Episode 058: It’s All About Attitude

Speaker 1: You are listening to Your Practice Made Perfect, support, protection and advice for practicing medical professionals brought to you by SVMIC.

Brian: Hello. Welcome to this episode of our podcast. My name is Brian Fortenberry and today we're going to be talking about taking back control of your life and your profession and maybe even some burnout issues, and we have an expert that is going to help us navigate this today. It is doctor Rebekah Bernard. Dr. Bernard, thank you for joining us.

Dr. Bernard: Thank you so much for having me.

Brian: Well, tell us a little bit about yourself before we jump into it. Tell us about your background. My understanding is you have written some books.

Dr. Bernard: Yes.

Brian: So tell us a little bit about that.

Dr. Bernard: Well, I went to medical school at the University of Miami and I did my residency in family medicine in Orlando, and after that I did a National Health Service Corps scholarship loan repayment type of program, where I went and worked for the underserved. I had to do four years and I did that and I did another two. So I did a total of six years with the underserved and it was a great experience and I learned a lot, but it was also very difficult in the sense that it did create some compassion fatigue. So I made a transition and I went to work for a different type of company, which was an employed practice, an outpatient type of hospital practice, and I did that for five years. And then I realized that a lot of the issues I had in the federally qualified health center were pretty similar in the hospital experience, basically corporate type medicine.

Dr. Bernard: And at that point I realized that I really needed to think about being my own boss. And that was when I decided to open my own practice. And then I converted that to a direct primary care practice. And part of all that, during that experience I learned so much and I was able to be one of the most productive physicians in both settings, to the point where people would ask me, how are you able to see so many patients and have such high patient satisfaction? And I thought, I don't know, what am I doing? So I started to write down the different tricks and techniques and tips that I was coming up with and I started compiling them, and it actually had so much information that it turned into a book.

Brian: That is awesome. And what was the title of the book that you wrote?

Dr. Bernard: I called the book How to Be a Rock Star Doctor. And the title came from, we would have all these patient satisfaction surveys, as all doctors are getting these days. So one of my patients had written that Dr. Bernard was a rock star and I thought, well that sounds like a great title of a book.

Brian: Absolutely.

Dr. Bernard: Yeah, that's how the title came about.

Brian: So tell us a little bit more about the concept of the book the rockstar doctor.

Dr. Bernard: You know, a long time ago when I was in my residency, I had an attending that told me that every time you're in front of a patient, you're on stage. And I really held onto that idea. I realized that we really, as physicians, we have to always give out the appearance and the effect that patients are looking for and what patients want. And it can be hard sometimes because we may have days when we're not feeling well. We may have just given somebody else bad news, and so we're not really feeling particularly chipper or upbeat. But when we walk into that next patient room, we're really on stage in front of that patient. We're kind of putting on a little bit of a performance, if you will, for them.

So the book tries to teach doctors how to get on stage and how to give that appearance of being the ideal doctor that patients are really looking for. And when you do that, number one, if you're not in a really great mood to begin with, sometimes you can actually feel better just by acting a little happier and acting a little more into the experience. And secondly, you get a lot more out of your patients that way. If you walk in with a certain type of an attitude, you actually can motivate your patients to be better with you. So getting on stage helps you as a doctor and it helps you get more out of your patients.

Brian: Often, whenever patients are coming into your practice or your office, certainly in a hospital setting, but in a primary care office setting or really any kind of doctor office setting, they're not at their best anyway. They're not having their best day either. So it really does make sense that you have to be on top of your game. Saying that, what are the rock star rules that you have employed here?

Dr. Bernard: Yeah, I came up with 10 different rock star rules and some of them are more important than others. The number one is that really you are on stage and so you want to portray those qualities that patients are looking for. One of the biggest qualities that patients are looking for is a doctor that has an affable personality. You know, sometimes you hear them say that there's the three A's of what people want, and it's availability, which is actually the number one thing people want. They want their doctor to be around when they need them. Affability, which is just somebody that's likable and somebody that they'd just like to hang around with. And the third is ability, which is interesting because that's the thing that patients are the least interested in. They sort of expect that all doctors know what they're doing, so what they're looking for really is the availability and the affability.

So you want to portray the type of doctor that's, you know, just kind of a nice person and a person that's interested in them and just kind of a person that they wouldn't mind just hanging around with.

Brian: Sure.

Dr. Bernard: So the best way to do that is really number one, just to listen to your patients. And that's something that doctors are not always very good at. In fact, I think the studies show that we interrupt our patients in about 22 seconds of them talking. And if we would just let them talk a little bit longer, they say actually six more seconds, they would actually finish what they were starting to say and they would feel as if they were heard. So in the book I call it Six Seconds to Rock Star, which is just giving people a few extra seconds to finish what they're saying and just listening to them. It makes a big difference.

