Well, it is time to update my resume. It has been a year, I have failed at more things. I’ve read more failure resumes, and I like some of the newer ideas, for example, listing your NON-skills. I’ve added mine.
Here is a new term for you: Doomscrolling. I am guilty of this, until I become aware of it and have to wrench myself away. It is a like car-crash in slow motion and you want to know how this horror story ends.
Virtual meetings are draining, and I’m on them up to 8 hours a day, even busier now with all the EHR modifications, keeping up with policy changes, what Covid-testing is available, how we admit, treat, discharge, follow, track patients.
At the ends of long hours, long days, long weeks, our nerves are frayed.
I’ve observed that interactions between people have everything to do with the interpersonal skills of the individuals. Sometimes the conversation does NOT go well. Whether it is by email (worst for crucial conversations), by phone (slightly less bad), by online video meeting (slightly less bad) or in person (best, when possible), it is certainly worsened by the pandemic situation.
I’ve been taking a Story Skills Workshop (by Seth Godin and Bernadette Jiwa) that recently concluded. I have to say that I’ve learned quite a lot, and not what I was expecting to learn. I highly, highly recommend it. Seth and Bernadette offer a series of online lessons, released over time. There are about 6 expert coaches, and the instruction is to sign up for an interest group or ‘accountability group’. You’re given a story structure (the 5 C’s: Context, Catalyst, Complication, Change, Consequence) and then specific lessons to write and polish specific elements of your own story in this framework. The cool part is the instruction to ‘first write your own story, and then go comment on at least 5 others.’
I learned that it is possible, in an online-only course, to develop a sense of community and collegiality in a short 30 days.
I learned that it is crucial to be gentle in first contact with others online. For example, when giving feedback on others’ stories, DO NOT start right in with ‘why don’t you add more Emotion to that moment in your story?’ You’ll learn (as did I) that conversation either stops or becomes defensive. Remember that online conversations carry ZERO nonverbal: no Kind tone of voice, no Friendly posture. All you see are the words, and it is automatic to imagine them coming from a frowning critic with crossed arms, shaking his brutish head. [Pause for self-reflection amongst my blog-readers, as well as from myself…]
Instead, try something my theater-trained son taught me:
‘I like… I wish… What if …’
My highly emotionally intelligent son
Framing any response this way allows your recipient to hear something positive, then a neutrally posed concern, followed by a tentative suggestion. Having been on both sides of such a well-formed critique, I can say: it is EASY to write, doesn’t take longer, and on the receiving end FEELS COMPLETELY DIFFERENT. It FEELS like a close friend, reaching a hand over to pull you up to a higher step.
FOR EXAMPLE: Take one of my story-critiques of a co-participant in the story workshop, not done well on my part: “Why don’t you add more emotion to your story? It reads like a timeline, but nothing about what you felt, or how that impacted you.” I thought I was clever, to point out one of the main points of that week’s lesson. What I received was… no response. Hmm.
Rephrasing the reply using this framework, when I replied to a different participant’s story, sounded like this: “Hi, Joe! I liked your story, especially the unexpected part about running away from home at 16. I wish I could be there at that moment when you made the decision, everything boiling-over, and then a crucial moment. What if you paused in your story and told us what you were thinking and feeling right then? I would be riveted.” Guess what? We had a great online conversation after that, and he re-wrote his story, and I WAS RIVETED. Win-win.
CMIO’s take? Story telling: cool. Gentle, effective feedback: cooler. Don’t we all need to get better at this?
If you’re not getting away enough from all things Pandemic, here’s a nice long-exposure photo from my iPhone 7. Yes, a CMIO with an iPhone 7. And I still love it. At least I have a smartphone, unlike one of my informaticist colleagues.
Forest bathing is a thing in Japan and increasingly worldwide, and perhaps we could learn a thing or two. OR, try Norway’s Slow TV (YouTube, almost 10 hours! Surprising how compelling it is, try it full screen), as highlighted by CBS Sunday Morning (8 minutes, YouTube). Don’t miss it!
I’m so proud to be part of a multi-disciplinary, talented group of clinicians. Our Department of Psychiatry is gearing up for what may become the second surge of our pandemic, as we relax the stay-at-home orders in Colorado:
Mental Illness. Depression. PTSD. Panic. Suicide.
These terms must no longer carry the stigma they do. There is no shame in reaching out for help. Appropriate and timely treatment can aid a person’s innate resilience and return him or her to health.
We have not experienced a pandemic of this scope for more than a century … We are psychologically inexperienced.
C. Neill Epperson MD
Read more of Dr. Epperson’s ideas and initiatives in this fight for mental health and the major investments UCHealth will be committing to improve the well-being of all residents of the State of Colorado. Welcome to the fight!
Executive Summary: We have a global pandemic, daily policy changes, we work from home, have new video tech, and we are learning to communicate and build relationships in new ways. It is easy to forget that there may be a scared patient on the other end, counting on us. How might we improve the patient experience? Some ideas:
Secure Chat with your MA
Scrub your schedule together, days ahead for patients more appropriate for telehealth vs in-person visits, med rec, troubleshooting, visit focus
Arrange your room, self
See tipsheet in Epic “Demonstrate Professionalism.“ How is: your room, your light, your clothing?
