Visit us at www.findingbalanceproductions.com; Email to us at healthcl@silcom.com
Welcome to volume five of the Finding Balance Newsletter. In this venue, I will try to provide you with useful thoughts, tools and fun recommendations. For more information on Finding Balance in a Medical Life programs, training and products go to FindingBalanceProductions.com.
Finding Balance has just completed a successful launch of our Total Physician Wellness Program (year long intervention) with Kaiser in Atlanta. I just want to publicly acknowledge their team for an amazing job!
Chattiness
Here's the scenario; you are in the exam room, one on one, and they won't stop talking. They are telling you about themselves in ways which can't be useful to you at all. You are trying to be polite and respectful, but inside, you're frustrated and irritable. Why can't they just focus on the reason for this visit? Finally, after what feels like an eternity, they stop talking about themselves and you can get to the point of the visit. Some doctors can really talk. Yes, I said doctors!
We have all had patients who will talk our ears off. They consume our time when we are busy and they talk about issues and concerns unrelated to the visit. On average, I would guess that about 2-3% of our patients are just there to talk. We sit with them, forcing a smile and trying to nod appreciatively knowing that we need to get moving, but doctors may be as guilty of this as their patients.
A study, published in the The Archives of Internal Medicine, looked at physician 'chattiness'. One hundred primary-care doctors in the Rochester, NY area participated in this study in which they agreed to allow two people trained to act as patients come to their offices sometime over the course of a year. The test patients would surreptitiously make an audio recording of the encounter. The investigators analyzed recordings of 113 of those office visits, excluding situations when the doctors figured out that the patient was fake. The outcomes were disturbing.
In one third of the visits, the doctor talked about themselves and their own interests, health behaviors and even vacations, without tying it back to the patients concerns. A sample conversation was as follows (taken from Gina Kolata, NY times, June 2007):
A new patient comes into a doctor's office weighing 204 pounds. He's six feet tall. The following conversation ensues:
Doctor: Is that up a little bit for you, weight-wise?
Patient: It might be up a few pounds. I used to jog and I just haven't ...
Doctor: See, 'cause I'm weighing more like 172, 173 and I'm six foot. And I'm still running. I'm doing the 5 and 10 and 15 K's. The half marathons and ...
Patient: So, I'm 30 pounds heavier than you?
Doctor: Right now, yeah.
Why would we do this in one third of all office visits? Susan H. McDaniel, lead author of the study, stated; "We were quite shocked. We realized that maybe not 100 percent of the time, but most of the time self-disclosure had more to do with us than with the patients."
It is often important for us to comfort or relate to the patient with our own experience and we often use it as a way of connecting with the patient and possibly to teach the patient ways of managing their health issues. This can be healthy and humane, but in this study, it appeared that the physicians were 'just talking to be talking'.
What would be a more appropriate way to connect? If you have had a similar health issue and feel that disclosing a personal story would be of comfort to the patient, then do so. However, do so in a concise way without loads of unnecessary personal disclosure. It may even be useful to ask the patient permission to do so. In the end always tie your story back to their health concern.
A good rule is to ask yourself, when you are about to tell your story, 'is this for me or for the patient?' If it's for you, you probably shouldn't bother. After all, most of us dread the 2-3% of our patients who just want to talk. And, after all, they are the ones paying for the visit!
Physician Self-disclosure in Primary Care Visits: Enough About You, What About Me? Susan H. McDaniel; Howard B. Beckman; Diane S. Morse; Jordan Silberman; David B. Seaburn; Ronald M. Epstein, Arch Intern Med. 2007;167:1321-1326.
Just for fun
Levon Helm, famed drummer and often lead singer of The Band, has released his first solo album in 25 years. This album, Dirt Farmer, marks his return to performing after a bout with throat cancer. The album is gritty American music at it's best, from rock to bluegrass and country in between. If you are fan of The Band, you'll love this CD.
