The (in)Patient Experience

3 Thank You Notes No One Will Ever Receive

 

Patients assume that we are making the right clinical and operational decisions on their behalf. This should be routine care. And while these decisions are certainly critical to optimal patient outcomes, the patient experience is most deeply impacted by the communication we share. 

Right Care. Right Communication.

(Do both.)

 

 

The Work That Can Never Be Completed

Earlier this year I was asked why my physician organization’s goal for the “Communication with Doctors” section of the HCAHPS survey isn’t a top box score of 100%. My explanation was that setting a goal of absolute perfection for a subjective assessment of communication between doctors and patients would likely be counterproductive, producing apathy rather  than engagement on the part of physicians (if you’re a fan of setting SMART goals, you’ll know that ‘A’ stands for attainable).

 

I later realized that although my answer may have been indicative of some short term managerial savvy, I failed to understand the challenge that my questioner was issuing. This realization struck me - nearly six months later - while reading a compelling piece from the New England Journal of Medicine entitled “The Word That Shall Not Be Spoken,” written by Dr. Thomas Lee, Chief Medical Officer of Press Ganey.

 

In it, Dr. Lee asks whether the relief of suffering is a reasonable expectation of the patient experience mission and explores why physicians traditionally shun the notion that they are responsible for “relieving suffering.” He writes that, “Relief of suffering may be a task too vast to seem real for most people — something on the order of achieving ‘world peace'.”

 

Despite this perception, Dr. Lee concludes that the relief of suffering is a valid overarching vision, noting that “good organizations have ambitious goals.” He also acknowledges the enormity of this profound goal and shares the critical message that lies within it, “Collectively, we should not shy away from work that can never be completed.”

 

As 2013 comes to a close, I’d like to commend the increasing numbers of physicians and physician organizations that have committed to improving the patient experience despite innumerable challenges and imperfect means of measuring success (read more in the Beryl Institute's white paper, "Voices of Physician Practices and Medical Groups: Exploring the State of Patient Experience").

 

We must continue these great efforts not because the patients receive surveys or because we’ve been offered performance incentives, but because our calling obliges us to promote, as Dr. Thomas Lee says, the relief of suffering. HCAHPS scores are short-term goals. The relief of suffering is the vision. Spend 5 minutes talking about your latest HCAHPS scores. Spend your career learning how to better relieve suffering.

 

And recognize that quality in healthcare will never be “complete”. Those who make great strides in patient experience improvement will be those who don’t shy away from the work despite this reality. Much of the challenge - and the beauty - of the work we do to improve the patient experience is that it is unending. While this may sound ominous, I find it reassuring for two reasons. First, it implies that it’s never too late to begin focusing on patient experience improvement. And second, it is indicative of the richness of the patient experience and the many incredible ways that we can positively impact it.

 

In retrospect, I believe the person who asked me why our organization wasn’t targeting 100% HCAHPS top box scores was making a deeper inquiry about our vision. They wanted to know that our doctors understand this is a career-long pursuit and that they won't shy away from the unending work of improving the patient experience. Now I understand the question. And I promise, we won’t.

 

 

Do I Deserve to Take Care of Patients?

Consider this message in a current advertisement:

This is it. 
This is what matters. 
The experience of a product. 
How it makes someone feel. 
When you start by imagining  
What that might be like, 
You step back. 
You think.

How will this help? 
Will it make life better? 
Does this deserve to exist?

These thoughts are from a company that makes phones, music players and computers. I couldn’t help but read this print and web ad from Apple over and over, wondering if we in healthcare are asking ourselves questions about the patient experience that are nearly as tough. In particular, after reading the last three lines, I kept thinking:

How do I help? 
How do I make lives better? 
Do I deserve to take care of patients?

These are questions we must ask ourselves regardless of rank or role. Our technical training has earned us a spot on the healthcare team but it does not differentiate us from any of our colleagues nor make us shine in our patients' eyes. The antibiotics and fluids I prescribe work just the same when my partner orders them for her patients. The medications you successfully administered could have been given properly by another nurse. Sure, there are times when these tasks call for a bit of finesse. In the balance, however, technical skills rarely set us apart when it comes to great care.

Do I deserve to take care of patients?

I do if I’m sure to address what I call the patient’s “core concerns”:

What is happening to me? 
Will you listen/talk to me? 
Will you look out for me?

