Doctor lottery? Really?

This is a passionate outcry from a patient and the daughter of a patient, to improve the state of healthcare today. Why does one need to win the “Doctor Lottery” to find a compassionate, caring physician with enough time to listen for the subtle clues that indicate distress, deterioration, and to save a life?

The author argues that patient engagement is a paradigm shift for many organizations, and that it is a clear win-win when done well. 

Both of these articles are well written and more articulate than I am. I can say, in our organization, I routinely conducted bedside rounds, where residents and students presented the patient’s history, their examination findings and their assessments and plans in front of the patient and family, and we would discuss our plans together. Even in clinic, I have my students present their data and we have a discussion about the patient in front of the patient and family. This ALWAYS leads to better understanding by all parties, and has never been an obstruction to patient learning, or to student or resident training. And generally it does NOT take longer.

CMIO’s take? Healthcare technology and paternalistic traditions in healthcare both conspire to take us away from the bedside and risk impairing communication. Lets design better communication into everything we do.

How to Actually Focus on What You’re Doing (NYTimes)

Cal Newport interviewed in the NYT

In the blizzard of our daily work and internal and external pressures, maybe think of putting the blizzard aside at times, and focusing on Deep Work (which I reviewed previously) or pursuing ONE Thing (also previously reviewed). Sometimes it takes a second or third exposure (or many more) to have a new idea really stick. Well, here it is again.

When I have the discipline to be present, to be aware of the cacophany that constantly blares and swirls around my head and consciously place it to the side for a few hours, or even an entire morning or whole day (what a luxury, but also a necessity), then I feel like I can accomplish something substantial.

Here are a few distractions pulling me away:

  • Post-office syndrome: 4000 items in my email inbox, 1000 unread.
  • External crisis: Colleagues whose Citrix or EHR (electronic health record) or Dragon (speech recognition) or other EHR-related tool does not work and “DON’T YOU KNOW I CAN’T TAKE CARE OF PATIENTS RIGHT NOW?”
  • “I would like a report pulled from the EHR and my request is too low priority, can you fix that?”
  • “I need something fixed in the EHR, can you help me?”
  • Shiny new object: “Hey, here’s a new opportunity to collaborate on a project!”

Here are a few BHAGs (big hairy audacious goals) just begging for time and effort from quadrant four (Low urgency, high importance, from Getting Things Done) :

  • Design and write a follow-up paper on EHR optimization through Sprints
  • Write the next QI/research proposal on patients viewing images online
  • Write the next QI/research proposal on using speech recognition tools in the examination room
  • Help an innovation partner company deliver a minimum viable product related to new prescribing tools linked to the EHR
  • Help an innovation partner redesign physician training for EHR
  • Help craft the vision and curriculum of EHRs role in telehealth for a national organization
  • Help craft the vision and curriculum of informatics training for medical students
  • Learn to be a better mentor: improve the quality of meetings-with and benefit-to mentees and direct reports

CMIO’s take? I realize that any ONE of my BHAGs could be THE ONE THING that I focus on and made substantial progress on. What are YOU focusing on?

“We have an electric planet” –NYTimes

Each wire runs vertically up through the mud, measuring up to two inches in length. And each one is made up of thousands of cells stacked on top of each other like a tower of coins. The cells build a protein sleeve around themselves that conducts electricity.

This is incredible: the discovery that bacteria can form chains, build a protein sleeve around themselves, and create electrical wires. I’m grateful for the clear-eyed journalists who find and write about such scientific discoveries for us lay-persons.

I’m excited to for 50th grade! (Re-inventing myself, via NYTimes article)

This is brilliant. Kids re-invent themselves each school year.

As a parent, I see my kids reinventing themselves every school year. They’ve gone through their Lego phases, their sporty phases, their drama phases, their communicating-only-via-eyerolls phases. 

Mary Laura Philpott, NYTimes

Why not, us, as adults? What a great way to encapsulate the neuroplasticity of our minds; we do know that our brains do not stagnate in adulthood, but continue to mold and change:

So, why do we continue on in our jobs without considering the annual-beginning-of-school-year re-invention? Remember in medical school learning Prochazka’s Stages of Change model: how our patients who smoke would go from Pre-contemplative to Contemplative to Preparation to Action to Maintenance? We see this in EHR adoption. Or perhap some go through Kubler-Ross’s stages of grief. OK, however you slice it, perhaps we do each need time and space and permission to “start fresh.”

CMIO’s take? I’m excited to be starting 50th grade! How about you?