Thanks for reading,
Lee Lipsenthal, MD, ABHM
Visit us at www.findingbalanceproductions.com ; Email to us at healthcl@silcom.com
Welcome to volume four of the Finding Balance Newsletter. In this venue, I will try to provide you with useful thoughts, tools and fun recommendations. For more information on Finding Balance in a Medical Life programs, training and products go to FindingBalanceProductions.com.
Workaholism in Medicine
What if there was a substance that made you stay away from home until very late and kept you awake at night? What if this substance created multiple family problems to the point of destroying your marriage? What if this substance decreased your efficiency and your ability to concentrate, and made you irritable and fatigued? What if this substance increased your risk of back problems, gastrointestinal disorders, heart disease, and stroke? What if you felt that discontinuing the use of this substance meant that your success and your self-definition would cease to be?
This is often how addicts feel about their drug of choice. They are so identified with the drug that they would lose themselves without it. On seeing a patient with these self-destructive tendencies, most of us would try to convince them to seek therapy or find other forms of help to eradicate the destructive substance from their lives. Unfortunately this is how many practicing physicians begin to approach the work of medicine. We become work addicted!
The practice of medicine becomes our drug of choice. We live in a culture that supports the practice of medicine above all else, which can often exclude our families and our health. If we stopped being a doctor, who would we be?
Unlike alcoholism, workaholism is rewarded with accolades and financial success, making it a very difficult process to stop. A workaholic has lost the ability to slow down and find value in anything other than work. Workaholism is a compulsive behavior and is probably related to other compulsive behaviors and addictions. I tend to think of it as a pre-disposition which can be modified by learning new behaviors, but for some, the compulsion is so invasive that medical treatment may be needed.
Workaholism is not measured by the number of hours you give to work. If that were the case, you would all be workaholics at this point in your career. It is more about the way you approach work and how it controls you and your ability or inability to focus on things unrelated to your career. Workaholism can also be measured by how work affects your life outside of medicine. If you have trouble shutting off your thoughts about your work and career, you may be a workaholic.
Intriguingly a wonderful psychiatrist friend of mine, upon filling out the work addiction test (below), realized the level of his work addiction. When we got into discussion about this, he insisted, "But I love my work." I then asked if his work has had an adverse effect on his life. His response was, "On my first marriage, yes." This is work addiction. If work is damaging your health and relationships, you may wish to consider this as a possibility.
We are often in denial about these behaviors because they feel productive. In a workshop, one colleague told me that she could cut down on her work anytime she wanted to. On saying these words, which many alcoholics in treatment have said to her, she knew that she was stuck!
Work Addiction Risk Test
The test below will help you evaluate your level or potential for work addiction. It is taken from Bryan E. Robinson's book, Chained to the Desk: A Guidebook for Workaholics, Their Partners, and Children, and the Clinicians Who Treat Them (New York University Press, 1998).
The following test was devised to help you evaluate yourself. Score yourself as follows:
1 = never true; 2 = sometimes true; 3 = often true; 4 = always true
Total your score, and then look at the scale below.
_____1. I prefer to do things myself rather than ask for help.
_____2. I get impatient when I have to wait for someone else or when something takes too long.
_____3. I seem to be in a hurry and racing against the clock.
_____4. I get irritated when I'm interrupted while I'm in the middle of something.
_____5. I stay busy and keep many irons in the fire.
_____6. I find myself doing two or three things at once, such as eating and writing a memo while talking on the telephone.