And those who truly understand this commitment will also listen, talk to, and look out for their co-workers, knowing that those efforts ultimately serve their patients as well. And these are also the people who see the strength in saying "yes" to those in need, creating great experiences for others knowing it's the shortest path to their own satisfaction and freedom in the work place. As author Pandora Poikilos wrote, “We are so accustomed to the comforts of "I cannot", "I do not want to" and "it is too difficult" that we forget to realize [that] when we expect others to dance around us, we are not achieving greatness. We have made ourselves weak.”

How do I help? 
How do I make lives better? 
Do I deserve to take care of patients?

I'm using these questions to stimulate conversations about the patient experience. Ask the next person you interview to reflect on them. And ask these questions of yourself. I’m doing the same. 

How You Solicit Questions Impacts the Patient Experience

"Judge a man by his questions rather than his answers."

-Voltaire

 

Something tells me there were more questions than answers about medical diagnosis and treatment in Voltaire's day. Healthcare care workers and professionals are now charged with the challenging task of synthesizing and processing large amounts of complex information in an effort to address patients’ clinical needs. And then we’ve got perhaps an even greater task in trying to explain these things to patients and families in ways they can understand. While certain techniques - such as the “Teach Back” method " - can be effective at confirming understanding or revealing confusion about the plan of care, patients and families often have concerns that we simply cannot anticipate.

 

This is why it’s critical to create an opportunity for patients and family members to share their questions, concerns or fears, no matter how redundant or extraneous they may seem in relation to our explanation of their illness. To Voltaire's point, the trick is often in the words we use to solicit these questions.

 

“Do you have any questions or concerns?” One of the most important things about this common query is that it almost universally signals the end of a conversation. Patients are keenly aware of the hectic pace we maintain and many may feel that we are finished speaking with them and that they are keeping us from other duties by asking more questions. Additionally, this question forces the patient or family member to acknowledge their confusion or the omission of information that they had hoped for. This may be embarrassing or feel inappropriate to some people.

 

“What questions or concerns do you have?” In stark contrast to the previous example, this query allows the provider to be the one to acknowledge that there are probably questions. And it opens the door to a conversation that is focused on any uncertainties and anxieties that the patient or family may have. Remember to follow-up your answers with another query to assure that you’ve addressed all of their concerns.

 

In addition to improving the patient experience with this approach, you’ll likely decrease the frequency of pages from nursing staff asking you to address unanswered questions or perform “service recovery” related to misunderstandings and frustration. And this will improve your experience.

Trust Us, We’re Doctors. Three Critical Practices for Establishing and Maintaining Patient Trust in the Inpatient Setting.

It’s not an easy task. You don’t know the  patient from a hole in the wall. Yet you’ve got to question, poke, prod, empathize, explain and gain their trust in the blink of an eye. There are three critical communication practices that will help you establish the trust you want and need to provide your hospital patients with great care and a high quality experience.

 

 

1. Beware the bystander effect. Be the boss and say so.

 

A recent Perspective piece in the New England Journal of Medicine addressed the bystander effect - the  human tendency to be less likely to offer help in emergency situations when other people are present - and  the increasing evidence of this phenomenon to occur during care in the inpatient setting. The authors describe a patient who posed a clinical conundrum and subsequently encountered over 40 physicians during an eleven day stay in the intensive care unit. The uncertainty over the patient’s diagnosis and the number of physicians involved led to provider passivity and directionless care.  

 

Unfortunately, as physician care teams balloon in size, even under routine conditions - a couple of ER docs, two or three hospitalists and a couple of specialists would be a common, if not conservative cast of providers - it’s easy for everyone to focus on their piece of the patient’s puzzle and forget that someone has to be the captain of the ship. And patients are acutely aware of this lack of accountability as we overtly pawn off decisions and explanations on our colleagues without reassuring patients that we are all part of a single team and that there is a clear leader.

 

It is a critical step for any attending physician, particularly for hospitalists who are most often the attending physician for both medical and subspecialty patients to explain your role as captain of the ship. Stating this plainly - “I’m the physician in charge of your care while you’re here” - is a powerful way to initiate the process of building trust as you vocalize your commitment to looking out for your patient’s well-being.

 

 

2. Let everyone know we work together. Convey continuity during transitions.

 

One of the biggest obstacles to patient safety, quality and good experiences in the inpatient setting is that of continuity of care, which I’ll define as “a patient experiencing care as clear and coordinated over time.” The reality of inpatient care is that multiple providers across different disciplines will manage patients during the course of a hospitalization. This lack of provider continuity has been shown to negatively impact patients’ experiences. A 2011 meta-analysis of studies evaluating patients’ perceptions of continuity of care found that, “when [provider continuity] was absent, patients expressed dissatisfaction, feelings of helplessness and isolation, as well as confusion by receiving different treatment and medical advice.”

