Are they really that necessary for your life? I bet you’ll find that your list of truly essential things is really small. Our lives would probably be a lot better if we spent more of our time there than with computers or phones. Give it a try!

Have a great day!

TheBossMD

Do you like The Position Paper format? Is this someone I should keep doing or trash it? Leave me a comment and let me know!

The Position Paper 9/1/17

Welcome to The Position Paper! The Position Paper is my series featuring my quick take on a particular topic to help you manage your position. I will often feature one outside article as well that will allow you to dig in deeper if you desire. Read this while you drink your coffee in the morning and start your day off right!

Today’s Position: Professional Position

Featured Article: Improving Physician Satisfaction By Eliminating Unnecessary Practice Burdens hosted by KevinMD

My Take

 

Dr. Yul Ejnes of the American College of Physicians (ACP) penned a home run with this guest post on KevinMD. Doctors everywhere have long lamented the mounting non-clinical activities that take up our day. We are finally starting to see some real movement to rein in all of this workload so doctors can focus more on patient care.

The ACP has a broader initiative, Patients Before Paperwork, which serves as its national campaign to support this topic. In this article, Dr. Ejnes discusses the growing burden of physician signature requirement and the absurdity associated with it. Any doctor that has checked their inbox can see the vast numbers of signatures required for items ranging from wheelchairs to diapers.

Dr. Ejnes eloquently discusses the intended role that insurance companies want doctors to play (medical fraud detectives) compared with the reality of completing all these forms while still providing high quality patient care. Physicians do not want or need to spend their time policing the contract between patients and insurance companies.

Up to this point, physicians have tolerated this exercise in the name of patient care. No doctor wants to see their incontinent patient go without diapers or their patient with history of stroke go without their wheelchair. We are here to help our patients, so that is what we have done.

The sheer volume of incoming fire, though, has triggered a tipping point where the time required to complete these tasks threatens our day to day ability to actually care for patients. We are willing to bend to provide our patients what they need. We are not willing to compromise the patient care we provide.

I am very hopeful that these type of national initiatives will spark real change in the insurance industry and, in turn, physicians’ day to day lives. Physician organizations will likely have to lead the way, as they are the only groups with the size necessary to interface directly with insurance companies.

Throughout our dialogue, we need to keep the patient at the forefront of our discussion. A signature may seem like a simple thing, but continued erosion of physicians’ time to focus on patient care will never have my endorsement.

TheBossMD

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The Position Paper 8/30/17

Welcome to The Position Paper! The Position Paper is my series featuring my quick take on a particular topic to help you manage your position. I will often feature one outside article as well that will allow you to dig in deeper if you desire. Read this while you drink your coffee in the morning and start your day off right!

Today’s Position: Financial Position

Featured Article: Rules For Riches by Wealthy Doc

My Take

I am a simple man, and I prefer to keep my life simple. Wealthy Doc does a great job in Rules for Riches espousing some simple tips that can lead to great results. The unfortunate reality is that many people don’t do the simple things to get the results they say they want. Do you want to win every free throw contest you enter? Practice them. Every day. Shoot hundreds per day. You’ll get really good at it. Guaranteed.


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The same simplicity exists in the financial world, despite how hard we try to make it. You want to accumulate a lot of money? Save it. Don’t blow it. Live a simple life. Don’t do dumb stuff. If everyone could pull that off, then we’d have a lot more wealthy people, physicians included.

In his article, Wealthy Doc outlines some of these simple items that can lead to great results. Educate yourself in an affordable, practical way so you can provide as much value as possible. Make career contingency plans so you always have options. Manage your personal life well by avoiding divorce, raising your kids in an economical way, and maintaining a simply lifestyle.

He, of course, also advises to save early and save often. Only then will you be able to execute a well defined plan of how to grow that money. Perfect asset allocation with five dollars is not going to be very impressive. Perfect asset allocation with five hundred thousand dollars will garner much better results.

The one observation I will add here is that his advice assumes a somewhat traditional career path involving employment. Entrepreneurship is the alternative, which comes with more inherent risk but also potential for higher reward. Last I checked, many of the really wealthy people I know own things, so I would add “Be The Boss” to his list (I had to say it).

