Steven A. BriganceUAMS West Resident Conference

January 23, 2013

Today’s Outline

• Who Am I and Why in the World Should You Listen to ME?

• To Start: Several Questions for YOU!• Your WHY.• 6 Tips for a Better you AND, Perhaps, a Better US.

The Most Interesting Man in the World

Who Am I and Why Should YOU Listen to ME?

Who Am I and Why You Should Listen to ME?

• This Man is NOT Me. In fact, particularly when I say anything about myself, I find that I may be the Least Interesting Man in the World.

• BUT, There May Be Some Good Reasons Why My Suggestions Today May Be Beneficial to You.

• And, Because of Any Benefit You Identify for Yourself, My Advice May Also One Day Benefit Your Patients and Their Families, Your Loved Ones, Your Colleagues and the Institutions for Whom You Work.

My Perspectives

• An Overly Experienced Patient (cf. Martha Keochareon, BSN, NY Times front page 1/11/13.)

• An Overly Experienced Caregiver. (Ibid.)• The Founder and CPO (Chief People Officer) of an

Elder Care Company whose Tag Line affirms that in healthcare “Perfection is the ONLY Acceptable Goal.”

• A Medical Malpractice Lawyer with FAR Too Much Experience With Bad Outcomes for My Takeaways NOT to be of Some Use to YOU.

So Why You Might Want To Listen• For Better or Worse, based on both Personal and

Professional Experience, I Have More Involvement with Bad Healthcare Outcomes Than Anyone Could Ever Want To Have.

• MY EXPERIENCE with a Multitude of Individuals, Institutions and Insurers Who Have Some Responsibility for the CAUSE(s) of a Bad Outcome; MY EXPERIENCE with Those Who Have Suffered, Directly or Indirectly, as the Result of a Bad Outcome; and MY EXPERIENCE with Those Who Feed Off of Bad Outcome(s).

• What Follows are My 6-Points of Advice for You Today. They Stem Directly from My “Learnings” from My Own Experiences in Healthcare Outcomes.

“Bad Outcome” Defined• An adverse medical result that affects someone in the

healthcare chain, which result could have been prevented by better, available medical care at some level.

• When healthcare is provided or attempted and Expectations are NOT met.

• Malpractice Claim = Miscommunication + Unmet Expectations + Un-Remediated Expectations + a Failure to Connect + Anger + Access to a TOOL.

• Cf. When Things Go Wrong: Responding to Adverse Events, A Consensus Statement of the Harvard Hospitals (March, 2006) (“DAO”).

“A Doctor’s Lament On Any Given Day”

“How the ___ am I supposed to do good medicine when I see 50 patients a day, plus rounds and phone calls every day with families and ___ing idiots telling me I am wrong because they’ve looked it up on the internet? I fight over billing; I fight over prescription coverage; insurance companies are dedicated to not paying me; and the big law firms—they’re just waiting, betting I’m going to make that one big mistake. This profession for me was a higher calling; I could make people’s lives better…Look at me now! Dr. Stan KnightLove and Other Drugs, the Movie

First, a Few Questions for YOU

• As You Sit Here Today at This Moment in Your Young Career, ARE YOU EXCITED ABOUT WHERE YOU ARE as a Physician?

• At This Moment, Are You Confidant That in the Next Five Years You Will Become MORE Excited About Where You Are Then versus Where You Are Now?

• Why or Why NOT?• What is Your main job as a Physician? • WHY Did You Choose to be a Physician?

6 Suggestions For Every Physician1. Find, Adapt and Never Lose or Let Anyone Take Away Your

Why! • “It is here that we encounter the central theme of

existentialism: to live is to suffer, to survive is to find meaning in the suffering. If there is a purpose in life at all, there must be a purpose in suffering and in dying. But no person can tell another what this purpose is. Each [of us] must find out for [our self], and must accept the responsibility that [the] answer prescribes. If [successful each] will continue to grow despite of all indignities.” Viktor Frankl, Man’s Search for Meaning (Emphasis added.)

• “He [or she] who has the right ‘why’ to live can bear with almost any ‘how’.” Friedrich Nietzsche (Emphasis added.) (See also, “That which does not kill us makes us stronger.”)

Your WHY Starts With Your Pledge

• “I solemnly pledge to consecrate my life to the service of humanity.” (The Declaration of Geneva, as amended 2006.)

• I will practice my profession with conscience and dignity. (Ibid.)

• The Health of my patient will be my FIRST consideration. (Ibid.)

• The top 4 Professions that give Humankind the most benefits. (Snofla Sacul)

6 Suggestions For Every Physician

2. Be A Team Player• “I solemnly pledge MY COLLEAGUES will be my sisters and

brothers” (Declaration of Geneva, as amended 2006)(emphasis added.)

• “Beware of the smartest guy in the room.” (Gupta, MD. and many others in other arenas; cf. Enron, one of my former clients.)