 

Thus, it is critical that we share with patients, particularly at transitions of care, our efforts to maintain continuity of care despite the fact that provider continuity is lacking. You can accomplish this by always informing patients that:

 

• You have reviewed their chart and that you are familiar with their diagnosis/reason for hospitalization

• You have spoken to the referring physician (PCP, ER doc, specialist or hospitalist) or your colleague for whom you are assuming care

 

Taking a moment to share this information with patients will show that you are committed to the continuity of their care and will also allow you to give context to questions you ask that might otherwise seem repetitious or suggest you are unfamiliar with their care. These efforts will allow you to build on the trust gained by the providers before you .

 

 

3. Talk about the team like you know them. Refer to colleagues by name.

 

You hear it all day long in the hospital:

 

“That’s a question for the hospitalist.”

“I’m going to ask nephrology what they think of that.”

“Let’s wait and see what ortho has to say.”

 

When we refer to colleagues in the abstract, it’s not very reassuring for patients. It suggests that we don’t have a relationship with those individuals, which certainly doesn’t support the notion that we are a team. Additionally, we often use abbreviations or terms that patients simply don't understand (nephrology, “ID”, “ortho”, etc.). Of course, there will be times  - such as when calling a consult - when you may not yet know which of your colleagues will be seeing the patient. And I would argue that you should share the name of that individual after you determine who it will be. This gives you an opportunity to manage up your colleague and will likely prove reassuring to patients since we all like to know who and what to expect whenever possible.

 

Our ability to establish and maintain trust with patients during a hospitalization is crucial to the patient experience and likely reflects the degree to which we are committed  to patient-centered care in a broader sense. Additionally, the implementation of critical communication practices such as those listed above stands to  improve provider satisfaction as patients respond to the high quality of communication and consideration being shown to them by their providers.

3 Tips to Help You and Your Business Card Improve the Patient Experience

Recently overheard in the hospital:

Nurse: “Has your doctor been in yet?”
Patient : “Yes, he was here earlier .”
Nurse: “Was it the doctor who saw you yesterday?”
Patient: “No. He did tell me his name... I just can’t remember it. I’m sorry.”

We’re the ones who should be sorry.

Let’s face it. Hospitalized patients have an exceedingly difficult time remembering who their providers are. Studies have repeatedly shown that few inpatients, often in the 20-30% range, can correctly name even a single physician provider. This should come as no surprise. Think about the last time you were at a business meeting or dinner party and multiply the number of new faces by at least ten. How would you fare on a pop-quiz asking you to remember who was who?

If you want to make a lasting impression that improves the patient experience, make sure patients know who you are and how much you care by using your business card. I’m all for using white boards and electronic patient communication systems (if your hospital can afford one), but they’ll never replace the value of a thoughtfully constructed and utilized business card.  Here are three tips for making sure that you and your business cards deliver a high impact message:

1) Use Big Fonts
This one is pretty straightforward. Traditional business cards often use miniscule fonts. Patients who are sick, tired and often without their reading glasses shouldn’t have to work hard to read a business card.

2) Include a Welcoming Photograph
People are much more likely to remember you when they have access to a picture. And a welcoming photo (one with a warm, encouraging smile) implies accessibility and genuine interest. There is data to suggest that photographs improve not just patients' recollection of their physician, but also patient experience of care perceptions.

3) Use It to Convey Accountability
This critical step is on us. Explain to patients that you are giving them your business card because you want to be sure they know who is caring for them. In addition to conveying accountability and confidence, this also helps to establish trust. And if you really want to knock it out of the park, combine this with a statement of accessibility and managing up, such as, “if you have any questions for me, please let [nurse name] know. He/she can reach me easily.”

No one should have to struggle to recall the name of their physician.  As Dr. Anthony Breu, a hospitalist, pointed out in a thought provoking January 2012 KevinMD blog post, “I am constantly a stranger and a new face.” It’s our responsibility to do everything in our power to facilitate patients’ understanding of who we are and how we are involved in their care. Use your business card well. And don’t be a stranger.

(Below is the business card of one of my colleagues who gave me permission to post this digital image of her card - this is a format we use throughout our organization. Note the inclusion of the statement, “I work with your doctors:” which allows us to write in the name of patients’ primary physician or the specialist that consulted us.)

