THE DIRECTOR'S TAKE

  • 12/31/2018 11:32 AM | Anonymous


    I have often been identified by people as being a physician, to which I generally respond saying, "Well, I'm not a physician, but I've played one on TV." At that point, I can tell if they grew up watching Marcus Welby MD or not. Regardless, I am like many physicians who are often prone to jumping very quickly into diagnostician mode whenever they see a problem: mentally you run through symptoms and observations, identifying potential solutions and make your assessment. Then you define a treatment that has the best chance at success. Take two and call me in the morning, right?

    But, in recent years many physicians are learning how to more fully involve their patients in decision making and finding it is a more powerful form of practicing medicine. This is especially true when a patient needs to make lifestyle changes that will enhance their health. Setting aside your differential diagnostician and voice of authority and eliciting their personal motivations and goals can be a challenge for many physicians (and certainly isn't appropriate for every situation.)

    So you might understand ACMS' challenge in facilitating a collaborative process that has many stakeholders and interested parties affected. Right now, I am just getting started on building a "Capital Coalition for Physician Well-being." We are at a place in our medical community where the collaborative intent around shaping a better healthcare culture is very high.

    But this isn't just as easy as saying, "What's the problem? What are potential solutions? Let's get to work." Collaborative problem solving is much more complicated, needing a high degree of trust and patience as each party shares their perspectives, negotiates towards agreed upon solutions, and then gets to work, each on their own and in parallel with the others.

    In our situation, this is further complicated by the fact that ACMS has no control over what participating physician groups or health systems may choose to accept or reject as potential solutions. I am not the fallback CEO who says "you all will do this if we can't agree to a plan of action." It is either completely collaborative, or nothing moves forward.

    I do have high hopes, however, mostly because of what I've seen emerge out of partnerships over the past 3 years as well as who I've seen emerge. Physician leaders from many different levels of health systems, educational institutions and solo practices are ready to roll up their sleeves and say, "Not just for my workplace, but for the good of all the doctors in town we're ready to get to work, together!"

    With that, we start 2019 with great anticipation of what is possible, not because it is easy, but because of the hearts of those who care for their colleagues in this noble profession.

  • 11/30/2018 10:56 AM | Anonymous


    I know some doctors who have never learned to establish good boundaries in their lives. By that I mean, they really don't know how to say "no." This is not entirely their fault: the medical education process teaches not only the applied practice of medicine but also the fortitude to be able to go beyond what is comfortable. And that involves a lot of boundary violations.

    So, it is no surprise that after residency, many physicians never really learn how to take back control of their life and save some white space for themselves. It can be a mental, and even spiritual, exercise to work through the difference of "the patient always comes first" and the need for your own rest, rejuvenation, and personal life away from medicine.

    Here are a few thoughts on creating some healthy borders in your life for your own longevity's sake:

    1. Give yourself permission to set boundaries. The practice of medicine will consume every inch of ground in your life that you don't reserve for other purposes.  It does not help that your education and enculturation will tell you that is normal. But it is your right to decide how much you’re going to give. You must choose when you are going to be generous, otherwise, it is too easy to feel resentful for giving more than you wanted to.

    2. Know your values. It is crucial for you to know in your life what is inviolable except under the most extreme circumstances. Is it your running therapy? Weekend worship? Family vacations? Personal space? Only you can say what you need to protect and what you can afford to be squishy on.

    3. Create structure.  Sloppy boundaries invite incursion. I remember a time when my wife was pregnant before we had a fence built and the neighbor boy would practice his ball bouncing skills against the outside wall of our bedroom. Not only did we tell him not to do this, eventually we built a fence. Structure in your work and family life helps reinforce boundaries you have established.

    4. Communicate your limits clearly and proactively. The Great Wall of China was a pretty effective sign saying, "thus far and no more." Same thing with razor-topped fences around U.S. military facilities. If you have not yet communicated to others what your boundaries are, then you cannot assume they are going to respect them.

    5. Prepare for violations. You can bet that every civilized nation has a plan for what happens if their neighbor crosses into their territory, be it land, air or sea space. People will push your limits, intentionally or otherwise, and you need to become adept as a physician at how you will respond. It does not have to be harsh, rude, or violent – it just needs to be clear and firm.

    6. Pay attention to your feelings. Guilt, resentment, anger, lashing out at others: these are all red flags that something has been violated, sometimes unspoken or unarticulated even to yourself. What kind of warning signs tell you when somebody has crossed a perimeter that you have established?

    7. Bring up boundary violations quickly. It is not effective to tell somebody that they violated your boundary six months ago. A perfectly acceptable response in the moment –  and an example of training others what your limits are – might sound like, "No, I am sorry.  I will not call in that prescription because I am not the doctor on call. Please call Dr. Jones instead." The problem with saying, "just this once" is that it never seems to end that way.

    8. Practice saying "no." It is so difficult for most of us to feel like we are letting others down and there are certainly times in your calling when you will have to say "yes" even though you don't want to. That is fine and none of us get this perfect. This is more reason why you must practice saying "no" to things you really can deny.

    ​When doctors unlearn some of the "brainwashing" they underwent early on, it helps create a more sustainable life of service to others.


