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Dawn and Dusk in the life of       a physician                       Dr Vijay Sardana                           MD,DM ( Ne...
The Noble Profession ofMedicine“There is no career nobler than that of thephysician. The Progress and welfare ofsociety is...
Health care sector: problems   Shortage of skilled labour   Increasing cost & complexity of    technology   Patient pop...
Doctors: Problems   Struggle to attract patients   Rampant prevalence of unethical malpractice   Declining social statu...
Doctor : Have to answer   Patients   Hospital Trustees   courts
Doctors : Definition of success  Having lots of patients  New car/plot Every year/lots of   money  Publishing papers in...
Doctor : Facts   One of the every three dissatisfied due to lack of    time for themselves or their families   Average l...
Stages of career   Entry   Establishment   Exploration   Specialization   Mastery
Sta ges of Professional    life   No work, No money, lots of time   Some work, some money, some time   Plenty of work, ...
Success   Know – How.   Know - W ho.         W ho you know.         W ho knows you.
Todays successful doctor   Clinician   Academician   Manager   Financial Expert   CEO   Family care Provider   Self...
Indian Doctor –Talented but less                Recognized   Research – no motivation   Infrastructure   Lack of workin...
Component of a good Job•   Economic – Salary & facilities•   Job security•   Good working condition•   Status•   Growth Op...
Judge your alignment with your job• Am i passionate about what I am doing ?• Am i using my talent and strength ?• Am i hap...
Job satisfaction among Doctors   69.5% –satisfied (AIIMS)   Medical doctor in Armed Force – 40%                         ...
Stress among Resident doctors   32.8% had stress-17.7%- mild,13.2%-    moderate,2.9%-severely   Reason- long duty hours,...
Physician motivation“determinants that drive performance  of a task, independent of the  resources and knowledge available”
Physician motivatorsIntrinsic Serving people Work interest Career growth Ability to support oneself & family Autonomy...
Physician motivators                organizational   Opportunities for higher education   Good working & hygienic condit...
Doctor-Patient Relationship Blind trustInformed trust with skepticism
Patients satisfaction   Satisfied patient        3 other people   Dissatisfied patient        20 others   Satisfying un...
Medical Professionalism“Contributing those attitude andbehaviors that serves to maintainpatients’ interest above Physician...
Medical pr ofessionalism :     deprofessionalism- causes   Technology – Depersonarlise medicine &    deprofessionlise a p...
Doctor-Patient Relationship Failure of referral system     Disproportionate work load   Unnecessary administrative    re...
Doctor-Patient Relationship       Influence of drug & medical   equipment manufacturer Pardoned Tolerated
Doctor s’ Expectations        Administration should punish the         guilty        Media –     - publish both views, a...
Doctor-Patient relationship:        Politicians   Political mileage.   Instigating patient to raise voice    against doc...
Display of War nings & Other            infor mation   Display warning in hospital premises    mentioning the consequence...
Improving Relationship   Teaching of ethics & communication    skills in UG curriculum.   Teaching of sociology aimed at...
Resident Evaluation checklist on               Professionalism       Marking       01234               5678            9 1...
Pressures   Ministers   Bureaucrats   Ex ministers   PAs   Political party office bearers   Other parties   Regiona...
Communication skills“ Patients don’t care how much you  know them, until they know how  much you care”
Communication skills in clinical   pr actice- Intr oduction“Its an art to talk medicine in the    language of a non medica...
What do patients want-   Patient dissatisfaction with doctors relate    to problems of communication rather than    clinic...
Benefits of doctor patient              communication- communication with personal touch    provides treatment beyond drug...
Answering skills    weakest communication skills among    Indian Medical Professionals   In Indian context patient satis...
Barriers to communication   Wor k over load on doctor s   Shor ta ge of man power- less time for    individual patient ...
Communication   7%   - Spoken words   38% - Voice quality like Tone,    Tempo, intonation   55% - Body language
How to perfect non verbal         signal    Smile    Open Posture    Forward lean    Touch    Eye contact    Nod
Information sharing & decision making   Most important when there is life threatening illness   When different managemen...
Communicating prognosis, hope & risk   Misunderstandings in these areas can lead to    patient dissatisfaction & litigati...
Dealing with relatives during                resuscitation Routinely   relatives are excluded Studieshave found no adver...
Anticipate & handle common reactions    Disbelief- Is he really gone- for their     satisfaction show them proof- eg. ECG...
Do’s    If too many anxious attendants, send them one    or another job. eg. Bringing medicines, arranging    blood- Ener...
Do’s     Patients should be attended promptly:    - Error in Decision making is Excusable but     not attending patients ...
Don’ts   Never argue with attendants. this    situation teaches you how to remain    calm in provocative circumstances.  ...