Patient Satisfaction: Here's the Deal

The link to a recent article in Forbes magazine entitled, “Why Rating Your Doctor is Bad for Your Health” keeps showing up in my inbox with the subject, “thought you would find this interesting.” The reason is because I’m responsible for overseeing education and training related to physician communication and patient satisfaction for a large national hospitalist practice. 

The article isn’t so much interesting as it is unfortunate. Its premise, based on comments from physicians, is that, ”many doctors, in order to get high ratings (and a higher salary), overprescribe and overtest, just to “satisfy” patients who probably aren’t qualified to judge their care.” And physicians report that this is taking place in an effort to meet patient satisfaction goals.

While it’s true that patients may be unable to judge certain aspects of clinical quality, there’s one thing they are quite capable of noticing (apparently a lot better than us physicians): a bad attitude.

The patient satisfaction mission is a critical one and our understanding and support of it is essential to the care of our patients and the credibility of our profession.

Before expanding on that point, let me try to establish some “street cred” by sharing that I’m a working hospitalist in addition to my administrative responsibilities and personal interest in patient satisfaction (which, for the purposes of this commentary is best referred to as the “patient experience” – I’ll explain below).

Much of what I hear from physicians about patient satisfaction is negative. And I do understand why. The government’s HCAHPS survey methodology and the Value Based Purchasing program are imperfect systems leaving obvious room for improvement. Additionally, hospital administrators sometimes have unrealistic expectations or misunderstand the limitations of these surveys. However, I believe these evaluation tools and their results can foster improved patient care. And with greater clarity regarding the goal of the patient experience mission and physicians’ role in it, I hope to convince my colleagues of the same.

What’s the goal?

One thing it isn’t, is making everyone satisfied (AKA, happy). And that’s the reason why the term “patient satisfaction” misses the mark. For one thing, trying to make everyone happy is a losing battle. The reality is that our recommendations sometimes collide with patients’ expectations. And this is where our expertise must show.  We physicians are charged with synthesizing many variables to determine what the correct care is for our patients. Effectively communicating the rationale for such care to patients so they can understand our recommendations is a responsibility we all signed up for and must abide by.  

The goal of the patient experience mission is to ensure that all our patient interactions culminate in decreased patient anxiety, increased patient understanding and hopefully improved patient compliance and outcomes. And we shouldn’t lose sight of the fact that each of these outcomes is a valid end-point in its own right.

Yes, there are patients and families that are demanding and the final risk/benefit analysis may dictate that we provide something that isn’t absolutely necessary but not overtly harmful. I have ordered an MRI for an inpatient with back pain and at best a marginal indication for it. It was an unnecessary expense (to the hospital and the health care system), but a necessary maneuver to avoid further inefficiency in the patient’s care and the potential utilization of other costly resources within the hospital. But these are the vast minority of situations and to focus on them misses the point.

If we’re preemptively over-ordering, over-prescribing or simply taking orders from patients solely to improve survey scores or to generate a chunk of bonus money, we have only ourselves to blame. And again, we are missing the point.

The vast majority of patients are appreciative of our explanations and expertise when we take the time to listen carefully and make the effort to explain things clearly. This leads to better patient experiences and it can only help patients’ survey ratings of care. Care that accomplishes these goals is achieved through superior communication, which informs our role in improving the patient experience.

What’s our role?

It goes without saying that physicians are responsible for providing the most effective and evidence-based medical care at all times. But accurate clinical decision making must be accompanied by communication that addresses what I refer to as the patient’s “core concerns”:

• What is happening to me?
• Will you listen/talk to me?
• Will you look out for me?

By offering clear explanations, listening compassionately and acknowledging patients’ predicaments with empathy and caring statements, we can restore a degree of autonomy that will allow patients to trust that we have their best interests in mind at all times. This is our role in improving the patient experience.

Patients surely have the ability to judge whether we’ve addressed the “core concerns.” And we should keep asking them how good a job we’re doing of it. After all, we’re healing people, not fixing computers.

The public will forgive us the occasional disgruntled patient who cannot be convinced of our best intentions, but they will never forgive us for misunderstanding the patient experience mission and failing to do the right things for them while under our care.

Interested Parties Should Have the Following Attributes

Last week I noticed a new independent coffee shop in my neighborhood. Seattle has a preponderance of coffee shops - in case you weren't aware - so I was curious to see what Milstead & Co. might have going for it. I googled the store name and found their website which contained a blog with a recent entry titled, "Milstead and Company is Hiring for Part Time," and consisting of the work requirements.

