If you had to write a prescription for balance for your patients, what would you include? Greater effectiveness at work? More time to play? Better relationships with others, as well as his/her self? Or all of the above?Like other prescriptions, a prescription for balance is not “one size fits all,” but a customized approach that is based on ambitions, goals, circumstances and preferences.

As the term “work-life balance” is used more frequently in healthcare these days, organizations are seeking programs that address work-life balance for healthcare providers, while also including the term in job descriptions to attract eager applicants. Just as the industry tries to define what work-life balance means to their organizations, ask yourself:  what does work-life balance really mean for you?

It doesn’t necessarily mean less work and more time for play, or even necessarily an equal time.  It also doesn’t mean giving up high-striving professional goals and rewarding leadership positions. Its definition is not static and depends on a variety of personalized factors.

As Stephen Covey wrote in The 7 Habits of Highly Effective People, “Many people seem to think that success in one area can compensate for failure in other areas. But can it really? True effectiveness requires balance.”

Achieving a sense of balance includes being at peace with where you are in your career and your personal life while still striving for advancements and promotions. It also means that you are content in your relationships at work and at home, and that you easily resolve or avoid conflicts.  You take care of your priorities, and none of the balls that you juggle in your professional and personal life come crashing down.

As a result of this balance, you work more effectively, provide more focused and compassionate care to your patients, while recognizing and honoring the importance for play, personal interest and family relationships.

Can this balance be achieved? Yes, and we have the success stories to prove it. With our coaching, healthcare professionals gain improved mindsets and successfully implement more effective skills.

In upcoming newsletters, we will share tips on how to:

• Effectively control stress
• Tighten your boundaries and leverage time
• Communicate more effectively with staff and patients
• Make time for fun, play and family
• Be more effective in a leadership position and
• Improve the productivity and output in your practice

I invite you to join us on this journey and engage in lively conversations around these topics. The more you become involved with these topics the easier you will recognize shifts and improvements in your own life.

A report in the Sept. 23/30 2009 issue of the Journal of the American Medical Association concludes that fatigue isn’t the only contributor to medical errors among medical residents but financial woes, family concerns and other elements of distress play also a major role in potentially fatal mistakes.

The study team used data from 430 internal medicine residents, who were surveyed quarterly from 2003 through 2008. During the surveys they were asked about their medical errors, if any, quality of life, fatigue, burnout, depression and sleepiness.

39 percent of the 378 doctors who responded to the questions about medical errors said they had made at least one major error.

This is also a study that found a connection between medical errors and fatigue. For every point increase in the fatigue score, doctors were 14 percent more likely to make a medical error. In addition, for every point increase in the sleepiness score, doctors were 10 percent more likely to err.

Researchers concluded that medical errors were also linked to burnout, depression and overall quality of life.

Is this ground-breaking data? Not at all and Dr. David J. Birnbach, a professor and vice provost of the University of Miami and associate dean and director of the UM-Jackson Memorial Hospital Center for Patient Safety at the Miller School of Medicine said, “We’ve known for a long time that fatigue in anyone is bad, and medical personnel who are very fatigued tend to make more errors. We in the United States have made a dramatic change in the way we train residents to limit the number of hours they work. That’s regulated at a federal level.”

Sure, this is a good beginning but it can be only just a beginning. Additional changes need to be:

• Focus on self-management skills which includes stress control, time management, and life skills for residents and physicians
• Continuous training on interpersonal skills to improve the relationship with patients and the teamwork with staff to ensure patient safety and quality care.
  (Both coaching / training on self-management and interpersonal skills can be provided in a CME setting.)
• Good role-modeling from mentors and professors in medical school and residency.

Another report in the same issue of JAMA claimed that  doctors who participated in a program that included meditation, self-awareness exercises and stories of “meaningful clinical experiences” improved their well-being, had more empathy toward patients and were less “emotionally exhausted” or burned out, the researchers found.