• Lone Wolves are dangerous for everyone in the healthcare chain. (Gupta, MD.)

• Arrogance precedes a fall—more arrogance, bigger the fall. (Gupta, MD.)

• Watch out for those who always have to blame someone or something else. (Gupta, MD.)

• Synergize. (Habit 6 Covey)

6 Suggestions For Every Physician3. Be Empathic• The Greek word "Patheo" loosely defined means "feelings" • SYMPATHY: I take on your feelings and the feelings of everyone around me…, which

eventually leads to: • ANTIPATHY: I now reject you, dislike you and I see you as making my life miserable…, which

eventually leads to: • APATHY: I could not care less about you and will do my best to shut off contact and

communication you. A therapeutic person has learned a better "pathy“:• EMPATHY: I sense your pain, your sadness, your fears, but I do not take them on myself. I do

not calm your fear by becoming fearful, alleviate your illness by becoming sick, remove your worries by taking your worries on myself. I hope to relate to you in a manner that allows you to feel understood. I will listen without lecturing, offer my presence without pretense and hope you will be better because I came your way.

• Nonattachment ≠ Indifference (Tolle).• Habit 5 (Covey)--Seek to Understand Before being Understood.

(The “Pathies” above come from the Wisest Man I know, the Reverend Jack Pollard, founder of Sparks’ Chaplaincy program, long-time Chaplain and frequent speaker at UAMS)

The Business Importance of a HUMAN Connection

“Extensive surveys…show that while a facility’s attractiveness and the availability of [certain amenities] might cause people [to come in the first time], what got them to stay [so that the provider retained their business]…was driven by emotional factors…people looking for an emotional connection.” (Duhigg)

6 Suggestions For Every Physician

4. Be a Great Communicator—Be a Fearless Advocate• For Whom, from whom and to whom• Information Imbalance (Silver, Ackerloff: The Market for

Lemons)• Different Languages• It’s up to you and it takes practice• Do it because it’s the right thing to do• Do it because it is the SMART thing to do!

6 Suggestions For Every Physician

5. Don’t Let Incompetence Slide• “Doctors swear to do no harm But on the job they soon

absorb another unspoken rule: to overlook malpractice in their colleagues.” (Marty Makary, MD.)

• “We cannot do the BIG things until we can do the SMALL things perfectly.” (Gupta, MD.)

• Nothing should EVER be left undone when someone’s happiness, health, safety and life itself is under your control—there is no greater responsibility. (Gupta, MD.)

• Look at, correct and learn from your mistakes—and then MOVE ON! (Gupta, MD.)

6 Suggestions For Every Physician

5. Don’t Let Incompetence Slide (continued)• At a recent national surgeons conference, Harvard Dr. Lucian

Leaps began his keynote speech by asking the thousands of physicians in attendance to “raise your hand if you know a physician you work with who should not be practicing because they are dangerous?” Every hand went up!

• The all-important follow-up question and disturbing answer.• A recent New England Journal of Medicine concluded that “as

many as 25% of all hospital patients will experience a preventable medical error of some kind!” (Makary, MD.)

• Bad outcomes always have a reason—find and correct it or you WILL repeat it. (Gupta, MD.)

6 Suggestions For Every Physician

6. Don’t Give Up—Don’t Let the System or Anyone In It Beat You!

• Because of the profession you are in…• Because of WHO you have become.• Develop good Habits (cf. “checklists”) and encourage

them in others through the right cues, “cravings,” routines and rewards. (Duhigg)

• Sharpen the Saw. (Covey, Habit 7.)

HabitHabitHabits

Stephen Covey, 7 Habits of Highly Effective People

Don’t Give Up—Don’t Let the System or Anyone In It Beat You!

The Right Habits are KEY

6 Suggestions For Every Physician

• Find, Adapt and Never Lose or Let Anyone Take Away Your Why

• Be A Team Player• Be Empathic• Be a Great Communicator—Be a Fearless Advocate• Don’t Let Incompetence Slide• Don’t Give Up—Don’t Let the System or Anyone In It

Beat You!

AN ABBREVIATED BIBLIOGRAPHY• Movies—The Doctor; Regarding Henry; Love and Other DrugsBooks: • Man’s Search for Meaning, Viktor Frankl• Monday Mornings, Sanjay Gupta, MD.• Unaccountable: What Hospitals Won’t Tell You and How Transparency Can

Revolutionize Health Care, Marty Makary, MD.• What Got You Here Won’t get You There, Marshall Goldsmith and Mark Reiter• The Art of Being Unreasonable, Eli Broad• The 7 Habits of Highly Effective People, Stephen Covey• The Smartest Guys in the Room, Bethany McLean• A New Earth, Eckhart Tolle• The Power of Habit, Charles Duhigg• The Signal and the Noise, Nate Silver• When Things Go Wrong: Responding to Adverse Events, A Consensus Statement of

the Harvard Hospitals (March, 2006.)