Happy, Healthy Docs

Disruptive Behavior - Owning Your Anger

 

"Disruptive Behavior" is the 2009 buzz word by The Joint Commission with their new Leadership Standard LD.03.01.01 mandating hospitals to address this issue head on.  A major hallmark of a disruptive individual is an angry outburst, often at the most inopportune times - in front of colleagues, patients, and their family members.  The "classic" profile of disruptive physicians are male surgeons who yell in the operating room, but they are by no means the only doctors who may engage in this behavior.  In fact nurses and other health professionals also project their anger outwardly.  Often such individuals have difficulty taking responsibility for their behavior.  Instead they blame their anger on others, such as laboratory personnel who produce late test results.  While it's true that poorly functioning departments or hospital systems can be very frustrating, screaming at those who work in them is not the answer. 

If you are quick to respond with anger in frustrating situations, especially if it happens more than you - or others - would like, the problem may also lie within you.  When I first saw the above cartoon, I  thought Lucy's response to "Why are you always yelling at me?" might be, "Because you're an idiot!"  To my surprise, she took responsibility for her yelling.  That is the start of the healing process for those who can't control their anger.  Chronically angry people may blame others for everything and see themselves as right.  They can't see how their outbursts exacerbate their problems.  They don't do this on purpose.  They really believe they're not at fault. 

This topic can take up many blog posts.  As a first step, ask yourself:  "How well do I handle my anger?  Does it handle me?  Do I feel powerless to control it?  Does it get in my way at work?  Is it affecting my relationships?"  If you answer yes, consider that you could possibly use some help.  The first step is owning the fact that this area of your life isn't working and is causing you pain.  Give it some thought, and stay tuned for more on this.  

Stress Management: Relax and Trust You'll Get What You Need

I'd like to share a stressful personal experience that ended up better than I could have imagined - a common life occurrence.  A not often discussed Stress Management tool when difficulties arise, is to fully feel your emotions, then let go of control and trust things to work out.  Be open to all possibilities, and know you'll get what you need.  As a friend said about my "cashew butter" story, we're not forgotten in any moment. 

 

So - I went to Trader Joe's to find out they no longer sell Cashew Butter (it was the cheapest place to buy it).  This is one of my favorite foods.  I was INFURIATED, and completely blown away.  I couldn't get over this, for hours!  What a loss!  (This was big, as I have food allergies and a limited diet to begin with.)  

 

In the aisle at that moment, I heard a voice ask, "Do you have a food processor?"  I turned around to see a man who looks like my superintendent's double.  I said, "Yes, why?"  He said, "I make my own cashew butter.  Just put in a little oil and it comes out fine."  I said, "Do you use roasted or raw nuts?"  He said, "Roasted."  So I went up the aisle and bought 2 1-lb. bags of roasted cashew pieces.

 

I got home and whipped out my food processor.  I threw in a bag of the cashews, processed, and Voila!!  Cashew butter!!  That tastes good!  And I didn't even have to add the oil.  I was amazed!  And the one bag, at $3.99, filled an old 1-lb. cashew butter jar that would have cost me $4.49 (at Trader Joe's vs. at least $7 in any other store).  So now I was no longer infuriated.  I felt grateful, happy, proud of my new talent, and thrilled that man (who is not actually my super's brother) was standing there at that exact moment in Trader Joe's.  

 

This was no coincidence.  The universe conspired to create these exact circumstances - no one could have planned it better.  So I went from fury, to shock, to curiosity, to determination and to gratitude and relaxation in a few hours, and went to sleep knowing I had been well taken care of.  And if you look in your own life, you'll find similar circumstances.  There really is a silver lining in every cloud.  You just have to trust it will reveal itself.  So if you have such stories, or good recipes for nut butters, please share them in a comment below! 

Learn to Reverse Negative Behaviors in a NO-COST STRESS MANAGEMENT Phone Seminar 2/17/09

 Are you stressed out because you have not very useful behaviors you'd like to change but can't?  Do you get easily angered and yell?  Are you disorganized?  Do you procrastinate, overeat, smoke, etc.?  Everyone has something.  So why don't we change?  One reason is we believe we can't.  You might find yourself thinking, "It's too hard, too much work, takes too much time, I'm not capable of changing that, I don't know how, I've tried and it didn't work, etc."  Most of us unconsciously think these thoughts all the time.  What we don't realize is that they drive our behaviors and keep us stuck in the negative ones.