The study demonstrated that primary care physicians participating in a continuing medical education program that focused on self-awareness experienced improved personal well-being, including burnout and improved mood, the researchers wrote. “They also experienced positive changes in empathy and psychosocial beliefs, both indicators of a patient-centered orientation to medical care.”

Healthcare organizations and physicians have been making the critical mistake that their continuing education has been focusing almost exclusively on clinical skills.

Several years ago research by the Dale Carnegie Institute concluded that 15% of a person’s success (physicians included) is dependent on their technical skills and 85% is dependent on their interpersonal and self-management skills. This doesn’t mean that clinical training can be neglected but the best clinical skills and knowledge will never be leveraged without appropriate interpersonal and self-management skills.

The Balanced Physician Program is a continuing medical education program that can be brought into any healthcare environment. It focuses on self-awareness, self-management, social awareness and interpersonal skills and addresses the personal well-being of the physicians and their professional performance. The proactive / preventative approach and the combination of training and coaching ensure that the acquired skills will be implemented in every physician’s life.

Physicians who feel control of their personal life; physicians who have a positive and strong relationship with colleagues and staff and physicians who are able to communicate effectively with their patients will experience less medical errors, burnout and dissatisfaction – that is a fact.

I hope more healthcare organizations are waking up and realizing the importance of investing in the life and communication skills of physicians. Ignoring these topics is like ignoring a fast-spreading cancer.

Almost every day you can read an article or a report that comments about the upcoming and sometimes already present shortage of physicians in this country. These reports are either focused on certain geographical areas or on specialties.

The Journal of the American College of Cardiology just reported in their September 2009 issue that cardiology is going to face decades of workforce shortages not only due to the decreased number of cardiologists but also due to patient aging, overweight and diabetic population increases. Currently there is a lack of 3,0000 cardiologists who could easily fill private-practice and academic positions.

The report mentions that this shortage is not a pipeline problem since many young physicians apply for the fellowships required to enter the specialty and there are 50% more applicants than spots available. The problem is that the federal government cut the funds for cardiology fellowships in the early 90’s under the assumption that managed care would reduce demand by making the family practitioner the main gatekeeper for people with heart disease.

So what does this mean for cardiologists?

1. There will be enough work for everyone.
   Even though they still need to build a strong relationship with referring colleagues, once they built the trust and connection, the practice should stay very busy.
2. Define what success means to each individual.
   Since the demand for cardiology services will be so high in the future, they probably could work 24-7 and still have more work that needs to get done. Therefore cardiologist want to be in control of their work day and work life by defining what a successful practice / career looks like to them and where they need to strengthen their boundaries.
3. Define work-life balance.
   One of the biggest complaints of many physicians is the lack of work-life balance. Going hand in hand with the definition of success, I also encourage cardiologists to define what work-life balance means to them so that they won’t fall into the trap of overwork, burnout and dissatisfaction and make sure they include time for family, fun, hobby and personal growth.

What does the cardiologist shortage mean for healthcare organization?

1. War for talent becomes fiercer.
   The shorter the supply of cardiologists (or any other physician specialty), the fiercer is the effort to find the best talents for the organization. I encourage healthcare organizations to develop a culture and reputation that easily attracts the best physicians to their organization. They want to become known as the organization that values physicians, engages them in the growth process and provides a harmonic environment for their entire staff.
2. Provide programs for their growth and leadership.
   Valuing physicians and engaging them in the organization includes leadership and professional development programs that provide the foundation for the physicians’ success and well-being.
   For further information about such a program visit www.BalancedPhysician.com.

We are all replaceable.

Many times when I talk with physicians I ask them for the reasons why they are working so many hours, take only short vacations and keep their spare time to a bare minimum. Their answer typically is, “The patient comes first.” “ My patients need me and if I am not there for them, they won’t know where else to go.” “ This is what is expected from me.”