_____7. I over commit myself by biting off more than I can chew.
_____8. I feel guilty when I'm not working on something.
_____9. It's important that I see the concrete results of what I do.
_____10. I'm more interested in the final results of my work than in the process.
_____11. Things never seem to move fast enough or get done fast enough for me.
_____12. I lose my temper when things don't go my way or work out to suit me.
_____13. Others complain that, without realizing it, I ask the same question after I've already been given the answer.
_____14. I spend a lot of time planning and thinking about future events while tuning out the here and now.
_____15. I find myself continuing to work after my coworkers have finished.
_____16. I get angry when people don't meet my standards of perfection.
_____17. I get upset when I'm in situations where I cannot be in control.
_____18. I tend to put myself under pressure with self-imposed deadlines.
_____19. It's hard for me to relax when I'm not working.
_____20. I spend more time working than on socializing, hobbies, or leisure activities.
_____21. I dive into projects to get a head start before all the phases have been finalized.
_____22. I get upset with myself for making even the smallest mistake.
_____23. I put more thought, time, and energy into my work than I do into relationships with other people.
_____24. I forget, ignore, or minimize celebrations such as birthdays, reunions, anniversaries, or holidays.
_____25. I make important decisions before I have all the facts and have thought them through.
Scoring:
25–56 You are not work addicted.
57–66 You are mildly work addicted.
67–100 You are highly work addicted.
The Realities of Work Addiction This material is also adapted from Bryan E. Robinson's Chained to the Desk. Work addiction is a compulsive disorder that workaholics carry into the workplace. It is not created by the workplace.
Work addiction is a mental-health problem, not a virtue, and it can create more problems than it can solve for the workplace.
The superhero facade masks deeper emotional and adjustment problems that workaholics shield with their accomplishments.
Workaholics do not sacrifice free time and family time for their work; they do it for ego gratification.
Although most workaholics say that they enjoy their jobs, work satisfaction is not a prerequisite to work addiction.
Workaholics become chemically addicted to their own adrenaline because of the stress they put themselves under, and they crave additional crises to maintain work highs.
Work addiction can be a primary addiction or a secondary one that blends with other addictions.
Workaholics do not have to be gainfully employed to become addicted; it can happen with any compulsive activity.
Recovering balance after work addiction improves work quality and productivity, and helps workaholics become happier and more effective at what they do.
Achieving balance from reduced work addiction requires more than cutting back on work hours; it involves deep personal introspection and insights, as well as attention to the parts of life that have been neglected.
I am not trying to pathologize us all, but I do believe that work addictive tendencies are highly prevalent in the medical community. Like other addictive behaviors, work addiction can't be 'treated' by the individual.
If you score high on the above test, I strongly suggest Chained to the Desk as a great place to start. I also cover this in great lengths in my own book, Finding Balance in a Medical Life, which will be available in October, 2007.
Fun Stuff
For those of you who love sweet jazz guitar, my pick of the month is Laurence Juber's "I've Got the World On Six Strings". This is a beautiful solo acoustic guitar album where Laurence interprets the work of Harold Arlen, composer of "Over the Rainbow", "Stormy Weather" and "That Old Black Magic".
Thanks for reading,
Lee Lipsenthal, MD, ABHM
Visit us at www.findingbalanceproductions.com ; Email to us at healthcl@silcom.com
Welcome to volume three of the Finding Balance Newsletter. In this venue, I will try to provide you with useful thoughts, tools and fun recommendations. For more information on Finding Balance in a Medical Life programs, training and products go to FindingBalanceProductions.com.
Women in Medicine
Ok, I am a guy, but I am married to a women physician, so I feel like a second hand expert. Let's take a brief look at issues for women physicians.
Women physicians have more complex lives than their male colleagues. Historically, medicine has not been a warm fuzzy place for women. While this is likely to change over the coming years as more women enter the medical workplace (greater than half of medical school enrollees over the past 10 years have been women) it is still not the happiest place for women today. Many women physicians are still looked down upon for taking time with their families or working part time. They are often seen as, or feel 'less' than men in this regard. This is changing. Part time medicine is on the rise for both men and women and in most environments, it is usual.
In primary care settings, women physicians tend to see more women patients with complex psychosocial problems, while seeing patients with the same numbers of complex medical problems. This is because a patient with complex medical or social problems believes that a women physician will be a better listener. This is especially stressful for these physicians as every patient seems to want to "talk their ear off". Thus women are seeing more challenging patients than their male colleagues. On average women physicians reported needing 36% more time than allotted to provide quality care for new patients or consultations, compared with 21% more time needed by men. This is probably due to the complexity of the patients. This is additionally stressful for women physicians who are being compared to their colleagues on a patient volume basis.