A trick to changing behaviors is to bring to conscious awareness the UNDERLYING BELIEFS we have about not being able to change them, and to replace them with beliefs that work.  To help you see this in action, I'm offering a FREE TELEPHONE SEMINAR tonight from 8-8:45 pm EST.  I'll do a GUIDED RELAXATION EXERCISE to help you work on your particular problem.  You call in from the comfort of your home or office.  CLICK HERE TO REGISTER.  This session will also provide a sample of what we'll do in the Meditation and Relaxation Training Phone Seminars (DESCRIPTION) on 2/19, 2/26 and 3/5/09 from 7-8am or 8-9 pm.  Read more about that in the post below, which also tells you how to enroll in the 3 session series. 

Stress Management for Valentine's Day - A Gift of Relaxation

In these scary economic times, it's easy to blow up at those we love.  Fear and feeling out of control can be all-consuming, and can wreak havoc in our relationships.

While you can't control the economy, you can control your reactions to it - with meditation and deep breathing exercises.  These improve communication.  You start conversations from a calmer place, more aware of your feelings.  I was touched by a quote in the "Mutts" comic in today's Newsday by Heather Cortez:  "To the world you may be one person, but to one person you may be the world."  Stress - about money, work or anything else - can erode any relationship, personal or professional.

  To help, consider giving the gift of relaxation - to yourself, for Valentine's Day, a birthday.  I'm offering a 3-week Meditation and Relaxation Training Telephone Seminar Series (description) on 2/19, 2/26 and 3/5/09 at 2 times:  7-8 am or 8-9 pm.  You attend from the comfort of your home or office, and the ongoing weekly support will motivate you to practice.  To enroll, click on "Register" and "pay" in this sentence, or by clicking on the 2 links under "Meditation Classes" under my photo (left).   

Meditation and deep relaxation soothe the soul, and provide a sense that all will be OK, at least for now.  Done regularly, that reassurance - especially nowadays - can feel like a million bucks.  Ask me, I know.  

Meditation Phone Conference Seminars

In an attempt to join the technologically savvy, I've designed a new seminar series on my favorite topic, "Meditation and Relaxation Techniques" that will be offered as a phone conference series.  You call in, and I'll teach you simple meditation and the deep-breathing based techniques of abdominal breathing and visualization by phone.  It takes ongoing practice to learn these.  As a start, I'll offer 2 series of 3 1-hour classes, one from 7-8 am, and one from 8-9 pm, on Thursdays, February 19, 26, and March 5, 2009.  Read the details here: Download Meditation Classes Flyer.

My experience teaching these techniques is that some prefer to learn them in the privacy of their own homes, offices or other location, without having others next to them peering at them with their eyes open.  If that describes you, these are ideal.  They're also ideal if you want to do this at convenient times, want ongoing instruction, and to be able to fall asleep after doing this (not during it, of course).   

Please join me in this new venture which could open many possibilities for you.  Enrollment takes 2 steps:  payment and registration.  You can do that on this blog.  Simply look UNDER MY PHOTO for "MEDITATION SEMINARS."  Under that, please click on "PAYPAL BUTTON" and "REGISTRATION FORM."  After you pay and register, you'll get confirmation and dial-in instruction emails from me.  I look forward to helping you really learn how to relax!

New Tough NY Physician Discipline Laws

  On 11/3/08, new legislation became effective in New York making the disciplinary system more strict for physicians reported to the Office of Professional Medical Conduct (OPMC) for misconduct, and makes such information more accessible to consumers. 

These law changes make it even more imperative for clinicians with addictive and psychological problems to seek immediate treatment to regain their health and avoid discipline.  A report to OPMC can result in quick publicizing of charges, and possible losses of license, job, career, income, self-esteem, and thousands in legal fees.  Colleagues in leadership positions should ensure such individuals get help ASAP.  Such individuals can also self-refer or be referred to the Committee for Physician Health at 1-800-338-1833 or 518-436-4723. 

A synopsis of the law changes include:

1.  OPMC now makes charges against a physician public much sooner: after they are served vs. after an order is issued, and before appeals.  

2.  OPMC can more easily obtain a physician's personal medical records if they believe s/he may be impaired by addictive and psychiatric disorders.    

3.  Physicians must update their profiles every 6 months, a condition for license re-registration.  

Other law changes involve mandating clinical competency exams, reviewing malpractice histories to see if doctors should be investigated, and more.  Courts must also notify OPMC of physician misdemeanor and felony convictions, such as DWI's.