  • 10/31/2018 3:10 PM | Anonymous


    St. Luke's Treasure Valley VP Medical Affairs Dr. Frank Johnson and Saint Alphonsus Physician Resilience Medical Director Dr. Sheila Giffen, during a joint Peer-to-Peer training session.

    by Steven Reames

    Let's look at some of our local health institutions' mission and purpose statements starting with the shortest:

    • Saltzer Medical Group: "To serve our patients in a manner worthy of their trust."
    • St. Luke's Health System: "To improve the health of people in the communities we serve."
    • Primary Health Medical Group: "Committed to providing our patients with the highest quality care that is both convenient and comprehensive.
    • Saint Alphonsus Health System: "We serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities."
    • Family Medicine Health Center: "Train outstanding broad-spectrum family medicine physicians to work in underserved and rural areas.  Serve the vulnerable populations in Idaho with high quality, affordable care provided in a collaborative work environment."
    • Idaho Physical Medicine and Rehabilitation: "To improve the lives of the functionally impaired. IPMR strives to provide a working environment that enhances the potential of its employees by encouraging mutual respect, job satisfaction, professional development and positive interpersonal relationships."
     
    Some of these are short and directly to the point; others make an effort not just to talk about their purpose, but also some of the values and modus operandi important to them.
     
    I also reflect on our own mission statement from time to time, which frankly looks like 75% of other general medical societies who modeled there's after the AMA's:
    "The purposes of this Society are to promote the science and art of medicine, the protection of the public health, the betterment of the medical profession and to unite with similar organizations in other counties of the State of Idaho to form the Idaho Medical Association."
     
    What is different about it than most healthcare organizations is the last phrase about "uniting with similar organizations" as a goal, not just a mode of operation. While it may be unique to being a "component society" of the state medical association, I also think there's an attitude of collaboration there that truly defines how we think here in the Treasure Valley.
     
    To truly fulfill our missions, we must join with other like-minded people and organizations.
     
    In fact, I wonder how it would change our healthcare institutions if they all added "with the greater medical community" to their mission statements and acted on it.
     
    This fall, Mayo Clinic's Colin West, MD, MPH, a leading researcher on physician burnout, spoke in Boise at two separate back-to-back events. In the first, he very subtly threw down the gauntlet to physicians and administrators saying:
     
    "I really believe that there's a gap that can be filled by those first adopter groups that actually reveal a competitive advantage when they successfully attack these issues (around physician burnout) … Nobody in the country is thinking about it that way systematically. So, there's a gap there and if somebody jumps into that breach, they're going to reap the benefit of that."*
     
    Two days later, he led a workshop on actionable next steps physicians can take towards enhancing their workplaces. One of our hospital system execs stood up and threw down his own gauntlet saying, "I think we need to stake a claim that Idaho is NOT going to be the 50th state in provider wellness." (He was referring to Medscape's 2018 report that ranks Idaho #1 in physician burnout.)
     
    These conversations raise the possibility from trying to address clinician distress at the micro level and aiming instead at the macro factors that drive it, and not just at the employer's level. To this end, ACMS is now gearing up to charter a coalition that would focus efforts across the medical community on tackling the largest contributors to burnout. We believe that by shooting at the same target together, we have a better chance at reshaping our community's medical culture in a way that supports the vitality of our caregivers for generations to come.
     
    Stay tuned.
  • 09/28/2018 3:25 PM | Steven Reames


    Not that long ago, one of the most creative entrepreneurs I know asked me, "What is a win for Ada County Medical Society?"

    It was an outcome driven question that challenges lifetime non-profit leaders like me. We tend to be all squishy on data-driven metrics and balk at having to prove our value to our constituents. Sitting around a campfire and singing "kumbaya" actually isn't a bad idea to us.

    However, as I reflect on what we truly aim to accomplish and the type of leaders we tend to attract to the board, there is something to be said about campfires. Our value statement is "We Connect the Docs of Ada and Elmore Counties." While we do have a longer formal mission statement (that looks just about like every other county medical society's), relationships are at the heart of our activities and efforts.

    This board has prioritized the building of collegial relationships in our programming and making lots of time for doctors to get to know each other. In fact, at our annual meeting in October, we will be recognizing one of our local heroes as the ACMS Physician of the Year, due in part to his gregarious nature of tending to other physicians and helping lead ACMS in this direction during his board tenure this decade. If you've been to any of our events, Dr. Kyle Palmer, a newly retired orthopedist, has undoubtedly shook your hand and made you feel welcome. 

    While many associations keep scoreboards for membership totals, peer reviewed publication readers, legislative victories or even the more ethereal "member engagement," I personally am most gratified by when I see doctors connecting.

    • It's a win every time ACMS gets to introduce doctors to each other who might provide value in terms of referral patterns, expertise, or mentoring.
    • It's a win cutting a check to our contract counselors for sessions through the Physician Vitality Program.
    • It's a win for doctors to push aside their laptop and look into their patients’ eyes, even when they know it means pajama time documentation.
    • It’s a win for doctors to connect their hearts with their hands through a medical volunteer opportunity they took advantage of.
    • It’s a win after hearing a physician tell me they cut their medical school debt in half because of financial services we referred them to.
    • It’s a win watching a doctor put a hand on another’s shoulder at an event and ask how they’re doing… “No, this is a mental heath check. Really, how are you doing?”


    If you are feeling disconnected, I encourage you to take advantage of the three upcoming events ACMS will have this fall: Legislative Night Update, the Annual Meeting/BBQ Dinner, and Winter Garden Aglow. And if big events aren't your thing, give me a call and we’ll go have breakfast, lunch or coffee together instead.


    Graphic by Freepik

Steven Reames has been the executive director of Ada County Medical Society since 2014. He has served in a variety of non-profit leadership roles in Boise since 2000.

Director: Steven Reames, director@adamedicalsociety.org  (208) 336-2930
Membership Assistant: Jennifer Hawkins, jennifer@idmed.org (208) 344-7888
305 W Jefferson Street Ste 101, Boise ID 83702  FAX (208) 336-3294

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