Brian: That makes a tremendous difference, because coming into an office, I can only speak from personal experience, there is a certain amount of vulnerability when you enter the office because you're there and you're kind of going, hey, I've got something going on. I can't handle it myself. Whether it ... Any type of issue, from having a baby all the way to having a disease process, and just knowing that you’re heard is a big deal.

Dr. Bernard: It is. And it is scary to be a patient. I think doctors, we need to remember that and sometimes it's good for us to sit up on that exam table and to remember what it feels like to be in that position. It's a good experience. You know, we may be saying something for the hundredth time, but it's the first time that patient's ever hearing it. It's the first time that they've ever experienced a particular procedure, even though we've done it, we could do it in our sleep. So we do need to have a lot of empathy for what people are going through and sometimes it helps for us to go through an experience just so that we realize what it's like. It's scary.

Brian: It is scary. I often hear people go, oh, that's minor surgery. And the first thing I think of is, it's minor if it's not on me.

Dr. Bernard: Exactly.

Brian: If it's on me it's a major procedure.

Dr. Bernard: Yes it is.

Brian: We've kind of hit on listening to your patients and showing that empathy. Are there some more rules out there?

Dr. Bernard: Yeah. You know, when you talk about showing empathy, a lot of doctors have empathy, but they may not be that great at showing empathy to their patients. And there are some tricks that doctors can do that are pretty simple. You know, one is just simply smiling. Just by smiling at a patient, you're showing them that you're warm, you're friendly, and that you care for them.

Brian: Right.

Dr. Bernard: Another is a little bit of physical contact, just shaking hands or putting your hand on their elbow or their shoulder. And then doing what we call active listening. So you're not just listening, but you're showing that you're listening by nodding your head, by giving them those verbal cues like, "Yes, I hear you. Go on." So those kinds of things can show more empathy towards your patients. And even just sitting down while the patient is talking and not standing over them or standing with your hand on the door.

Brian: As we're talking about this, I'm thinking through in the past when I have gone to see a physician and sat down in the office and how much of a difference it puts me as the patient in a mindset, when those types of things have been done. For instance, I have been in a situation before where the nurse came in and took all of my previous history and we talked about why I was there and what I was experiencing, things like that. And then I sit and wait until the physician comes in, they come in the door and they go, "Well, hi Mr. Fortenberry, why are you here today?" And you go, well I just went through like 20 minutes of that. And you kind of think, well had they take an extra second just to look at the chart before they came in the room? It put me in a different place.

Dr. Bernard: Yeah, and that's another one of the rules, which is to use efficiency tools to make your office visit a better experience your patients and for yourself. And one of those tools that I recommend to doctors is you can have your last office note printed out from the previous visit and you can have your nurse print it out and put it on the door of the room, so that you pick it up and you just look it over before you walk in the door. Your nurse can jot notes on there so that you can just look it over.

You know the name of the person when you're walking in, you know what you saw them for last time. Maybe you've written on that note some small reminder about that patient, like a personal detail about them, like that their kid's in college or they just came back from vacation, something that gives you that personal queue. And then when you walk in the door, that also creates that bond with the patient and you don't also have to reinvent the wheel every time. So that's an an efficiency tool, but it's also something that creates a better relationship with your patient.

Brian: I totally agree with you. Because then when you as a patient feel like you're not just the next patient, but you're really a person to them, that puts the patient in a different mindset.

Dr. Bernard: It does. Of course, you know, part of the problem that we have now as physicians is the increasing use of electronic health records and increasing data checklists that we have to perform. So one of the tips, many tips, that I give in my book is how to create more efficiency tools like forms and handouts and templates that you can create to make some of those things easier on yourself. And those are ... Nowadays that we have to do so much data collection, anything you can do that you don't have to reinvent the wheel or type the same thing over and over again helps tremendously.

Brian: There seems to be in modern medicine now these incredible amount of hoops that you have to jump through.

Dr. Bernard: Yes.

Brian: So what are some of those things that you have learned and have implemented that help you with that type of efficiency?

Dr. Bernard: Well, when I used to work with a very large Medicare practice and we would have annual Medicare wellness visits or we would have screening questions that we would receive reimbursement for, I would create a form or a template that I would give to the nurse and have the nurse start to fill it out before I even came into the room. Because sometimes those were very simple to do and they didn't take a lot of time, and just by having someone else complete some of that work before I walked in the room, I will be able to capture that information. So creating simple forms for things that you do all the time is a great tool.