Years ago, when I moved to the U.S. and started working in corporate America I saw many people take their laptop computers on their vacation because they “needed to stay in the loop”, they were afraid that the department might break down while they are gone and they always wanted to be accessible. When I noticed this unhealthy behavior, I immediately realized that corporate America wasn’t for me long-term. Too many people in this country live to work and miss out on the good things of life.

But this is not the major point I want to make. Instead, I want to share a personal story that happened to me last week and demonstrates that consumers and patients are typically very flexible. If the doctor isn’t available for whatever reason and if patients don’t get what they want and the way they want it, they quickly find a replacement.

This story is not about a human doctor but a veterinarian doctor but the lesson can be applied to any doctor.

My German shepherd Cito is having some muscular / skeletal issues. We are not sure whether he has a torn / ruptured ACL or a pulled muscle or anything in between. Basically, he hesitates to run and he won’t jump.

4 years ago he had a subluxated shoulder. An orthopedic vet recommended surgery but fortunately we found Dr. S. in Raleigh, who prescribed 3 weeks of intense physical rehab at his facility in Raleigh, NC. We were extremely pleased with the outcomes of Dr. S.’s services and in the years ahead we recommended several friends to take their dogs to Dr. S.

When we noticed that Cito had issues with his hind legs, we immediately thought of Dr. S. and called his office. I made an appointment a week out (after all they are in Raleigh, I am in Atlanta; this takes a full day out of my week and I needed time to coordinate and reschedule my appointments).

2 days before my appointment I received a phone call from Dr. S.’s office manager that he is on medical leave and at this time they don’t know yet when he will return. She couldn’t even give me an approximate return date.

We have been knowing Dr. S. for 4 years and we got to know him a little bit personally. We know that he works a lot. His office is open 6 days a week, he rarely takes any vacation and he is always there for his patients.
He always walked like an “old” man with a forward-bent back and he told us that he had back surgery. He said,  “I should have done more rehab and I should start exercising but I just don’t have any time. The practice is taking all my time.”

For many years he used his body and didn’t give himself the care he needed and now he is unavailable for his patients for a few months because he was never available for himself.

Could this happen to you?

However, my dog is his patient and my dog needs help and I don’t know how long Dr. S. won’t be out of pocket; so I had to look for a new vet. Sure, I was sad and I was frustrated; after all we felt he is THE ONLY doctor who could truly help our dog. But that doesn’t matter anymore because he has to take care of himself now. He used to put his patients first and himself second and that came with a price.

I found a new / different vet here in the Atlanta area and we have our appointment next week. Hopefully, he is just as good as Dr. S. Once Dr. S. will return to his practice, I believe we will go back to him because we trust him and we like him. Time will tell.

If you think that you have to sacrifice your personal well-being and your life for your patients, think again because that sacrifice will come with a heavy price tag for you. Not for the patients because the patients will be flexible when you are not available. They will adapt, they will find a replacement, they will find a solution until you will become available again or they might not even return to you at all. There is not that much loyalty these days. I hate to say it, but everybody is out for themselves.

Therefore, I encourage you to start today and think about the life that you want to live and then build your career or your practice around it.

If you start to become defensive and hear arguments come up in your mind such as “what about the money, others depend on me, my situation is different” etc. then this is where you want to start the process … if you truly truly want to live a more balanced and peaceful life. Now sure there will be some sacrifices that you have to make for that option but then again you are sacrificing right now as well. Every prize has its price and you have to decide what price you want to pay.

If you are dissatisfied with your career and / or with your life; if you feel burned out or stressed or frustrated with your work, now is the time to change it. It doesn’t do you or your patients any good if you are dissatisfied, moody, grouchy or tired.  Put the number one person of your life first and put your patients second. That will help you and them.  

If you don’t know how to do that or where to start, give me a call at 770-428-2334 and I can support you in that.

I am looking forward to your comments,

Iris Grimm

Insufficient working conditions in primary care are associated with adverse physician reactions

Studies publishes in the July 2009 issue (Volume 151 Issue 1 | Pages 28-36) of Annals of Internal Medicine suggest that adverse primary care work conditions could lead to a reduction in the primary care workforce and lower-quality patient care.