Once you grasp these simple items, then you can progress to the higher level stuff. As momma always said,”You gotta walk before you can crawl.” Or something like that…

Have a great day!

TheBossMD

Do you like The Position Paper format? Is this someone I should keep doing or trash it? Leave me a comment and let me know!

The Position Paper 8/28/17

Welcome to The Position Paper! The Position Paper is my series featuring my quick take on a particular topic to help you manage your position. I will often feature one outside article as well that will allow you to dig in deeper if you desire. Read this while you drink your coffee in the morning and start your day off right!

Today’s Position: Personal Position

Featured Article: Take Back Your Sanity By Switching From Push To Pull by Keep Thrifty

My Take

Chris over at Keep Thrifty wrote a home run with this article. He published it some time ago on his blog, but many people should probably save it to read periodically. If you’re anything like me, there’s an infinite number of “things” competing for your time. These things often distract me from what really matters in life, and I’m not OK with that.



Chris talks about switching, as much as you can, from a push to a pull method for incoming information. This method applies especially in the context of electronics but can be used in many realms of life. In short, others should not decide what you hear about first or what you react to first; you should.

Do you want your email to stop interrupting your day? Then turn off email alerts on your phone. How about social media? Phone calls? Text messages? Your mother in law? You decide if these things automatically interrupt you (the push method) or if you decide when you view these items (the pull method).

Chris makes a great case that our society often advocates for constantly being in push mode, however there is likely a better way to approach this. He references the great Dwight D. Eisenhower and his Eisenhower method for determining exactly how tasks should be reviewed and accomplished through the day.

By using this method to classify tasks based on urgency and importance, you can set up your day to focus more on tasks that really matter to you, and eliminate or delegate the rest. I especially like how Chris has applied this concept in his life to be more present with his family when he spends time with them. His phone no longer dings with each incoming email or Twitter post. That stuff can wait. Watching his kids grow up can’t.

I encourage you to check out the article over at Keep Thrifty and give this a shot in your daily life. I personally apply this concept a lot, and it has paid large dividends for me. Remember, I am out to help doctors control their lives before someone else does. We need more pull and less push to do that.

Have a great day!

TheBossMD

Do you like The Position Paper format? Is this someone I should keep doing or trash it? Leave me a comment and let me know!

The Position Paper 8/25/17

Welcome to The Position Paper! The Position Paper is my series featuring my quick take on a particular topic to help you manage your position. I will often feature one outside article as well that will allow you to dig in deeper if you desire. Read this while you drink your coffee in the morning and start your day off right!

Today’s Position: Professional Position

Featured Article: How Does Clutter Affect Employee Productivity shared by Productive Physician

My Take

In today’s Position Paper, Productive Physician shares an article outlining the many influences clutter has in our workspace. I think we have all walked into a physician work room or office with papers scattered everywhere. If you’re like me, it gives you a mini panic attack!

The article mentions some interesting statistics that are especially relevant for physicians. One cited study states the average employee spends up to 4.3 hours per week looking for papers. Physicians, I shouldn’t need to remind you of the administrative drain already placed on your day. If you’re like me, then you routinely traipse around the office looking for those home health orders or lab results.



There are several common sense tips mentioned including keeping an organized filing system and keeping workplaces clean. Personally, I speak with my physicians a lot about keeping our workspaces organized. Though this article may talk about the real economic cost, there is also the clinical cost to our patients we have to consider. Losing lab results or patient messages has real consequences for our patients.

An area the article does not delve into, which I think is especially relevant for doctors, is electronic clutter. Many electronic medical record (EMR) companies would have you believe that you can fire up your computer and only open your EMR each day. That is simply not true.

How many times a day do you realize that you have numerous things open on your computer including your EMR, email, reference materials, internet, and the list goes on? All of these extra “things” that stay open distract you from your primary job, patient care.

You don’t need to see what the next email is the second it comes in. You need to take care of the patient in front of you and check the email later. Decluttering your electronic workspace is key to accomplishing this.

Now go and clutter no more!

