Our ROCC star doctors pass the people skills test…

There is a great article in the NY Times about a new screening procedure many medical schools are using to find the best candidates for med school:  screen them on their people skills, not just their test scores.  I think this is a great idea, as we have come in contact with many physicians who were smart, but not very sociable.

If you read about the four physicians (and their staff) in our first book, you will notice that these folks don’t have this problem:  all of them made our list of trustworthy physicians because they have the ability to listen first and consider the whole person.

This is where compassion becomes important in building trust.  It is important to be a competent, reliable and honest physician, but if you don’t have compassion for those you are helping (as evidenced by your ability to listen) or the ability to be a team player with the staff and other physicians who are involved, then you don’t really achieve the level of trust with your patients that you would if you spent time cultivating compassion for those you serve.

It is a little thing that makes a big difference.

What do you think?


A Magician Leads Pediatrics at Virginia Commonwealth University

Here’s a great write-up about Dr. Bruce Rubin, our wonderful friend, our favorite pediatrician in the world, and on the world’s experts on cystic fibrosis.  I’ve been one of his oldest “pediatric” patients for many years, and I trust him completely.  For the full introduction by VCU’s Medical School Dean, please go here.

No doubt about it. One of the first things to catch your attention when you look over Bruce Rubin’s CV is his affinity for all things magical. Not only does he work it into his patient exams, he teaches it to students, to residents and even to practicing pediatricians at CME conferences around the world.

He maintains that physicians are natural magicians, with our special costumes, magical potions and incantations. We’ve even got X-ray vision, to his way of thinking.

But Dr. Rubin’s magician’s props are tongue depressors and ear specula, with the occasional rubber band or sponge ball thrown in. And his goal is communication. “It gets the kids interested, listening and engaged. And it makes me more human and less intimidating,” he says.

Dr. Rubin works his magic
Dr. Bruce Rubin, the new department chair for pediatrics, works with an impromptu magician’s assistant on a recent afternoon at the Children’s Medical Center.

Or maybe the first thing to catch your attention was his amazing record of professional accomplishment.

He says that he’s known as the mucus guy. But I say he’s known for developing effective and appropriate aerosol therapy for children with lung diseases. And for advocating the antibiotic drug azithromycin for cystic fibrosis.

He’s also known for setting the traditional understanding of CF on its head by discovering that, contrary to conventional wisdom, it’s not that there’s too much mucus in the CF airway. Instead CF patients’ lungs fill up with pus. And that, of course, leads to a very different treatment approach.

He is indeed a darn good magician, too, to which my kids and I can attest.  To learn more about this great physician and human being in our book, Trust is Everything, please go here.

Can you have a conversation with your doctor?

A recent NY Times article describes the habits of highly respected physicians, which include that they:

• Ask permission to enter the room; wait for an answer.

• Introduce yourself; show your ID badge.

• Shake hands.

• Sit down. Smile if appropriate.

• Explain your role on the health care team.

• Ask how the patient feels about being in the hospital.

One patient in the article mentioned that she liked her doctor because she could actually have a conversation with him–as if this is something miraculous!   It reminded me of the doctors in our book—I think that they are trustworthy primarily because we have always been able to have conversations with them.

I remember my first visit with Alan Finkel, MD.  I think I was in his office for over two hours.  I thought this was amazing because he actually asked me questions–about migraines, yes, but also about my life–he wanted to know me and to see how migraines fit into my life.  And, he listened.  He was not there just to give me a pill and send me on my way.   The time he spent with me convinced me that he was both competent and compassionate.  As a result, I refer people with migraines to him all the time.  I know he is good at his job because he has helped me and because there is always a long wait until I get to see him again.


Use Checklists to Increase Your Reliability

A great article in a recent issue of The New Yorker, brought to my attention by good friend Dr. Kevin Lobdell, points out the critical importance of checklists in achieving reliability in highly complex task environments:

In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. He didn’t attempt to make the checklist cover everything; he designed it to tackle just one problem, the one that nearly killed Anthony DeFilippo: line infections. On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check. These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.

The next month, he and his team persuaded the hospital administration to authorize nurses to stop doctors if they saw them skipping a step on the checklist; nurses were also to ask them each day whether any lines ought to be removed, so as not to leave them in longer than necessary. This was revolutionary. Nurses have always had their ways of nudging a doctor into doing the right thing, ranging from the gentle reminder (“Um, did you forget to put on your mask, doctor?”) to more forceful methods (I’ve had a nurse bodycheck me when she thought I hadn’t put enough drapes on a patient). But many nurses aren’t sure whether this is their place, or whether a given step is worth a confrontation. (Does it really matter whether a patient’s legs are draped for a line going into the chest?) The new rule made it clear: if doctors didn’t follow every step on the checklist, the nurses would have backup from the administration to intervene.

Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.

Pronovost recruited some more colleagues, and they made some more checklists. One aimed to insure that nurses observe patients for pain at least once every four hours and provide timely pain medication. This reduced the likelihood of a patient’s experiencing untreated pain from forty-one per cent to three per cent. They tested a checklist for patients on mechanical ventilation, making sure that, for instance, the head of each patient’s bed was propped up at least thirty degrees so that oral secretions couldn’t go into the windpipe, and antacid medication was given to prevent stomach ulcers. The proportion of patients who didn’t receive the recommended care dropped from seventy per cent to four per cent; the occurrence of pneumonias fell by a quarter; and twenty-one fewer patients died than in the previous year. The researchers found that simply having the doctors and nurses in the I.C.U. make their own checklists for what they thought should be done each day improved the consistency of care to the point that, within a few weeks, the average length of patient stay in intensive care dropped by half.

The checklists provided two main benefits, Pronovost observed. First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. (When you’re worrying about what treatment to give a woman who won’t stop seizing, it’s hard to remember to make sure that the head of her bed is in the right position.) A second effect was to make explicit the minimum, expected steps in complex processes. Pronovost was surprised to discover how often even experienced personnel failed to grasp the importance of certain precautions. In a survey of I.C.U. staff taken before introducing the ventilator checklists, he found that half hadn’t realized that there was evidence strongly supporting giving ventilated patients antacid medication. Checklists established a higher standard of baseline performance.

Dr. Lobdell will be discussing his similarly successful efforts to improve reliability and patient outcomes in his critical care units next month in an executive education program at the University of Michigan. Based on what he showed me and my Wake Forest Charlotte MBA students last summer, I look forward to learning about his latest results.

My wife Karen who is assistant professor of marketing at Meredith College, and Melanie Bergeron, CEO of Two Men and a Truck, International, are both huge fans of checklists. They are two of the most Reliable people I know on this planet, and constant reminders for me to improve my own “checklisting.”