However, the study could not conclude whether adverse work condition and adverse physician reaction would have any impact on the quality of patient care.

Researchers studied 422 family practitioners and general internists at 119 clinics and the results include:

• 53.1% of physicians reported time pressure during office visits,
• 48.1% said their work pace was chaotic,
• 78.4% noted low control over their work,
• 26.5% reported burnout.

Adverse workflow (time pressure and chaotic environments), low work control, and unfavorable organizational culture were linked with low physician satisfaction, high stress, burnout, and intent to leave. Some work conditions were associated with lower quality and more errors, however findings were inconsistent. No association was found between adverse physician reactions, such as stress and burnout, and care quality or errors.

What peturbs me about this study is the following:

Half of all the physicians found that they felt under pressure during office visits and their work pace was chaotic.
My question is, how can this be a nurturing and healing environment for sick patients? How do they want a patient to open up and share – sometimes embarrassing and sometimes very intimate information – when the patient feels the tense and impatient energy in the physician?

One in four physicians reported burnout, which means they are suffering from a debilitating psychological condition that drained their energy, increased their depersonalization in interpersonal relationships and increased their dissatisfaction.
One in four physicians!!! Is anybody in healthcare listening to this?

Would we allow pilots or air traffic controllers work under these circumstances?

• What improvements will healthcare organization do now that are based on these findings?
• How will primary care physicians adjust their work flow and work environment to improve their job satisfaction?
• What proactive measures will they take to reverse burnout and possibly prevent it?

My guess is considering that there was “no consistent association between adverse work conditions and the quality of patient care”, this study won’t be taken into any consideration to make any significant improvements. Instead it might get used as an excuse to forego an examination of working conditions of doctors and recommend any necessary changes. As long as doctors perform at an acceptable level and their dissatisfaction and burnout doesn’t affect the quality of patient care, I assume that nobody sees the need to do something about it. Does that mean ”mediocrity is still king?”

Studies are done to make improvements; the time to do them is right now. Physician coaching is a perfect tool to lead the improvement.

To read more details about the study, go to http://www.annals.org/cgi/content/abstract/151/1/28

A study published in the April 2009 Archives of Surgery revealed that 30 – 38% of surgeons across the country suffer from burnout.

That is no surprise to me and I can see these numbers rise rather quickly in the months and years to come if circumstances don’t change and challenges in healthcare continue to get worse.

The study suggests that younger surgeons and female surgeons are at especially high risk for stress and burnout, and lists a number of factors that lead to its cause, including:

• Length of training and delayed “gratification”
• Long working hours and enormous workloads
• Imbalance between career and family
• Feeling isolated / not enough time to connect with colleagues
• Financial issues (salary, budgets, insurance issues)
• Grief and guilt about patient death or unsatisfactory outcome
• Insufficient protected research time and funding
• Sex- and age-related issues
• Inefficient and/or hostile work environment
• Setting unrealistic goals or having them imposed on oneself

As the leader and head coach of the Balanced Physician program I work with my physician clients on the above mentioned topics on a daily basis.

More and more physicians are looking for outside help since they are not able to cope on thier own with all the challenges that they are facing in their practices and lives. Overwhelm, loss of control, damaged personal relationships and unfulfilled goals leave them empty, frustrated and burned out.

Coaching is the perfect vehicle for physician who want to regain passion for medicine, develop a sense of life balance and feel more fulfilled not only in their professional but also in their personal lives. Coaching

• Allows physicians the space to voice their frustrations, opinions and dreams without being judged
• Is a solution-oriented method of guiding physicians in the times of challenges and change
• Focuses on setting and achieving goals as well as bringing out their strengths
• Increases awareness, opens up new perceptions and offers new options for more effective behavior
• Is flexible and customized. They don’t lie down “on the couch” and it doesn’t get added to their files.
• Leads to significant results within a short period of time.

