Establishing a positive practice starts with leadership

Miami Beach, Fla. - Making each patient visit unforgettably positive requires looking honestly at oneself and one’s practice, says an expert who spoke at the annual meeting of the American Academy of Dermatology.

Steve Shama, M.D., M.P.H., says that for each dermatologist, what makes a day of practicing medicine unforgettably positive resides “in the eye of the beholder.” When he asks fellow physicians to define this quality, however, “The responses we get are, ‘the patients are on time; staff is on time; I’m on time - not overbooked or overwhelmed. I’m making the right diagnosis and giving the right treatment.’”

Moreover, doctor, patient and staff are smiling.

“If I see someone smile when they’re telling me this, I know it’s a very important quality” they aspire to in their daily practice.

What prevents dermatologists from achieving these ideals?

“We are the biggest obstructionists in our lives and offices. We make these problems - or make them bigger,” says Dr. Shama, Brookline, Mass., who spoke at the annual meeting of the American Academy of Dermatology.

Scheduling issues

If scheduling creates problems, Dr. Shama asks, “Who’s in charge of the scheduling, and how long we talk to someone? It’s the dermatologist. You are ultimately responsible, and can simply make the decision to have a perfect day,” or as close to it as possible.

“The ‘aha’ moment comes when a physician realizes, ‘I’m responsible for almost everything in my office that I think is making my day miserable.’”

On a more tangible level, he adds, dermatologists frequently identify factors such as people, systems, managed care and insurance as chief causes of their misery. In workshops he conducts, Dr. Shama says, some dermatologists reject the idea that they’re in charge of their practices because they work for an HMO. It might suddenly dictate that instead of seeing four patients per hour, participating physicians must see six.

“And I say, ultimately you do have control. You can push the system back. You can tell the HMO, ‘I can’t do this anymore.’ Or you may start to self-destruct - your patients become very unhappy because you're so flustered. Or, you say to yourself, ‘I’m so miserable, I’m leaving.’ Sometimes I suggest that to people - leave the HMO and do something else,” or, in extreme cases, leave dermatology altogether.

For some frustrated physicians, he says, the label “Dr.” becomes a trap because they can’t envision themselves enriching the world in any other way.

“Ask your family and friends what your greatest value is. They’ll say it’s being a good friend, a good spouse, or a good parent. But many people - especially doctors - value ‘doing’ over simply ‘being.’”

However, Dr. Shama says, “It’s the ‘soft’ values that really drive us.”

Accordingly, he says, getting more fulfillment from one’s practice begins by deciding “what are you really there for - to make money, or to be happy and make the world a better place?”

Next, “Recognize that you’re the captain of the ship, and tackle the key issues that are bothering you. You can actually decide to see fewer patients - and spend more time with each one.”

Similarly, he suggests scheduling the occasional patients who take the most time not randomly, but strategically - at the end of the morning session, for example, so that running overtime impacts only your lunch hour, not the rest of your day.

“We’ve become very skilled at taking care of the average patient. But there’s no such thing as the average patient. If we schedule 20 patients for a morning, because we're so skilled at taking care of the average patient, by noon we will be finished - whether we've taken care of them well or not.”

Don’t try ploys

Ultimately, Dr. Shama says, happier physicians find it easier to put themselves in their patients’ shoes - to be truly patient-centered. In this regard, he says, “Any wait longer than 30 minutes must have an explanation, otherwise, you’re really not valuing their time.”

When wait times stretch into this territory, “One trick people use is to move patients from place to place - they’ll have an extra waiting area, a room to put them in. And the patient assumes they’re going to be seen soon. But now they’re worse off - they’re in a gown, naked, waiting in an unfamiliar place. Patients ultimately understand this ploy and often are not happy about it.”

Over time - or after the good vibes of a weekend seminar fade - sustaining a positive approach requires commitment, Dr. Shama says. This could include a “buddy system” of peer support, he adds, as well as setting manageable goals - such as addressing scheduling issues for one month.

On a broader scale, “Try a mental diet for 30 days. Commit to thinking of only positive things in your life and in your practice in particular. See the world of gratefulness rather than the broken parts. And every time you have a negative thought, start over.” Cultivating positive thoughts for 30 consecutive days will create “a habit that’s very tough to break,” Dr. Shama says.

Disclosures: Dr. Shama presents the workshop “How to Have an Unforgettably Positive Office Visit” with patient advocate Tena Brown to medical audiences around the country.