Have positive attitude
Attitude• Way a person feels, thinks & behaves towards aparticular issue.          - half full-hall empty
Positive Attitude - Benefits• Pleasing personality• Energizing• Inspiring• Problem Solving• Increase work output
Attitude                Job/promotion/success- 85% Attitude- 15 % Intelligence & knowledge of specific facts $ figures    ...
Elements of success            AttitudeKnowledge              Skill
Attitude formation of a Physician  Medical student  Altruism  Role models behavior  Prevailing commercialism  Work en...
Positive Mindset• Look for Positive in every person.• Develop an immunity to negative criticism.• Learn to find pleasure i...
Identify & avoid negative     people
How value system change Intolerable      Constant ExposureAcceptable       Constant Exposure       Self justificationInvol...
‘Fr enemies’
Positive                 Negative• Part of the answer       • Part of the problem• Has Program              • Has excuse• ...
Positive               Negative• Firm on values,   • Firm on petty things,Compromise on       Compromise on valuespetty th...
Use common sense with knowledge
Knowledge Vs Wisdom• Common sense – 6th sense               - Ability to see things as they                 are and do the...
Knowledge Vs Wisdom• Knowledge - Piling up facts  Wisdom   - Simplifying it•Knowledge - Potential power Wisdom    - Real p...
Believe in reasoning & have critical thinking
Reasoning• Cognitive process of looking for reason,  Beliefs, conclusion, actions & feeling• Why reasoning – What we shoul...
Critical Thinking• Involve determining the meaning & significance of what is observed & expressed•If adequate justificatio...
Lord Buddha : 6 centaury B.C.   Rely not a teacher/person, but on the teaching   Rely not on the words of teaching but o...
Lord Buddha : 6 centaury B.C.   Don’t believe anything because it is spoken &    rumored by many   Don’t believe in anyt...
Emotional Intelligence (EQ)Def – “The ability to monitor one’s own & other feelings & emotion to discriminate among them, ...
EQ Components   Knowing your own emotions (Self awareness)   Managing your own emotion (Self regulation)   Motivating y...
EQ   Physician cannot perform his job without    understanding his emotion & those of    patients   IQ   -   Technical C...
Keeping updated : Managing        knowledge   Medical books    -- Become outdated fast   Medical journals -- Costly   C...
Keeping updated   Imitation   Structure your knowledge around    patients   Learn from your past mistakes   Master cli...
“ The education of the doctor which  goes on after he has his degree is  the most important part of his  education”       ...
TRADITIONAL CME Vs CPD                          73        www.cpdindia.in
www.cpdindia.in   74
www.cpdindia.in   75
Develop friends & interest outside medicine
Vulner able times for         mistakes Tired, lazy, sleepy Angry Overconfident Patient irritating Complex medical Pro...
Mistake : Response   Blaming the system   Blaming the colleagues, even patients   Disconnecting of importance ( No    C...
Dealing with mistake   Accept responsibility for the mistake   Discuss with trusted friend, colleague or    spouse   Di...
Mar keting in medicine “Marketing is Practice building   not advertising”
Pr acticebuilding/Mar keting   Satisfied patients   Volunteering at community medical    service.   Organizing an event...
Informing patient in  information agePrinted material Broachers
Exercise has life transforming benefits
Regular exercise: benefits   Improves cardio vascular fitness   Improves mood   Reduces stress   Loses fat, not lean m...
Physicians: problematic spouse?
Mar riages   Perfectionism, compulsiveness &    wor k holism – good doctor but    problematic spouse   Many mar ried to ...
Mar riages   Stage 1 -- Romance – you are    perfect   Stage 2 -- Fault finding   Stage 3 -- Blaming   Stage 4 -- Acce...
Issues Threatening marriage   Money & Financial arrangements   Infidelity   Boredom   Career crisis   Empty nest synd...
Mar ria ges   Spend time together   Respect each other   Have fun together   Treat your spouse as your most    impor t...
childr en and jealous                mistress   A meal together ever yday   Fun together once a week   One holiday ever...
Physicians: personal crisis
Doctor : Personal crisis   Illness   Divorce   Financial Loss   Being Sued   Bereavement
Doctor: Personal crisisQualities make you better equipped to handle   Self confidence   Optimism   Sense of humor   Re...
Litigation   Patient dissatisfaction   Mistrust   Medical litigation
Litigation   Professional failure in diagnosis or    treatment   Lack of communication   Some form of insensitivity by ...
Litigations    Reasons related to clinical competence Failure to perform adeq clinical  assessment Omission of necessary...
Legal battlePhases   Denial   Anger   Bargaining   Depression   Acceptance
Legal battle   Single law suit doesn’t mean you are a bad doctor.   Usually results from unavoidable bad outcome,    com...
