Thoughts for the Day - The heart of a child... Lessons in caring for others

Today I went into the city with my family, and before going home we stopped by a little burger joint to avoid rush hour traffic.  It's a bit of a eclectic part of town to say the least, and has a lot for the eyes to absorb.  In keeping with the surrounding the place we stopped at only has a walk up counter with all windows.  Like usual my daughter wanted to go up and order for herself, but this time she was more enthralled with all the pigeons and then starting noticing all the people around that weren't in line.  She started to tell me how many of them had signs, and that this one boy looked very sad. 

As I was trying to remember the order I was also trying to remain keenly aware of my surroundings, and had a hand on my little girl at all times.  She tried to push my hand a way, but I kept putting it on her as a security blanket trying to protect her from the world.  Finally, we got our order and made our way back to the car.  When we arrived she started looking through her little purse.  I asked her what she was doing, and she said she wanted to give the sad boy some of her money.  After finding what she needed we walked up to this young man, and she handed him some money.  He looked surprised and elated to see this little girl sharing her money with him. 

Afterwards I praised her for her kindness, and then I asked her how she knew what he had written on his sign.  She said, "Daddy he just looked sad, and I knew if he had a sign he needed some money."  During this whole event I was maintaining an awareness of our surroundings which meant sense, but lost sight of the people in need.  It took a child's heart to reach out and care for another.  It amazes me everyday what that little cutie says and does.  I'm thankful that this world still has the heart of children to teach us how to see and care for the needs of others.

Here are some thoughts for your day.  Take care.  Dave

“All I ever wanted was to reach out and touch another human being 

not just with my hands but with my heart.”

― Tahereh Mafi, Shatter Me

“Too often we underestimate the power of a touch, 

a smile, a kind word, a listening ear, an honest compliment, 

or the smallest act of caring, 

all of which have the potential to turn a life around.”

― Leo Buscaglia

“Self-absorption in all its forms kills empathy, let alone compassion. When we focus on ourselves, our world contracts as our problems and preoccupations loom large. But when we focus on others, our world expands. Our own problems drift to the periphery of the mind and so seem smaller, and we increase our capacity for connection 

- or compassionate action.”

― Daniel Goleman, Social Intelligence: The New Science of Human Relationships 

“Some people think only intellect counts: knowing how to solve problems, knowing how to get by, knowing how to identify an advantage and seize it. But the functions of intellect are insufficient without courage, love, friendship, compassion, and empathy.”

― Dean Koontz

“I believe empathy is the most essential quality of civilization.”

― Roger Ebert

Three ways we can help our patient - Look, Listen, and Feel

Three ways we can help our patients - Look, Listen, and feel.

Health care continues to change daily with new treatments, equipment, and positions designed to support these efforts.  It seems the only constant that remains in health care is that person lying in the bed or sitting on the exam table.  The patient.  Hopefully they will continue to be the focus of all this new activity, but it seems that the relationship we need with our patients to create positive change is slipping away.  How can we restore that relationship, and help our patients?

It's as easy as to  Look, Listen, and Feel.  For many of us that conjurs up visions of other medical training or actual interventions, but I'm speaking to how we must engage our patients to honestly help them experience positive change.

“There is nothing like looking, if you want to find something.”

J.R.R. Tolkien, The Hobbit

Look - We first have to look or see our patients.  Often this can be challenging because our vision is blurred by the view of a patient who's not acting as we would choose, or maybe the smell is burning our eyes, or maybe we have our eyes closed because we're disgusted with the situation before us.  The challenge is that we can't help the people we serve unless we truly look at them, and see them for who they are in that moment.  It's like looking at an oil painting from accross the room.  What we see is the finished product of the image we see, but when you're next to the painting you can the uneven surface and brush strokes.  Our patients are like the painting because each brush stroke may be an experience that has impacted their life resulting in the physical manifestations of their health problems.  Without getting close enough to look at them we won't appreciate the foundation of the person, and know how we can or can't help them.

“Most people do not listen with the intent to understand; they listen with the intent to reply.”

― Stephen R. Covey, The 7 Habits of Highly Effective People: Powerful

Listen - How true are the words by Stephen Covey?  For many of us we either don't stop to listen to others or are distracted by thoughts in our heads.  Either way we miss out on the story we need to hear.  Listening can be difficult and time-consuming, but without listening we can't appreciate the journey.  It reminds me of the numerous vacations I was blessed to enjoy as a child with my family.  My Dad was a school administrator, and therefore had part of the summer off each year.  When he was off we would hop in the car, and travel accross the country producing amazing experiences seeing places like Mount Rushmore.  On these long road trips my mother would help her two rambunctious boys pass the time by reading us books.  Whether it was the Hardy Boys or the Lion, Witch, and the Wardrobe my Mom's voice would draw us into to an exciting story.  In these instances our listening created visions of characters, and took us on journeys that enriched our experiences.  In order to have that same experience in our interactions with patients we must listen to the story they're telling.  Without truly listening we can't appreciate, understand, or attempt to help in a way that will benefit them and impact their health.