TheBossMD

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The Position Paper 8/23/17

Welcome to The Position Paper! The Position Paper is my series featuring my quick take on a particular topic to help you manage your position. I will often feature one outside article as well that will allow you to dig in deeper if you desire. Read this while you drink your coffee in the morning and start your day off right!

Today’s Position: Financial Position

Featured Article: The Golden Handcuffs For Doctors-Loan Forgiveness by InvestingDoc

My Take

In today’s Position Paper, InvestingDoc talks about loan forgiveness and the many factors you must consider if you are going to accept an employment contract with loan forgiveness. First, loan forgiveness comes in many flavors. Here are just a few examples:

I have been offered loan forgiveness via employment contract, and InvestingDoc correctly points out that these are often structured as loans. Either the full balance will be due if you don’t stay for the length of the service agreement, or a portion of it will be due depending on how long you stay. There is often interest attached to the balance you must repay.


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I recommend actively negotiating that the balance be repaid if needed based on the portion of the service agreement you complete, avoiding interest altogether, or negotiating the lowest interest rate possible on the loan if interest must be included.

InvestingDoc also discusses PSLF, which can be great if you work for a federal agency or 501c(3) non-profit. He correctly states that you need to be prepared to fulfill the full 10 year commitment if you want the tax-free loan forgiveness at the end.

He also discussed the recent paranoia surrounding ending PSLF for physicians. Though it is definitely a possibility that physician access to the program could be limited, I highly doubt the government will end the program for physicians already out of training.

The government’s modus operandi for cost reduction is to limit anyone new from entering a program, not cutting off people already in it. As someone with federal employee experience, I can tell you this is always what happens. Not only is it the most fair thing to do, but it is also the most politically popular thing to do.

Remember docs, if you want that PSLF to stay, vote early and vote often!

Have a great day!

TheBossMD

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How To Disagree With A Patient

There has been a lot of talk about physician safety after the recent tragic news of a physician getting killed for refusing to prescribe opioids. The sad reality is that these types of situations are not new. Though many don’t end as tragically, physicians are bullied and pressured every day to provide care that is medically unnecessary.

How should we respond in these tense situations? What should we do when we anticipate that a confrontation might occur? These are questions every clinic and physician should be asking. Though the temptation may be to give in at times to avoid potentially catastrophic consequences, we must not do this. As the professionals tasked with caring for the public, our duty is to provide safe, high quality healthcare.

All of these situations, however, start out as a basic disagreement. It is there that I would like to focus our attention today. How can physicians best manage situations when patients ask for something we are not going to give? Do we yell and scream? Do we immediately assert our authority and shut down the conversation? Do we go silent and simply let the patient talk?

While no “strategy” is going to change a patient’s mind or prevent all situations from escalating, we owe it to ourselves, our families, and even our patients to manage these situations as best we can. I would like to propose seven strategies below to help us safely and effectively disagree with our patients. To be clear as well, many physicians have used all of these strategies I list below and still had bad outcomes. We are not going to prevent every bad situation, but we have to take action to reduce them.

Communicate Expectations Up Front

Every new patient that comes through my clinic spends the majority of their first appointment discussing office procedures and expectations. My nursing staff does the majority of this work, and it is essential. In essence, we tell each patient that we promise to communicate professionally with them, and in turn, they need to communicate professionally with us.

Professional communication entails communicating in a timely and civil way, and it goes both ways. We promise to communicate with you in a clear, calm, and courteous way and you must do the same. During moments of disagreement, I can call on this deal we made and remind them that I have held up my end of that bargain. It has been very helpful at times.


Tell Them You Care

As soon as I feel a disagreement is happening, I am going to work how much I care about the patient and their health within the next two sentences that I say. The reasoning for this is simple. First, I really do care about my patients. It’s not an act or a line I’m feeding them. My treatment of them prior to that moment can speak to that.

Second, discussing how I care for them reframes the conversation. The patient is approaching the situation as confrontational. I am approaching it in a cooperative manner. This is not the patient vs the physician. This is the patient and the physician against your chronic pain, or the patient and the physician against your viral URI that is making you miserable.

No matter what the patient says, I will always reiterate that we are on the same team and I am there to help them. It is much harder to escalate the situation when framed this way, and I can often steer us back towards something productive.