Brian: That makes a lot of sense. Also, I wanted to ask you about when a physician comes in the room, often you feel like, man, they're trying to get out of here quick. I understand they have things to do, but I do want to be heard. Just a physician that comes in the room and sits down and takes time to look at me and listen to me, that's different to me than a physician that comes in the room, never sits down, stands up the entire time. Do you have anything in your book about those types of issues?

Dr. Bernard: We do. And I said "we" because it made me think of my new book, it's a followup to the Rock Star Doctor book, it's called Physician Wellness, and it is the Rock Star Doctor's Guide. So it's all about how to use psychology. So the subtitle is, "Change Your Thinking, Improve Your Life." And so we talk a lot about psychology tools, and so it leads me to exactly the question that you asked, which is how do you move somebody through a visit, help them feel heard in a very short period of time? We know that doctors have maybe 7 to 10 minutes in a visit, and we also know that doctors, for every one hour they spend with patients, are spending two hours on computer work or desk work. And that's not fair to anybody, but that's the reality. So you really want to be efficient during those patient experiences.

So the key to having patients feel heard is to listen to them and to repeat back, do something that's called emotional mirroring and verification and validation. So in other words, when you have a patient that has a laundry list of complaints and problems, number one, we as physicians need to acknowledge that we cannot solve or remedy everything on that list, at least not today.

Brian: Right.

Dr. Bernard: But we can listen to what they have to say and we can acknowledge that we've heard it and let the patient know that we've heard it. And the way we do that is when they say, "Well also my head hurts and it runs down the back of my neck and then my toe tingles," you can say, "So you said your head hurts. It runs down the back of your neck and your toe tingles. Is that right?" And they say, "That's right." And then you say, "Well that must be very uncomfortable." So you just acknowledge what they said, you verified that you had it right and then you gave them some validation of their feelings.

Brian: Gotcha.

Dr. Bernard: That's all you have to do. You don't necessarily have to solve it. Then you can say, "But I can't talk about all of that today because we have some other issues that are more pressing. So I want to focus on the diabetes. That's the main issue today. And then next time we'll get more into these other situations, these other pains and symptoms that you're having." And that will usually result in a patient feeling good because they feel like at least you heard them, even if you didn't necessarily address it or solve those issues today.

Brian: You know, and communication really seems to be the issue. And you can communicate obviously with words, but like you're saying, just your demeanor and how you approach it, how you walk in the room. It's all a form of communication. And that could be important not only to the patient, but to the physician as well. You know, being a doctor today is tough. It is taxing as well. And you really as a physician have to make sure that you're taking care of yourself as well. Right?

Dr. Bernard: You really do. Doctors are increasingly burned out. The studies are showing that it's more than 50% of doctors across the board of every specialty are reporting high levels of feeling burned out. And the Physician's Foundation released a survey in 2016 and in that survey, 47% of all physicians that answered said that they were actually looking for a way out of the clinical practice of medicine and making active plans to do something different, like retirement or trying to find administrative work. So doctors are really needing help. And one way that we can do that is to look at options that we can take back control from some of these stressors that we're facing every day and get support and get help for these issues and talk about them because they're real.

Brian: What are some ways that as a physician you really can take back control?

Dr. Bernard: Well, one thing that you can do is you can try to work within the system that we have, and that can be done. But another option is to decide to completely opt out of the system and do something totally different. And that's something that I started doing two years ago. I decided to transition my practice to something called direct primary care. And we call it primary care because that's my field as a family doctor, but specialists can do this as well, and they would just call it maybe direct patient care. And what that means is that we, in these types of practices, we eliminate the third party payer, which would be the insurance company or Medicare or Medicaid any government payer, and we just contract directly with the patient, meaning the patient pays for the care either on a monthly membership or by the visit. And the doctor provides that care.

Dr. Bernard: And when you do that, what happens is you remove all these administrative and bureaucratic and regulatory aspects that have created this paradigm where doctors are spending an hour with patients and two hours on the computer. So it's a little bit of a drastic way for people to change and take back control, but it's real and it's growing. Right now there are 900 direct primary care practices across the United States and it's something that I think we're going to see continue to grow as doctors realize it's a viable option.

Brian: I think that is fantastic, because burnout is really a problem out there. Join us on next week's episode when we continue our conversation with Dr. Rebekah Bernard, regarding physician burnout and talking about her book, the Rock Star Doctor's Guide: Change Your Thinking, Improve Your Life.

Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect, with your host Brian Fortenberry. Listen to more episodes, subscribe to the podcast, and find show notes at svmic.com/podcast.

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