Because of societal roles set for women, they often do more than their share of work in the house, with the children and with community activities. Women may feel that they have tried to please everyone, and end up feeling they have pleased no one. With all of the above responsibilities, women physicians find that their personal needs are last and often lost. They put their personal and emotional needs at the bottom of the list of priorities. There is no time to consistently take care of themselves, even the basics such as exercising, eating well, getting enough sleep, and spending time alone or with friends.
"I feel like I have to justify every minute I spend not taking care of some one else"
- T. K-H, MD, Family Physician and mother of five children
How does this effect women physicians' mental health and attitudes? Women had 1.6 times the odds of reporting burnout compared with men. The odds of burnout for women increase by 12% to 15% for each additional 5 hours worked per week over 40 hours. The odds of burnout were 40% less for women when the support of colleagues, a spouse, or significant other was present for balancing work and home issues.
I strongly suggest beginning to take care of your selves. Don't sacrifice yourself for the good of others. Burnout and fatigue are likely to be the result and then you can serve no one! And there is hope, over the next generations there will be more women practicing medicine in the US than men!
So, how to manage the stress of all this? Two of the most distressing events, for a women are coming home to a clean house and talking with friends, so some suggestions:
1. Get a message – you deserve it!
2. "Outsource" your house clean – this is one place not to 'cheap out'
3. Find time with you friends to talk
References:
Career Satisfaction of US Women Physicians; Results From The Women Physicians' Health Study E Frank et al. Archives of Int. Med., July 12, 1999, v.159, n. 13
The work lives of women physicians' results from the physician work life study. The SGIM Career Satisfaction Study Group. McMurray JE; Linzer M; Konrad TR; Douglas J; Shugerman R; Nelson K J Gen Intern Med 2000 Jun;15(6):372-80
Women in medicine: stresses and solutions, Mamta Gautam, MD,West J Med 2001;174:37-41
Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight. Taylor, Shelley E.; Klein, Laura Cousino; Lewis, Brian P.; Gruenewald, Tara L.; Gurung, Regan A. R.; Updegraff, John A., Psychological Review. 107(3), Jul 2000, 411-429.
Fun stuff for this month:
If you've not yet seen the movie "What Dreams May Come" with Robin Williams and Cuba Gooding Jr., I highly recommend it. While it is a few years old, it certainly is one of my favorite movies of all time. It explores the possibilities of soul mates. (if this does not fit your belief structure – don't bother) It is also a visual masterpiece.
For you and your patient:
A great way to manage stress is guided imagery. For learning this, I highly recommend Marty Rossman, MD's "Stress Relief through Guided Imagery". This is a simple and great set of imageries that will work well for you or you patient.
Thanks for reading,
Lee Lipsenthal, MD, ABHM
Visit us at www.findingbalanceproductions.com ; Email to us at healthcl@silcom.com
Welcome to volume two of the Finding Balance Newsletter. In this venue, I will try to provide you with useful thoughts, tools and fun recommendations. For more information on Finding Balance in a Medical Life programs, training and products go to FindingBalanceProductions.com.
Faculty training offering – July 15 – 20th in Petaluma California – see the web site for details, (click here).
Dead Zoners Vs. Downloaders; Post work day communication errors
You finish a hard day at the office. Your tired and maybe a little irritable. You finally get home to those whom you love. Do you enter the 'dead zone' or do you want to 'download' your day. People seem to fall into one category or another and either may cause stress at home.
The dead zone
In the December issue of the Harvard Business Review, there was a survey of 975 global managers by Sylvia Ann Hewlett and Carolyn Buck Luce. It showed that about 45% of 975 high-earning managers enter a conversational dead zone after a long workday, meaning they just don't want to talk.