“We think too much and feel too little.”

― Charlie Chaplin

Feel - The act of touching another person to convey caring, compassion, or empathy.  Also, to connect with someone emotionally to produce a positive interaction.  With the hustle and bustle that occurs in most health care facilities there has become very little time for making these connections.  Time is often our enemy, so we have to take advantage of the interactions we have with our patients.  We need to be in the moment with them, and put away any assumptions about them or their situation.  We must try to understand their situation without measuring it against our own judgement and values.  To honestly help, we have to be with them in their pain and let the experiene unfold.  We have to absorb the anger and the grief they are feeling, and not distance ourselves with some phoney excuse about maintaining professionalism.  It's difficult to embrace the feelings because it can elicit emotions on our part, but that's what is needed to show them we can help in their time of need.  We are not treating diseases, but people who need us to Look, Listen, and Feel their need for our help.  Then we can drive positive change in the lives of those we're trying to serve.

"Be kind for everyone you meet is fighting a hard battle"

The Vanishing Leadership behind Healthcare Reform - Why Emerging Leaders Must Play 3 Roles to Ensure Continued Progress

We are currently in the midst of tremendous changes in our health system here in America.  Just like any organization or group, change in health care comes from the top.  One of the biggest challenges facing the health system today is the soon to be disappearing leadership.  With a huge number of senior leaders edging closer to retirement, there will soon be a void of decision makers trying to reform a broken system.  The need for new emerging leaders is evident, but how can they continue the work?  Driving positive health care change will require new leaders that will ensure they can make an impact on those they lead, the organizations they support, and the patients and families they serve.

When was the last time you looked in the mirror?  Did you stand there and ponder how other people see you in the world?  Most of us at some point in our lives stand in front of that mirror, and look at the image of our life wondering the same thing.  Have we done enough, been enough, or pursued enough?  How much more important is this action for those people who lead organizations or have the ability to affect others lives.  Learning to lead can be a daunting task that may not come naturally to some, but these emerging leaders can be successful when they learn to function in 3 specific leadership roles that can deliver dramatic results.  

• Be a Custodian - Where would we be without that dedicated force that ensures that the person or building receives the best care?  Can you imagine what it would look like without the involvement of a custodian who humbly does their job with little gratitude.  To be a successful as a Custodian a leader must have two defining traits:

• Confidence - When you do a job that others may not value or appreciate you have to be confident in who you are, and the mission that you're trying to support.

• Consistency - Secondly, to ensure the support of those you lead requires creating a consistent presence that acts proactively, plans for challenges, and provides a calming presence in times of change.

• Be a Curator - According to the dictionary this is someone who cares for a museum.  What is in a museum?  Things of great value.  Therefore, an emerging leader needs to learn that they've been put in a position to oversee the valuable commodity of the team they lead.  Success as a curator requires two characteristics:

• Caring - As a leader you must care for those valuable people who've been entrusted to you.  Your role is to help them see their potential, and stay encouraged about carrying out the mission of the organization.  In the case of health care, it is the patients and families that are the recipients of our care.

• Collaborative - No man is an island, and new leaders need to be taught that without their team nothing will get accomplished.  Therefore, it's vital to tap into this valuable resource, and collaborate to ensure the best outcomes for those you serve.

• Be a Counselor - The final role each leader needs to play to ensure they make an impact is a Counselor. What is it that a counselor does?  Their title speaks to one of their functions of guiding people to achieve personal success in their lives, but successful counselors also act by using two other actions:

• Challenge - A seasoned counselor challenges their clients or those in their care to be better people.  They ask the hard questions, they say the tough things people need to hear, and they're dedicated to seeing that person reaches their potential.

• Compassion - Success as a leader can only occur when the people you lead believe in your sincerity, and that you have their best interest at heart.  Being a compassionate leader means understanding that life and people are not perfect, and it means giving others the benefit of the doubt until they cause you to change your mind.

With so much work ahead of us in creating a health system that provides for the needs of the many, we need to ensure that we have leaders who won't falter when times become challenging.  When these emerging people learn to become the Custodians of our care, the Curators of collaborative innovation, and Counselors led by a compassion then we can be confident that we'll have a new generation of prepared leaders.  They will be able to look back at the image in the mirror, and prove they are enough to continue the good work.

Breaking Addiction to Missiles to Improve Healthcare

“During the Korean War, the Navy kill ratio was twelve-to-one. We shot down twelve of their jets for every one of ours. In Vietnam, this ratio fell to three-to-one. Our pilots depended on missiles. They lost their ‘dog-fighting’ skills.”*

~ Jester, Top Gun, 1986

I remember seeing the movie Top Gun in the mid-1980’s and how this quote struck me … and believe it or not … it has informed much of my work in healthcare.