As long as healthcare organizations don’t recognize the importance of investing in the physicians’ personal and interpersonal skills, the above mentioned burnout factors will never go away. Now sure, physicians have to take responsibility for their lives and its results as well but I believe the healthcare organizations need to provide the education and access to physician coaching programs and personal development seminars. As the saying goes, “you can lead the horse to the water but you cannot make it drink.” Healthcare organizations cannot make physician drink but at least they can lead them to the water. By providing these kinds of programs, healthcare organizations not only invest in the productivity and well-being of their physicians but also in quality patient-care.

Iris Grimm
www.BalancedPhysician.com

In the January issue of the Atlanta Hospital News Susan K. Blank M.D. wrote an article on “2009 could bring increase in drug abuse among healthcare professionals”. In this article Dr. Blank explains that the economic situation and the financial uncertainty in the years to come can lead to an increased drug and alcohol abuse not only among the common population but also particularly among health care providers. Certain studies have shown that healthcare industry workers are more prone to drug abuse. Studies in the UK have shown that as many as 15% of medical professionals will abuse drugs or alcohol sometime in their career, with pain killers and sleeping pills the most common type of drug abused by medical professionals.

She continues “A complicating factor inherent in the problem of doctors abusing drugs is the reluctance of their fellow professionals to report their suspicion and the general unwillingness of the impaired physician to suffer the humiliation that attends a confession of his or her disease.”

You can read the entire article here at http://bluetoad.com/display_article.php?id=99942

After reading this article I was reminded again about the benefits of coaching for physicians. In my work as a coach I don’t talk with my clients about their alcohol or drug consume; it is none of my business; I am not a therapist and I am not a psychiatrist, I am their coach.

I support physicians who want to play a bigger game, who are ready to face what is not working in their practice and or life and we strategize the tools and methods to make improvements in a time-efficient way!

In our conversations my clients and I talk about their stressors, we talk about how they can streamline their responsibilities, simplify their lives, approach and resolve difficult conversations with colleagues or staff members. We talk about time wasters, we establish challenging goals, we are celebrating progresses and wins … we just talk about so many things. At the end of each conversation they walk away with an action plan to tackle and solve some of the issues, they realize how they shifted their perception about a specific topic and suddenly they feel a sense of relief or empowerment.

When we wrap up our coaching relationship I always ask my physician players how their life has shifted / changed over the months. And many times I heard some of them say “ever since I have been working with you / facing these issues, I come home and I don’t have the desire to pour a glass of wine or beer; I drink less, I sleep better, the energy at home is less tense. Even my family notices that I am more relaxed and present.”

I am proud of my “players” being honest with themselves and for themselves. Again, most of the time this is the first time that I hear from them that they had consumed more alcohol than they really wanted to. They are now having the awareness that alcohol didn’t fix their situation; just suppressed it. At the same time they are now having the awareness and the tools to resolve whatever it is bugging them and that takes away the thirst and desire for alcohol.

Again, coaching is not an intervention for physicians who are addicted to drugs or alcohols; however if you are noticing that you drink more alcohol now than you have in the past and you have been doing that because you feel frustrated with a certain situation in your practice and / or life, then physician coaching can be the perfect tool for you to move beyond it.

If you want to learn more about coaching, sign up for a complimentary consultation.

Iris Grimm
www.BalancedPhysician.com

Last year I wrote about the Zagat Survey for physician ratings: http://balancedphysician.wordpress.com/category/patient-service/

The Zagat Survey was designed to allow consumers to rate physicians based on 4 criteria: trust, communication, availability and environment. Patients are also allowed to leave comments.
Today I read that many doctors – including those in California, Connecticut and North Carolina, where the Zagat-WellPoint project was first introduced – voiced criticism.

William Handelman, president of the Connecticut State Medical Society said “It is curious that they would go to a company that had no experience in health care to try to find out how good a doctor is,” adding, “It certainly is very subjective.” Ronald Thurston, a psychiatrist, remarked, “Are patients the best judges of health care? Patients notoriously ignore their doctor’s advice to eat well and exercise. Often they quit taking their pills when they’re feeling better. They usually don’t understand the technologies and skills needed for treatment.”