Why would this happen? Our work days are filled with conversation, people trying to get our attention, multi-tasking and emotional outpouring. I would guess that the dead zone might even be greater for us docs. Another reason we don't want to talk is that we don't want to bring all of the 'bad stuff' that happened at work home with us. This is especially true when your days are filled with trauma or difficult diagnoses. The problem this creates is that your family wants to talk to you and when you are silent, they can presume that they did something wrong.
The downloader.
The downloader is one who wants to tell their family about their entire day. This is more likely true for women in that women under stress are more likely to want to talk about it than men (Taylor et al, Psychological Review. 107(3), Jul 2000, 411-429.). This puts them at a disadvantage, because, if married to a man, the man is more likely to prefer quite time post work.
The solutions.
If you are a 'dead-zoner' be honest about it and ask for what you need. Let them know that you had a rough day and that all you need is 20 minutes by yourself. Short walks are great for this or just some 'couch time' without stimulation. If you tell your family that you just need a short break, they won't presume that it is about them and they can relax about it.
If you are a downloader, ask for time to download. Keep in mind that most men, on hearing about difficulties will try to fix them. This feels like work for them and if they are tired is unwelcome. Let your spouse know that they don't have to make it better, they just need to listen. Talking alone, without kids or distractions, make it better. Over a glass of wine may be useful too.
If you are a downloader married to a dead-zoner, make time for both of you. Twenty minutes of downtime, followed by 20 minutes of downloading may be the best solution.
The bottom line is that we all function differently and that honesty about your needs is critical. Pretending to listen is worse than not listening at all!
Fun summer entertainment
A critical component of life balance is fun. Reading is one of my favorite summer activities. With that in mind, I want to recommend a great book that my wife and I both enjoyed; The Lost Diary of Don Juan by Douglas Carlton Abrams. I loved this book. It was fun, sensual and cinematic in scope. It is written as a diary by Don Juan and describes is life exploits and adventures in love. The author makes Don Juan a rich and believable character; someone you would love to sit in a tavern with and hear his stories unfold. Truly a fun read.
After reading this book, the two of you may have something to talk about besides work or maybe you won't want to talk at all (wink).
Thanks for reading,
Lee Lipsenthal, MD, ABHM
Visit us at www.findingbalanceproductions.com; Email to us at healthcl@silcom.com
Welcome to the first Finding Balance in a Medical Life Newsletter. I am pleased to introduce this as resource to my friends and colleagues as a way to keep abreast of issues in physician well-being.
Why this, why now? There has been no known venue, until this time, to share and contribute information about physician health and well-being outside of the area of physician chemical dependency and recovery, yet the average physician in our community is struggling to manage their life. The American College of Physician Executives 2006 report of Physician morale speaks to this need ( ACPE.org). In this study 46% of physicians surveyed had a low morale, 77% experience fatigue, 67% experience burnout, 33% depression & family discord as a result of their work as physicians.
These numbers can be daunting; however there are ways to manage these issues. Each monthly the Finding Balance Newsletter will provide information from the literature and helpful tips and resources from me and others on ways to manage stress, diminish burnout and have more fun in your career. After all, you will be working hard, you may as well have fun doing it! I will also include recommendations of fun music and books for your pleasure.
I also encourage you to give input to the newsletter – articles and stories – from your career which you feel will help us all. Please email us at healthcl@silcom.com to contribute. I look forward to hearing from you and helping you in your careers.
I have also set up a web site to serve as a resource for us all, www.findingbalanceproductions.com . It will include:
A store including recommended books, CDs, health products and resources for you and your patients. (click here)
A list of resources for you, the practitioner (click here)
A listing of Finding Balance Programs for you and your health system (click here)
Upcoming Finding Balance Programs – Hawaii, May 20-26th, (click here)
To get us started on the fun – Check out "Gently Weeps" by Jake Shimabukuro. Jake is an incredible ukulele player who combines Jazz, rock and blues for a phenomenal result! Click here to check it out. (click here)
Thanks – See you soon
Lee Lipsenthal, MD, ABHM
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