Making slides for a talk? How to make them more memorable (advanced tips)

Powerpoint deck on how to give a good powerpoint talk linked here:

I’ve been thinking about giving talks backed by powerpoints. Leaving aside the many talks on “Death by Powerpoint”, the lifeblood of the industry is on slides-man-ship in presenting new ideas to our own organization’s leadership, and at national meetings.

And then you see these lovely presentations by TED speakers who are inspiring, tell great stories, but DO NOT have to provide detailed scientific rigor underneath their high-flying narratives.

We, in informatics, have to contend with both parts of this conundrum: how to tell a compelling story well enough to capture imaginations, and more importantly, purse-strings, and yet back it with enough data and science to be compelling to our very picky bean-counters and scientists.

Further complicating this fact is that often, our powerpoints get distributed by email and have to STAND ALONE to convince others, sometimes. Therefore, the whole TED TALK, with IMAGES ONLY and NO DATA become useless in this context; now we have to figure out EITHER how to write an entire white paper (1-4 page brief that can be read quickly) to supplement any slides we give, or to modify these slides so that they CAN stand alone. Ideally, we can write a powerpoint slide deck that includes enough detail to satisfy data-hounds, and yet engaging enough, with a minimum of words, to create a compelling narrative.

CMIO’s take? Only you can judge if I’ve achieved my goals (see link). This is a summarization of more than a decade of my ‘doing it wrong’ and set of guiding principles that I’ve used to continually improve my own talks. I already presume that you know how to build a Powerpoint deck, and that you’ve read other articles on How-To in powerpoint, maybe Garr Reynolds’ Presentation Zen, or Dan Roam’s Show and Tell. There’s lots out there. But this is my take.

“Thinned-out interactions made empathy harder to access.” News: Scientific American

Scientific American, article by Jamil Zaki

I’ve been saying this for awhile. Important communications are best had in-person. Meetings 1:1, meetings with groups IN PERSON. What percent of emotional communications occur through BODY LANGUAGE versus TONE OF VOICE versus THE ACTUAL WORDS?

  • Body Language: 50%
  • Tone of Voice: 40%
  • Actual Words: 10%

Sure, you can dispute the evidence, as some have, but I find the ratio to be about right. In my medical practice, and also in our Informatics work with the Electronic Health Record, that if we consider in-person conversations the gold standard, that telephone conversations (where the body language disappears) are a risky way to have an effective conversation and to diagnose the patient (leaving aside the inability to do a physical exam).

Worse yet, having patients use MyChart, or at UCHealth “My Health Connection” online patient portal, drives use to communicate using ACTUAL WORDS, without the benefit of Tone of Voice or of Body Language. And, as you can see from the percentages above, this allows much greater opportunity for misunderstanding. For example, can you imagine how the following statement might be misunderstood?

I’m sorry that your father passed away.

I’m “sorry” that your father passed away.

I’m sorry that YOUR father passed away.

I’M SORRY that your father passed away.

Tone of voice and body language USED TO BE how we communicated such difficult emotion. Now, we are only left with words. And, if we are NOT SKILLED with the wordcraft (as many of us are not, were never trained, some of us can’t even really manage a keyboard effectively), what chance do we have of being understood?

CMIO’s take? I love the quote above, will say it again.

Thinned out interactions make empathy harder to access.

Jamil Zaki

It is so true. What am I going to do about this? What are YOU going to do about this?

Improving Wellness via EHR Optimization Sprints and High Performing Teams. WellDOM speaker series with Amber Sieja and Katie Morrison

It is always a pleasure to stand up and discuss our Informatics work in public forum. We always strive to reduce physician burnout and the EHR burden by improving teamwork and practice efficiency. As a side effect, we discovered the principles behind Agile teamwork, reducing waste, and the ideas underlying High Performance Teams (both running one, and teaching clinics how to become one).

The talk is 50 minutes and the podium is shared with my colleague Katie Morrison MD, Director of the WellDOM program (Wellness in the Department of Medicine at University of Colorado) and my colleague Amber Sieja MD, Senior Medical Director of Informatics at UCHealth. I’m grateful for their brilliance and collaboration.

The TL;DR is:

  • Sometimes you have to borrow and steal a team to get started
  • Get the right people on the bus: a physician informaticist, nurse informaticist, project manager all are crucial
  • EHR efficiency is NOT only about physicians: it is about teamwork
  • 2-week Sprints are a good timeline: short enough to be urgent, long enough to make some real change in the clinic
  • Eventually you’ll discover Agile, Lean, High Performance Team principles. Live them, and teach them to sustain yourselves

CMIO’s Take? TL;DR. Just do it.