I've been perusing job descriptions for roles outside the healthcare industry to learn how others express the passion and commitment they seek in their employees, so I was interested to see what Milstead was looking for.

I'm a firm believer in the notion that healthcare has a lot to learn from industries further along in the quest to improve the quality and consistency of the experiences they offer.

The fact is, every industry offers the same service: the solution to a certain type of problem.

That problem might be pneumonia, or the need for an attorney, or the simple desire for a cup of coffee. And sure, the stakes are quite different in each case, but the fact that the quality of every consumer's experience is determined by our communication and actions holds true whether we're providers of healthcare, legal services or a cup of joe.

With that in mind, let's look at Milstead and Co.'s job posting:

We are looking for individuals that are interested in providing our clientele with a singular coffee experience. Interested parties should have the following attributes:

• Self-motivated – are you the first one to attack a problem?
• Hard working – are you the last one to quit?
• Empathic customer service – can you connect with our customers in a professional manner?
• Thirsty for knowledge- do you want to learn new skills? Are you open to criticism and self-improvement? Are you excited about the task at hand?
• Sense of urgency – can you do many things at once? Can you identify and prioritize what needs to be done and do so in a speedy, efficient manner whilst never breaking a sweat?
• Observant – do you pay attention? Are you diligent, careful, and keen to remember all of the details of our process?

What struck me most about this posting was the focus on attitude rather than skill. The question isn't what kind of problem you can solve, it's whether you'll be the first one to attack it. It's not whether you'll connect with customers, but whether you'll do it empathically and professionally. And perhaps most importantly, it's not just that you're interested in learning a specifc skill set. Rather, you're open to criticism and self-improvement.

I stopped by Milstead & Co.'s shop to chat with owner Andrew Milstead, an accomplished Seattle barista who has used his undergraduate work in psychology and his ten years of experience in the coffee business to distill the attitudes and behaviors of successful people. He is particularly on the lookout for those who exhibit "proactive living," which he describes as people who have a passion for "engaging with life and people."

"Ultimately, as a business, it's not all about the product - it's about how we take care of the people," says Milstead, adding, "If we don't take care of the people we're serving - it's worthless." His least favorite experience in life is, "going someplace that I want to love because they offer a great product or service, but finding people with miserable attitudes. Life is too short for that."  

If life's too short for mediocre attitudes at our favorite retail and hospitality providers, then surely we don't have time for such attitudes in the healthcare setting. 

Yes, it's true that doctors, nurses, phlebotomists or CNAs must be properly trained and capable of maintaining certain clinical skills. But these competencies are simply an admission ticket to consideration for the job. The requirements should never stop there.

Caregivers of every discipline should understand that they must lead with a constructive and service-minded attitude to earn a spot on the healthcare team today.

And leaders in healthcare must clearly focus on hiring for attitude by creating organizational expectations and job descriptions that acknowledge skill requirements and put the focus squarely on attitude.

As Andrew Milstead points out, interested parties should have the following attributes...

Don’t Just Do the Job. Be Passionate About the Purpose.

I was sitting at a computer terminal writing admission orders for Mr. H, a sixty year old gentleman I’d just seen for complaints of chest pain. I had requested another EKG and so popped my head back in his room to let him know someone would be repeating the procedure and why.

A few minutes later, a young woman appeared with an EKG machine and knocked on his door. She introduced herself as “Christine, the CNA, or Certified Nursing Assistant” who would be taking care of him during the next shift. She told Mr. H that she would be obtaining an EKG but first informed him that, “I’m writing my name on this white board so you can remember who I am and ask for me if you need anything at all. I always write in big letters so you can read my name – how’s that,” she asked. “Perfect," he said. “And thanks for taking the time to do that.” She then proceeded with the EKG, which showed resolution of some previously concerning changes.

Mission accomplished.

It may be a stretch to think that Christine’s thoughtful and informative communication resolved Mr. H’s EKG changes. There was no question, however, that her passion for communication and excellent care had an impact, as evidenced by his comment, “Thanks for taking the time to do that.” Christine could have walked to the white board and just written down her name. She would have been doing her job. But she embraced the purpose of the board and the recording of her name and improved the quality of the patient experience by simply explaining that she was doing it to better serve the patient.

I was appreciative of Christine’s communication and decided to tell her so. “That was great, how you explained about the white board and why you were putting your name down. I appreciate your making that effort and Mr. H certainly did too.” Christine later approached me and thanked me for the feedback. She had been making a concerted effort to explain things to her patients in this fashion and the few words of encouragement made it that much easier for her to remember.