Legal battlePatients has to prove 4 things   Duty   Breach of standard care   Injury   Proximal Cause
Legal battle   Inform your professional indemnity insurance    company   Discuss with your spouse   Don’t discuss with ...
How to reduce chances of litigation      Be a nice person      Be honest      Be open      Be accessible      Keep up...
BurnoutLoss of Physical, Emotional & Mental Energy
Doctor - BurnoutPersonality Traits   Perfectionists   Want to do anything themselves   Often act as if infallible
Burnout : Symptoms   Behavioral – Angry/Depressed, poor    concentration,   Chronically late or psychologically    absen...
Burnout – Things to do   Learn to take care of yourself                     – learn to rest                     - learn t...
Doctors are not organized or united
Physicians: well equipped but don’t venture in leadership
Physician : lets take lead   Leadership – genes, charisma, education, wealth,    luck, training, experience              ...
Physician – lets take a leadphysicians well groomed to be good leaders     Educated     Articulated     Affluential   ...
Physician : Lets take a lead   Lets make a professional bodies strong   More representation of Professionals in policy  ...
Patients spiritualitySoft definition – “The way you find meaning, hope,  comfort & inner peace in your life’’   Spiritual...
It pays to address spiritual belief of                  patients   Religion belongs to spiritual needs are    common amon...
Patients & Spirituality   Spirituality concept not scientific   Few physician are hard core    religious/spiritual   Sp...
Doctor & Spirituality            HOPE   Hope   Organized religion   Personal spirituality & practices   Effect or medi...
Doctor & Spirituality   No Further Action   Spirituality as adjuvant care
Impaired Physician     “ one who is unable to practice medicine with         reasonable skill and safety of patients”   P...
Impaired physician   Denial   Physician Health Programme   Peer assistance committee- early identification,    treatmen...
Think of retiring when you feel time is                  right
Preparing to retire   What would you do if you didn’t have to work for    living   Where do you want to live   How will...
Retirement   Don’t retire unless you have enough financial    security   Studies-Retirement has Predominantly positive  ...
Think of retiring when you feel time is                  right
Preparing to retire   What would you do if you didn’t have to work for    living   Where do you want to live   How will...
Retirement   First year is difficult, adjustment subsequently   Old spouse is the best friend around   Grand children k...
Take home   Let us enjoy being a doctor/physician, let us work    for joy of working, nor for a home, car or vacation   ...
Take Home    Social capital is more important than financial    capital at end of the day.   Work & practice with Medica...
Visualised your self   Visualize your funeral with these    speakers – A family Member, a Friend,    a colleague & a pati...
T hanks
Dawn n dusk   In the life of a physician
Dawn n dusk   In the life of a physician
Dawn n dusk   In the life of a physician
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Dawn n dusk In the life of a physician

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Lecture delivered at IMA CME Kota on 30th oct 2011

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Dawn n dusk In the life of a physician

  1. 1. Dawn and Dusk in the life of a physician Dr Vijay Sardana MD,DM ( Neurology) Professor & Head Deptt. Of Neurology Govt .Medical College, Kota
  2. 2. The Noble Profession ofMedicine“There is no career nobler than that of thephysician. The Progress and welfare ofsociety is more intimately bound up withthe prevailing tone and influence of themedical profession that with the status ofany other class…” Elisabeth Blackwell, MD, 1889
  3. 3. Health care sector: problems Shortage of skilled labour Increasing cost & complexity of technology Patient population more demanding Increasing orientation towards consumers
  4. 4. Doctors: Problems Struggle to attract patients Rampant prevalence of unethical malpractice Declining social status Threat of litigation
  5. 5. Doctor : Have to answer Patients Hospital Trustees courts
  6. 6. Doctors : Definition of success  Having lots of patients  New car/plot Every year/lots of money  Publishing papers in journals  Teaching students
  7. 7. Doctor : Facts One of the every three dissatisfied due to lack of time for themselves or their families Average life 10 year less Depression 4 times higher than general population US- Physician suicide 3 time than general population 10% - Develop drug addiction
  8. 8. Stages of career Entry Establishment Exploration Specialization Mastery
  9. 9. Sta ges of Professional life No work, No money, lots of time Some work, some money, some time Plenty of work, Plenty of money, no time
  10. 10. Success Know – How. Know - W ho. W ho you know. W ho knows you.
