There are moments when I am a great physician for my patients. We laugh. We connect. We work together through health issues. We get to the answers.
During these moments I adroitly pivot projected worries, fears, and helplessness towards empowerment, positivity and purpose. I inspire.
There are days when I do not connect with my patients. I evoke subtle anger, and worries, and fear. I am disconnected. Sometimes I am aware of this. Often I am not.
And life goes on.
I have a sense that I can be a better physician. I want to be the best.
I live with the idea that I can learn the skills to take the most difficult patient with the most challenging disease and help them. I can improve their sense of themselves and their perspectives of the world. And I can do this in a few minutes.
I don’t think this is a pipe dream. I know exceptional individuals who foster their abilities to connect and inspire. They are the healers, the helpers and the leaders whom I look up to.
I want to be like them.
It Takes Practice
My wife is a surgeon. We met as medical school classmates.
She does advanced laparoscopy. She uses small cameras and long precision instruments to operate through small holes in the patient’s abdomen. She performs surgery while watching a video monitor. And she records her procedure.
At the end of the week, she sets aside time to think about how she performs surgery. To think about how to be better. She watches the videos.
She sees wasted moves. She sees pauses. She sees crossing of instruments. And she works to eliminate them one by one.
Each week, the prior week’s mistakes go away, and new opportunities to improve surface. And each week she is a better surgeon.
How To Improve?
My satisfaction scores arrive. Good, but not great.
I’ve been to lectures about using “key words at key times”. I smile and shake the hands of everyone. I tell patients that “we are going to take excellent care of you”. Yet my scores show that this may not always be the case.
There is something about what I am doing. Something about what I am not doing.
I think of my wife watching her surgical videos. Where are my wasted moves? Where am I crossing my instruments?
I don’t know.
I’m talking to one of my clients. She is a physician leader at a large academic medical center. I am her executive coach.
She believes that few individuals can sustain their best performance on their own. She has come to coaching because she wants to be better.
Each week we talk about her challenges. She enters the session wondering about her approach to a contract, or thinking about how to manage a particularly difficult colleague, or trying to figure out what to do in her career. As we finish each call, she has processed her possibilities. She has developed her future actions.
Coaching provides her an outside set of eyes. Someone who can help her see through her blind spots. Someone who can help her edit her actions, her thoughts and her responses to create a more powerful narrative to what she does, to who she is.
She could talk to friends, or co-workers, or her family, but they have connected and emotional agendas. They respond as friends, or co-workers, or family. The coach has none of these agendas. Her agenda is the coach’s agenda. Her thoughts, her relationships, her career are all safe in this setting to explore and to improve.
And she does.
Coaching the Coach
“You need to interrupt him.” My coach tells me as we listen to a recording of a coaching session I had with one of my clients. The irony is that as an emergency physician, my interrupting skills are definitely one of my more honed skills.
I’d been having difficulty getting this physician client to transition out of talk of a recurrent problem. So the next session it comes up again, I quickly interrupt.
“Yes, yes.” and I repeated back his problem talk. “And what do you want to do now?”
There was a long pause. And then this physician formulated the future. The problem now in the past.
And I had learned, through coaching, how to be a better coach.
Atul Gawande, a surgeon and journalist, wrote an excellent article about coaching in medicine. He points out that professional athletes, opera singers, and Fortune 500 CEOs at the top of their game have coaches. They believe that you never get good enough. There is no graduation. You are always a student. You can always use guidance to help you reach new goals.
The practice of medicine is a lifelong learning process. A lifelong of learning about the way we think and do. We are not born from residency with the innate knowledge to accomplish all of our possibilities. We are born into a field of opportunities with tools for professional and personal growth.
We are being measured. We are challenged to measure ourselves and our self. To strive to improve our abilities to connect and positively impact patients. To practice to be better leaders in healthcare and in society. To be better at the technical details of our art.
The opportunities for the coaching model in medicine are vast. They are available at the bedside, on the phone, over the network, in groups, through simulation, from recordings, etc. They will be powerful.
It’s time we fully embrace the coaching model in medicine. It will make us better physicians.
Things You Can Do Now:
Read Atul Gawande’s article about coaching a surgeon or watch his presentation at The New Yorker Festival. He talks of his experience of being mentored and coached. He explores the use of coaching in other fields.
Attend the Institute of Coaching’s Coaching in Leadership and Healthcare conference at Harvard on October 21 and 22. I am a founding member and find their evidence-based approach to coaching science to be refreshing.
I have a graduate certificate in executive coaching. I am very interested in hearing your ideas about coaching in medicine or talk to you about how to train to be a coach. You can read about my physician coaching practice.