The following afternoon, Mr. H was ready for discharge. I explained the results of his tests, all of which were fortunately negative, and answered a couple of remaining questions. Mr. H then sheepishly asked me for a copy of his chart, not knowing if such a thing was possible to obtain. After informing him that he would need to request a copy from medical records on Monday, I realized I wasn’t really embracing my purpose. “What did you want it for,” I asked, suggesting that there might be an easier way to get the information he was requesting. “I’ve got an appointment with my doctor on Monday – I just want her to know what happened here,” he replied.

Because it was a Saturday, there was no way his physician would get a discharge summary by Monday for the appointment. In almost the amount of time it would have taken for someone to explain to him how to contact medical records to request his chart, I printed out the pertinent test results and typed up a quick discharge note. I put everything in a folder, stapled my card to the front and explained that his doctor should call me if she had questions. “Wow, I really appreciate your doing this for me.” I couldn't help but wonder why everyone doesn't walk out of the hospital with this sort of information, but that's a topic for another post.

Taking advantage of opportunities to exceed people’s expectations gets to the heart of improving the patient experience. And when being passionate about the purpose makes someone’s day, you’ll usually find that it makes yours too.

Choosing to Create Connection - Words of Wisdom from the Medical Axiom Master

"When done properly, your relationships with your patients should hold up in the elevator, in the lobby and in the grocery store aisle."    

-Mark B. Reid, MD

***

I am fortunate to have had the opportunity to attend medical school with a master of the modern-day medical aphorism, Dr. Mark B. Reid. Currently an academic hospitalist and Assistant Professor of Medicine at the University of Colorado Health Sciences Center in Denver, Mark enjoys expressing his wisdom creatively through axioms which he catalogs on his website, www.medicalaxioms.com.

Many of Mark’s axioms reference provider attitudes and behaviors that are crucial to a great patient experience. I've asked Mark to share his thoughts on some of his most relevant axioms and will be sharing them in installments here on the (in)Patientexperience.

***

What first inspired you to create medical axioms?

I have always been a fan of folksy sayings, axioms, fables, and truisms. My father came from a Kentucky farming family and he had a saying for almost any circumstance that entailed things like horses and water and purses from sow's ears. Once I got on the wards in medical school, I started noticing wisdom being tossed around in this familiar format and I started cataloging them. It seemed easier to remember a handy saying instead of the relative risk reduction from a randomized controlled trial. On the wards, I am known to author unlikely metaphors for common medical situations, fitting with my definition of teaching: "Saying something that is both true and impossible to forget."

I decided two years ago to become an expert in axioms and aphorisms. I bought a collection of quotes by Osler and read some great old paper books by famous doctors. I started sharing them on the website www.medicalaxioms.com but I quickly realized that even the most famous axiom-makers produced only a short list of wise sayings. And many great axiom writers died before we had things like CT scans, medical malpractice and evidence-based medicine. There are many new truths in the modern era! So I started firing some off myself.

 

Many of your axioms - like the one at the top of this post - focus on important components of the patient experience, such as the connections we make with patients. What message do you give to young doctors to help them understand the importance of these connections to both patient and provider?

I think medical training over the past 40 years or so has required residents to adopt an attitude of survival and self preservation. When I was a trainee, I learned to prioritize illness, make proper decisions, and avoid disaster. Fast. In order to do so, I was taught to avoid unnecessary work and push aside obstacles that might limit my ability to accomplish these aims. I remember distinctly feeling like I was being torn in two sometimes by the need to "treat 'em and street 'em" and the desire to actually practice medicine properly.

I have been a doctor for about 15 years now. What I have seen in these years is many doctors succeed and many more fail to make these connections. I have learned that our attitude towards work and our enjoyment of our career doesn't have much to do with how hard you work or how busy you are or how much you get paid. It has to do with how you construct your interactions with your patients to create connection. Happy doctors set up each interaction to be mutually beneficial. They pick a style of helping that results in appreciation. They give a little more of themselves emotionally, but get much more back in return. If you are doing it right, you will want to get up and go to work. This situation is not something that happens to you if you are lucky. It is something that you choose and construct intentionally.

***

Fortunately, Mark has much more to say and I’m looking forward to sharing his thoughts on both  leadership and the patient experience in coming posts. In the meantime, you’re sure to find something inspiring at www.medicalaxioms.com.