Go to www.abramslaw.com for an article fully describing the new law, "The Office of Professional Medical Conduct:  How Changes In Public Health Law Section 230 May Affect You" by Lawrence F. Kobak, DPM, JD and Michael S. Kelton, Esq.  

   

Stress and Humor

Dear Reader,

May this cartoon bring you a few laughs, and may your self-consciousness disappear.  I wish you a HAPPY NEW YEAR filled with peace, prosperity, self-confidence, and lots of humor.  Stay tuned!

Susan Eisner

Perfectionism and Medical Errors: What's the Connection?

  After my last post on “Perfectionism:  An Unacknowledged Source of Stress” (below), I was asked to conduct Grand Rounds on this topic.  (Having only been a blog post, the stress of creating a perfect seminar on perfectionism was great.)  At its end, a participant told me it was a great talk, as it was a topic never discussed anywhere in medicine – an arena in which everyone is expected to be perfect.  This expectation attracts perfectionists into medicine, which in turn creates perfectionistic medical leaders who train new doctors to be perfect.  
    The low self-esteem (and fear of making errors) that underlies perfectionism can ironically be transformed into arrogance – the flip side of the same coin – when compounded by the rigors of medical training and sometimes accompanying demanding, highly critical clinical trainers.  Initially fearful residents who drive themselves very hard into becoming highly skilled practitioners, may eventually find themselves saying, “Me?  Make a mistake?  I DON’T MAKE MISTAKES!  I’M PERFECT!”  This creates a closing off to constructive criticism and feedback from others.
    My seminar discussion went onto that track.  An attending shared he had mistakenly mixed up medication orders for two patients.  A resident realized it, and kindly said:  “Dr. Smith (name changed), in looking at these two patient records I think there may be a mistake in your medication orders you might want to look at.”  Dr. Smith was very grateful to this resident.  She averted a possible disaster.  He was humbled by this and saw that despite his high skill level he was still capable of making medical errors.  He was aware of his humanism and imperfection.  
    He further shared stories of famous doctors, experts in their fields, who write the teaching manuals, create the training videos – and who still make mistakes and get sued for malpractice.  He said, “Wouldn’t it be great, if when a nurse says to such a doctor, ‘Doctor, please take a second look at the paperwork, as I believe you may be about to remove the wrong organ,’ that physician could respond with, ‘Thank God you noticed!’ vs. ‘Don’t question my authority!’?”   
    Dr. Smith's point was that BECAUSE no one is perfect, it’s vital for medical team members to stay humble and open to receiving constructive feedback from each other no matter what their status – AND to feel safe in giving it.  My point is the cure for perfectionism is to work on raising your self-esteem.   These two things work together.  True self-respect – vs. arrogance – creates a comfort level with one’s own imperfections and an openness to admit mistakes.  It also creates respect for others – a vital need for a functioning medical team that ultimately results in fewer errors and optimizes patient care.

Perfectionism: An Unacknowledged Source of Stress

   As a very smart child, I typically got 100%'s on school tests.  With the occasional 98% came my mother's (may she rest in peace) inevitable question:  "What happened to the other 2 points?"  Excellence, I was taught, would not do - it had to be perfect.  As an adult, a woman I know once suggested I strive for 75% accomplishment in my life's tasks.  I looked at her as if she had five heads.  75%?  At least 90% was necessary.  A third wise woman later told me perfectionism is an illusion - it does not exist.  I wanted to throttle her.  After a lifetime of striving for perfection, and all the stress, time and energy this entailed, I was angry at and disappointed by the thought that it was an impossibility to achieve.

If you had a similar upbringing, perhaps you know of this drive to be perfect.  What you may not realize is that what may underlie it is low self-esteem.  Perfectionism is an unconscious attempt to overcompensate for feeling bad about yourself.  It's a way to get external validation from the world.  If you look good, sound eloquent, achieve, save others, etc., you MUST be valuable.  If not you're not, and you've somehow failed.  We create high standards for ourselves and thereby in others.  This causes stress within us and in those close to us.  It strains our relationships.  No one can live up to such standards.  And when we focus on what's wrong vs. on what's right in us, it only makes us feel worse about ourselves.

The other day I had an epiphany.  Looking around my apartment, I wondered what life would be like if I no longer existed.  My home and the things in it suddenly seemed empty.  My existence had made them what they were.  In that moment I had a deep knowing that I mattered.  I was completely unique and left my own imprint on the universe.  I had value - intrinsic value, not based on grades or what I achieved.  My stress level suddenly decreased.  The pressure was off.  I was perfectly acceptable AS I WAS.  I was ecstatic!  What a relief!!

