New year, new plan

January 6, 2006

This doctor has a unique plan to be the finest person and best doctor he can be.

I don't usually make New Year's resolutions. But while shaving on New Year's Day, a resolution popped into my head. It was a simple little idea, but it made sense to me, and it may be helpful to you, too: "Teach one thing; pay one compliment." I decided I would do both in each patient encounter during the new year. By the end of the day I had added a third component-share one laugh (or at least a smile).

The fact that this resolution involved patient care isn't really surprising; I often struggle with the challenge of achieving high-quality patient visits. The way I see it, I have four things to accomplish during my patient encounters: (1) I need to ask enough questions, give clear answers, and evaluate the patient thoroughly (and ideally solve his problem); (2) I must allow enough time to remain calm and friendly during that visit (and between visits as I relate with my staff); (3) I must do it all quickly enough that other patients aren't kept waiting too long; and (4) I must still see enough patients each day in order to cover bills, payroll, and my children's tuition. Achieving any three of these at the expense of a fourth may be quite feasible, but balancing all four is a profound challenge.

I realized this three-part New Year's resolution might be the ideal way to achieve the thoroughness, the calm friendliness, the punctuality, and the productivity I had been aiming for. Let me share the components of the resolution in greater detail.

During medical school and residency, I assumed I'd go into teaching, but, I eventually chose private practice. I soon came to realize, though, that teaching has an important role in patient care. I'm a teacher much more than a "healer."

Almost everything I see in general pediatrics can be handled with antibiotics, steroids, or time. Yet my patients (and in pediatrics, the parents of my patients) are most in need of teaching. The new parents with a colicky baby, the mother whose infant has ear infection, or the parents with an asthmatic son all need education, encouragement, and support. The 4-year-old boy requires teaching on why he and other "superheroes" need good nutrition. The 9-year-old girl needs instruction on her upcoming onset of puberty. And that 16-year-old boy must be taught the technique (and importance) of testicular self-examination.

Of course, teaching isn't unique to pediatrics. The 30-year-old lawyer now diagnosed with high cholesterol, the 50-year-old woman adjusting to her "empty nest," and the 80-year-old man with prostate cancer need instruction as well.

We know, however, that people can only assimilate so much information. And I learned long ago I can only cover so much if I'm going to include efficiency and punctuality into my visits.

So I find it works better to include just one (or at most, two or three) relevant unsolicited pieces of information. I can then concentrate on answering questions and providing requested information. Often the patient or family comes struggling with their own issues and I can address these "teachable moments." Besides, it often seems my most important question is, "Does that answer all your questions and accomplish everything you needed today?"

Pay one compliment

I'm not that surprised the decision to "pay one compliment" came to mind either. Paying compliments and building self-esteem are a big part of pediatrics; not just in dealing with our patients, but with their struggling parents as well. So, yes, I can tell the uncertain new mother how well her baby is developing. I can high-five the 8-year-old when I hear about his home run. I can praise the teenage girl on the improvement in her grades. But the concept can apply to any age group. The 35-year-old man who finally lost a little weight, the 55-year-old faithfully sticking to his exercise routine, and the 85-year-old woman in the pretty new dress all need to hear compliments as well. Compliments have a wonderfully therapeutic effect on anyone.