Fifty-one years ago (1964) the Hippocratic Oath was rewritten by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, to include (excerpts):

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.

… may I long experience the joy of healing those who seek my help.

With this is mind, and in the blog post How a lack of empathy affects our healthcare I made note …

“Thirty years ago, medical schools taught that the most important component of a mental health healing encounter is empathy, human connection, and authentic relationship between a physician and patient.” 

And yet more recently we healthcare leaders have evolved the healthcare delivery system to include:

·         Clinicians triple booked every 15 minutes

·         8 to 12 minute office visits

·         The I-Patient (to borrow from Dr. Abraham Verghese) replacing the actual patient

 

·         Patients being dehumanized and becoming a diagnosis rather than a whole person

·         Clinician focus turning away from the human being before them and toward electronic health records, target organs and test results

·         Technology becoming the solution focus rather than a tool

·         Care teams held to the same productivity standards as clinicians (as noted above) and yet providing less continuity for a patient with “their” clinician

·         A model which rewards excessive tests and invasive procedures

·         Physicians and nurses burningout and worse

We have switched from “dog fighting” i.e. avoiding overtreatment, establishing and ensuring human connection and authentic relationship, and finding joy in healing to “missile dependency” i.e., the “evolved” model described above.

In our effort to make things better we have forgotten why we are here in the first place.  We have sought “missiles” to improve the broken system. We have lost our way. And we are harming those we are honored to serve.

If we truly want to improve the health of our patients, families and communities, it is time to break our addiction to missiles and reconnect with the Hippocratic Oath, what was taught in medical schools thirty years ago, and to our patients, families and communities. 

For only then will we truly innovate healthcare.

It’s not too late and yet long overdue. 

 

 

* As both an animal lover and someone who desires peace this analogy was challenging and yet hopefully lends itself to creating a compelling argument for the need for dramatic change and improvement to our healthcare delivery system.

The "Marc" of a True Physician - A Decade of Compassionate Care

Just recently we again experienced the great care of this physician, and the amazing team of individuals who support his efforts.  It was scary knowing she had to have surgery, but comforting to have such a caring and compassionate physician who was able to calm our nerves.  I just wanted to repost this to say thank you for giving my wife such great care, and providing me with peace of mind.  

What is it that sets apart a great physician when you look at those who've been involved in your care?  Is it the board certification, the experience and credibility, or their rate of successful patients treated?  I would imagine for each and every one of us that those are obviously important, and guide our decisions when choosing a physician for our care.

The other amazing gifts a physician can offer is their humanity, compassion, and empathy.  I know this first hand because we as a family have needed that care for the past ten years.  Thankfully we've been the recipient of all these wonderful traits that I've described above in our surgeon.  He has been skillfully taking care of my wife for ten years, and providing the expertise and guidance we've needed to make it through these challenges in our lives.  What makes this amazing man the "Marc" of a True Physician boils down to 4 things as I look back on a decade of care:

• He speaks to us with respect - We don't have medical degrees or wouldn't ever claim to be as brilliant as this man, but he doesn't treat us any differently.  He takes the time at appointments to carefully speak to us in terms that we can grasp without being demeaning, and with total dignity and respect.

• He's Transparent with the Truth - When we've had those difficult appointments, and know that things in my wife's condition haven't been progressing well he's been honest.  He doesn't claim to be the answer to every cure, but instead promises that he will always keep our best interest at heart during her treatment.  It has increased our confidence in him because we know that he will always deliver the truth because he's a man of integrity.

• He's a Patient Teacher - Not only does he speak to us with respect, but he takes the time to ensure we have an understanding and grasp of the challenges we're facing.  He takes the time to go through the labs and the scans to share what each number and term means.  He knows that by increasing our understanding he's helping to reduce our anxiety and fear.

• He Cares for Us as His Own - Throughout the years when we've been faced with difficult decisions concerning my wife's care, he has said on a number of occasions "This is what I would do for my own family".  Hearing those words creates so much gratefulness and thankfulness in my heart because I know that he is caring for my family that day if they were his own.

This has been a challenging journey, but it has made all the difference to have such an amazing physician at our side.  He has been a blessing in our life even through the struggles.  Being exposed to a physician who speaks to us with respect, is always truthful in every situation, ensures we understand the gravity of our decisions, and promises to care for us like we were his family has made all the difference.  I want to publicly thank Dr. Marc Mayberg for providing a decade of compassionate care for my wife.  I can never repay you for your kindness, the skillful use of your talents, or the empathy you've showed after each surgery when you shared the successful outcomes of my wife's procedures.  You are truly an amazing man and physician.  Thank you.

Dave