Meditation: Quieting a Chaotic Mind

The mind can be chaotic.  Most people can't shut it off.  Some, including me, are "mind" types:  bright people who think - a lot.  My mind goes incessantly.  Some mind types obsess and ruminate constantly about the same thoughts.  I find this maddening.  The only thing that helps me is meditation.  Sitting quietly.  Focusing on my breath going in and out, allowing my thoughts to fall away.  Some think meditation should clear the mind of thoughts.  Not true.  It's a way to be present without getting lost in, or controlled by, your thoughts.

Obsessive thinking and worry can be a way to calm anxieties, to avoid difficult feelings.  Overly thinking a problem to solve it creates a sense of having control over it.  While problem resolution requires thinking, when it becomes obsessive it becomes a problem in itself.  This is especially true for controlling people.  They have difficulty feeling powerless.  Overly thinking something  submerges the powerlessness and gives a false sense of safety.  But worry never solves problems.  It only creates more anxiety.  Hence, the need for meditation.  It breaks this cycle and gives the mind a break.  And it creates real safety, because the stillness that occurs within reminds you that everything is going to be OK.

For some, though, stillness is scary.  Why?  Inner quiet allows emotions to surface.  With difficult emotions comes the urge to squash them by getting busy.  Of course drugs and alcohol create the same effect.  For some people, "busyness" is their addiction.  In fact they say, "Meditation isn't for me.  I can't sit still."  In truth, they're avoiding the anger, sadness, fear, disappointment, etc., that surfaces when they sit still.  This isn't conscious.  But it's useful to become aware of.  So meditating means learning to be OK with your emotions no matter what they are.  It's in this acceptance that calmness truly occurs.

I've had a tough week with lots of major decisions to make.  So I've been meditating a lot.  Before breakfast on my terrace, and in moments when decisions need to be made.  It calms me, and allows me to feel my feelings.  This then tells me what to decide.  Magic.  If any of this describes you, try meditating.  Just sit quietly, breathe in to the word "one," and out to the word "two."  Over and over.  If a thought pops up, acknowledge it in your mind, and then bring your focus back to the counting.  It's very simple.  And it's a great step toward cultivating stillness within your chaos. 

The Minimization of Drunk Driving and DWI

With July 4th and the holiday increase in drunk driving, I've been thinking about a comment an instructor of mine made years ago when I was in training to become a Credentialed Alcoholism and Substance Abuse Counselor.  He said, "People convicted of 1 or 2 DWI's/DUI's in reality probably have hundreds of "DWI's" for which they were never pulled over."  The enormity of that statement struck me.  In other words many people routinely drink and drive but only rarely get caught.  Such people, and society in general, greatly minimize the significance of this.  They see this behavior as being a "problem," or see themselves as "having a drinking problem," only if they get caught and convicted, regardless of how often in reality they drink and drive.    

An editorial by Michelle Chen in the July 1, 2008 issue of Newsday, a Long Island, NY newspaper, further reminded me of whether people look at their own drinking and driving behavior.  In Nassau County, NY, the County Executive recently put on its website a "Wall of Shame," a frequently visited site of photos of people charged with driving while intoxicated.  While questioning whether shame and mass humiliation work, Ms. Chen makes an interesting point:  "When shame devolves into spectacle, we enter a moral theater where the audience's reaction, not the nature of the offense, is the key player.  The Wall's awkward faces probably elicit more snarky chuckles than grave reflections on the dangers of reckless driving.  It's validating to know you're not "them."  And there's the titillation of knowing that your own transgressions remain secret because of your smarts or good fortune." 

Unfortunately cars can be huge weapons of destruction on the road.  And coming out of denial about personal behavior requires a willingness to be self-honest.  Do you drink and drive?  How often?  Are there passengers and kids in the back seat?  As health professionals there's an even greater social responsibility to get honest.  I used to smoke.  I'm a Health Educator.  I couldn't bring myself to teach smoking cessation classes until I quit.  It's hard to be a role model, and it's even harder to look inward at ourselves.  But driving under the influence and thinking it's no big deal is even worse.  As Ms. Chen says  in conclusion, "It's unclear whether the Wall [of Shame] will make roads any safer, but it could at least force us to turn the lens on ourselves..."