Eye Contactand, put a sticky note on PC cam to “LOOK HERE!”
Arrange the camera at eye level if possible. For some, looking down = frowning? Eye contact on video visits is EVEN MORE important. “If I look away it is because I’m looking at information in your chart”.
Avoid running late
If you DO, inform your MA by Epic secure chat & they can inform patient
Greet the patient
I like to raise my arms in surprise when we connect: every human connection now, is amazing. Maybe thank them for connecting with you. Ask if they’re in a safe private spot (eg: advise patient NOT to be driving!)
Talk, human to human
Ask: how are you coping (aside from medical concern)? Scared? Worried?
Even more important now in this time of anxiety. You can reflect or say back Data, Ideas, Feelings, Values. It strengthens connection: for example DATA: “It has been 5 days of worse symptoms?” IDEAS: “so you think it might be gout?” FEELINGS: “you’re worried about work? Hmm.” VALUES: “so, what’s important to you is your family.”
Some clinicians may have taken the Excellence in Communication course. The PEARLS acronym can also be helpful. Some examples: Partnership: “We’ll get through this together.” Empathy: (reflective listening, as above) Apology: “I’m really sorry that happened.” “I’m sorry for my part in it.” Respect: “You have worked really hard on this.” Legitimization: “Anyone in your situation would feel that way.” Support: “My team and I are here for you. We aren’t going anywhere.”
Physical Exam creativity
Teach them to take a pulse “say beep when you feel it” and YOU can count. Patients may have a BP cuff, Pulse ox, flashlight, thermometer.
Ask for help from family
Others may help add to history or exam findings
They may ask about YOU as a human
“How are YOU doctor? Are you staying safe?” So many surprising comments from patients worried about their doc. Thank them!
Brief LIFE advice
During pandemic, consider: A) Limit news/social media to 30 min/day. B) Exercise daily. C) THREE GOOD THINGS exercise: proven to reduce depression, anxiety if done consistently “What 3 things are you grateful for today?” Can become a great family habit at dinner.
AVS, Open Notes
From My Health Connection, they can see your AVS (after visit summary) and your Progress note (called Clinical Note) to remind them of details of your visit. Maybe at end of visit, ask: “Sometimes I don’t explain myself well. Can you tell me what you’ve heard, so we’re on the same page?”
Reassurance and Hope
“We’re going to get through this!” “Stay in touch with your loved ones.”
Ending the visit
Consider: a handwave OR palms together, nod OR thumbs up OR “You Got This!” Forecast next steps or if your MA will call them after.
Secure chat with your MA
Handoff any items after visit for continuity (referral, next visit, lab, etc)
I was chatting with an informatics colleague last week, mentioning that our family had spent some time in Utah recently.
He sent me this photo he had taken in Utah recently. Beautiful, no?
Are you taking care of yourself? It looks like we are in this for the long haul. Colorado is now under a stay-at-home order, and it looks like our infection curve is more like Italy than it is like Taiwan or South Korea: it is still accelerating, and will be awhile before the worst is past.
So, take a break. I tried hard this weekend to step away, watch a movie, hang out with the family, go for a walk, a run, a bike outing, bask in the sun, get some sleep, in between online-work. Maybe JOMO is a good word to think of at times like this.
We wrote on our family white board some daily tasks:
I’m part of WellDOM, the Wellness initiative within the Department of Medicine at University of Colorado. As such, I continue to support the idea of Sprints, the way we boost physician and team efficiency and effectiveness using the Electronic Health Record. However, we know that a large part of physician burnout and wellness have to do with other components: a Culture of Wellness and Personal Resilience, in addition to Practice Efficiency.
In thinking more about these broader components, I’m reminded of the work of Robert Putnam’ Bowling Alone, a towering work, documenting the decline of civic virtue and engagement in this country, illustrated most profoundly by the fact that membership in bowling leagues has declined 40% from 1980 to 1993, while individual bowlers rose by 10%. There has been a dramatic drop in face-to-face social gatherings outside of work in the past few decades, and the thought is that this decline in the social fabric has led to isolation, loneliness, and a general decline in civility and personal resilience. See the recent Atlantic article “Kicking in Groups” on this, also.
We’re looking for objective measures that might allow us to survey for and detect burnout and resilience, that might get past ‘soft’ measures like “do you feel burned out” and perhaps measure “Do you have social groups that you meet with regularly at work” or “Do you have social groups that you meet with regularly outside of work”, and also “Do you meet regularly with a mentor or mentee?” We believe that measuring such behaviors MIGHT be a more objective way to determine who is more protected, and who is vulnerable, to burnout.
CMIO’s take? Physician/provider burnout is a real thing; difficult to address; and may be embedded in a larger change in the social fabric. Are you having success thinking about and intervening in this fraught area? Let me know.
We are honored to be among the organizations awarded the inaugural Joy in Medicine honor. We applaud the AMA for standing up a framework that all healthcare organizations can pursue, to ensure that the work-life balance of physicians is considering in the coming topsy-turvy days of healthcare.
Physician burnout is a national epidemic, with suicide rates among doctors 2-3 times the average for US adults.
CMIO’s take? Come join us on this stage! We should not rest until ALL healthcare organizations win the Joy in Medicine award. ALL our healthcare colleagues deserve this.