Patients rate their physicians typically based on 2 criteria: their clinical skills and their interpersonal skills.  

A rating such as the Zagat Survey has less to do with the quality of the doctor’s clinical skills and the effectiveness of care but it allows patient members to rank physicians based on their interpersonal skills. In other words, it has something to do with the customer service experience of healthcare.

• How long did I have to sit in the waiting room?
• Did the staff communicate with me (the patient) when the doctor was behind schedule?
• Did the physician explain my disease in words and in a manner that I understood?
• Did the physician take his / her time to hear me out?  

Contrary to Ronald Thurston’s remarks, I believe that patients are the best judges of health care because they are the once who decide whether they come back to see their doctor again or not.

Physicians who realize that their interpersonal skills (whether it is the communication skills of the staff or of the physician) are part of their healthcare package will most likely spend less money on practice marketing or patient retention.

Therefore I recommend physicians who are not part of this Zagat Survey to include a similar patient satisfaction survey in their practice to improve the practice efficiency and patient retention.

Iris Grimm
www.BalancedPhysician.com

USA today posted an article on lack of sleep of medical residents on Monday, August 4, 2008.  In this article they are talking about the 2003 policy change from the Accreditation Council for Graduate Medical Education, which cuts shifts to 24 to 30 hours with a maximum of 80 hours per week.

This study of 220 residents shows only small improvements within the last 5 years:

• The number of residents working 30 or more consecutive hours changed from 80% of residents before 2003 to 56%.
• The sleep amount of 7 ½ hours a day stayed the same for residents.
• The number of mistakes – 1 ½ for every 100 orders given – stayed the same.
• Needle-sticks and car wreck incidents didn’t improve.
• Residents burnout decreased from 75% to 57%. 

As a result there have been positive changes regarding the residents’ burnout and the number of residents working 30 and more consecutive hours but when it comes to mistakes and accidents, there have been no improvements for the residents.

The article also talks about junior doctors in New Zealand who may not work more than 16 hours straight and 72 total hours a week. And in Europe doctors can work only 13 consecutive hours and 48 to 56 hours a week. Now the article doesn’t say what the medical mistake percentage and car accident rates of residents are in those countries.

Rebecca Sadun, director of student programming at the American Medical Student Associations states that cutting work hours cannot be the only answer. “We need more physicians in training. Without more residents, we can’t give people more rest.”

I am sure that is one of the reasons for this awareness-raising study. What else is missing?

Even though there has been a policy change, it doesn’t mean there has been a paradigm shift. After all, successful and permanent behaviorial change can only happen when it was preceded by a change of thinking. As Albert Einstein said, “The significant problems we face cannot be resolved at the same level of thinking we were at when we created them.”

Why didn’t the number of medical mistakes improve? Interesting questions with several possible answers:

One could be that residents are too tired to concentrate which causes them mistakes. On the other side, if they say that they get about 7 ½ hours a night, that is a fairly good and normal sleep duration. Therefore it is difficult to say whether the concentration is such a major factor.

Another answer could be that residents don’t feel comfortable asking teaching physicians for help or advice. Many residents probably feel intimidated by their mentors to ask questions or admit a mistake so that it gets easily corrected. After all, many of these teaching physicians are not aware how to build trusting relationships with colleagues and staff members.

Rather than just giving residents a policy that the number of work hours gets limited to 80 hours a week, residents need to learn valuable self-management and interpersonal tools to maximize their time in residency such as:

• How to control stress and limit the energy drains in difficult situations
• How to communicate most effectively with nurses and teaching physicians
• How to put your ego to the side and use the collaborative environment
• How to raise your energy quickly and in a healthy way
• How to streamline life to leverage time

As long as residents and physicians don’t master these essential skills, no policy will create major improvements. What are your thoughts on that?

Iris Grimm