Let The Patient Talk

As someone who personally fields many patient complaints and reviews patient/physician disagreements, I can tell you that the vast majority of patients will tell you that they escalated the situation because they didn’t feel heard.

Yes, they disagreed with the doctor’s decision, but the part that really ticked them off was when the physician shut down the conversation. No one likes to be told they’re wrong and then be told to shut up, even if you know the other person is much more knowledgeable. There is a basic human response to lash out in that situation.

So, I tell my providers all the time to let the patients talk. Give them the courtesy of being heard. Sure, it may put you behind schedule. It may produce no change whatsoever in the decision you make. But, if it can save your relationship with your patient and help prevent something disastrous, then we must do it.

Tell Them Everything

Once you let your patient say everything they want to say, then tell them everything you possibly can. Explain in detail why you’re making the decision that you’re making, and explain it in a way that they understand. Define what certain terms mean if you have to, but you need to show your patient that this is not just a “cookie-cutter” decision. You have looked at their specific situation and applied your medical knowledge to them.

This way, patients know that you are not just lightly or blinding making decisions about aspects of their lives that affect them so much. You have taken your extensive medical knowledge and applied it specifically to their situation to formulate the best treatment plan. I will often say this exact phrase to make sure they understand this. I’m making the best choice for them, not just the best choice in general.

Lower Your Voice

Ok, this move is straight out of parenthood but there are multiple psychology studies to back this up. When someone is confronting you, the natural reaction is to raise your voice. Don’t do it. Consciously lower your voice. It is very difficult to yell at someone speaking softly back to you. Most people will naturally lower their voice if their verbal fire is not returned.

Interestingly, speaking softly can also be a very effective method of communicating confidence. Any of you that had a parent or boss use this style with you can attest to this. A person that quietly outlines their position and does not yell often appears much more authoritative and sure of themselves. A person that yells appears to be covering up their insecurity with volume.

Don’t Fire The Patient

Some of you are going to disagree with me on this point, but that’s OK. I very rarely “fire” patients. I’m not saying it never happens, but it’s rare. Part of this does have to do with my sense of duty towards the patient. The other part though is that you would be shocked how effective it is when you tell the patient that you want to see them again.

We all have cared for patients that have been fired from a previous practice. I have forged some pretty good relationships with some of these folks when I refuse to prescribe something and then immediately ask to follow up with them closely so we can see how things are going.

This reinforces the fact that I really do care about them; it’s not just an act. I’m also reinforcing that I really believe the treatment plan that I have proposed, and I’m willing to see them through it.

Many physicians will make a one time recommendation and ask the patient to never come back if they disagree. Right or wrong, this looks like you simply said something for the sake of saying it and then got rid of them. Consciously telling the patient that you want to keep seeing them communicates confidence and a desire to have an ongoing relationship with them.

Have A Safety Plan

At the end of the day, you’re still going to run into situations where patients inappropriately escalate a situation. Be ready. Have a written policy of how to handle these situations. Make sure everyone on your staff knows the policy and better yet, practice it regularly!

What do you do when a patient yells and won’t stop? What do you do when a patient threatens you or even becomes physically violent? Have everything planned down to how you communicate with your staff that you need help to who is responsible for calling 911.

As with all emergency situations, you will always revert to what is most ingrained. If you and your staff know your policy cold and have practiced it, then you will be much more likely to safely handle the situation. Heaven forbid that something were to happen and a patient would accuse you of wrongdoing, a written policy with documented staff education and routine practice will also help you prove that you had a well thought out plan that you followed.

Remember Your Value

At the end of the day, if no one else says its to you, let me tell you that you do hard work and you are valued. Healthcare is a tough environment right now, and doctors’ well-being is often lost in the shuffle. I hope the seven tips above can help prevent a at least a few situations from getting out of hand. We need more doctors engaging with their patients and honestly caring for them, not fearing for their safety.

I’m curious to hear from all of you about your experiences and what you think might help doctor safety. Leave a comment below so we can discuss more. This conversation needs to continue as we aim to make the exam room a caring environment for everyone, even the doctor.

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