  11. 11. Todays successful doctor Clinician Academician Manager Financial Expert CEO Family care Provider Self care taker
  12. 12. Indian Doctor –Talented but less Recognized Research – no motivation Infrastructure Lack of working hands, lack of time Commercialization No evidence based medicine approach
  13. 13. Component of a good Job• Economic – Salary & facilities• Job security• Good working condition• Status• Growth Opportunities• Recognition of work done• Challenges of work
  14. 14. Judge your alignment with your job• Am i passionate about what I am doing ?• Am i using my talent and strength ?• Am i happy in my work ?• Does it bring joy & fulfillment ?• Am I Earning what I deserve ? Improve & change
  15. 15. Job satisfaction among Doctors 69.5% –satisfied (AIIMS) Medical doctor in Armed Force – 40% Choudhary et al MIAFI 2004;60:329-32 Initial satisfaction high , falls > 35 years, again rise laterMadan N. job satisfaction among doctor in a Tertiary Care Hospital jk science:2008,10(2)81-83
  16. 16. Stress among Resident doctors 32.8% had stress-17.7%- mild,13.2%- moderate,2.9%-severely Reason- long duty hours, departmental academic activities, Financial constraints, family & emotional problem. Predictors – year of Residency, giving time to family & friends, job satisfaction, existence of children, place of graduation. Saini NK et al Iindian j public health. 2010;54(4):219-23
  17. 17. Physician motivation“determinants that drive performance of a task, independent of the resources and knowledge available”
  18. 18. Physician motivatorsIntrinsic Serving people Work interest Career growth Ability to support oneself & family Autonomy EmpowermentSocio-cultural Respect Social rewards
  19. 19. Physician motivators organizational Opportunities for higher education Good working & hygienic conditions Personal safety Good professional experience Good pay Financial incentives other than pay
  20. 20. Doctor-Patient Relationship Blind trustInformed trust with skepticism
  21. 21. Patients satisfaction Satisfied patient 3 other people Dissatisfied patient 20 others Satisfying unhappy patients 50 others
  22. 22. Medical Professionalism“Contributing those attitude andbehaviors that serves to maintainpatients’ interest above Physicians’self interest.”
  23. 23. Medical pr ofessionalism : deprofessionalism- causes Technology – Depersonarlise medicine & deprofessionlise a physician Corporatization of Medicine Specialization – Most patients identified by disease rather than human beings who happens to have disease Patients knowing limitation of modern medicine Greed
  24. 24. Doctor-Patient Relationship Failure of referral system Disproportionate work load Unnecessary administrative responsibilities
  25. 25. Doctor-Patient Relationship Influence of drug & medical equipment manufacturer Pardoned Tolerated
  26. 26. Doctor s’ Expectations  Administration should punish the guilty  Media – - publish both views, avoid sensationalism, seek an expert opinion preferably from another city - more positiveViolence Against Doctors
  27. 27. Doctor-Patient relationship: Politicians Political mileage. Instigating patient to raise voice against doctor, at times unjustified.
  28. 28. Display of War nings & Other infor mation Display warning in hospital premises mentioning the consequences of violence against doctors in hospital Display flow chart/plan in Emergency Room Display information on boards, counters etc. Try not to escalate costs later or change pla frequently
  29. 29. Improving Relationship Teaching of ethics & communication skills in UG curriculum. Teaching of sociology aimed at creating cultural sensivity,empathy & respect for patients’ dignity. Teaching legal aspect of practice. Physician has to enter patients world- to see illness through patient’s eye
  30. 30. Resident Evaluation checklist on Professionalism Marking 01234 5678 9 10 Unsatisfactory Satisfactory exemplary(4) Empathy in patient care.(5) Appropriate fund of knowledge.(6) Soundness of clinical judgment.(7) Technical expertise with diagnostic and therapeutic procedures.(8) Communication with patients, families and staff.(9) Sensitivity and responsiveness to individual patient differences in economic status,ethinicity,age,gender and disabilities.(10) Honesty in dealing with patients and colleagues.(11) Accountability for action.(12) Conflict-resolution skills.(13) Adherence to regulatory, institutional and departmental norms.
  31. 31. Pressures Ministers Bureaucrats Ex ministers PAs Political party office bearers Other parties Regional parties Media others
  32. 32. Communication skills“ Patients don’t care how much you know them, until they know how much you care”
  33. 33. Communication skills in clinical pr actice- Intr oduction“Its an art to talk medicine in the language of a non medical men” not an option but a necessity separates successful doctors from unsuccessful ones include ability to engage with patients at emotional level, to listen, to convey information with clarity & sympathy
  34. 34. What do patients want- Patient dissatisfaction with doctors relate to problems of communication rather than clinical competence- They want - quality information about their problems - risks & benefits of treatment - relief of emotional distress - to be active participate in medical decision making
  35. 35. Benefits of doctor patient communication- communication with personal touch provides treatment beyond drugs- Patients more likely to comply- The overall quality of care & patient satisfaction improved
  36. 36. Answering skills weakest communication skills among Indian Medical Professionals In Indian context patient satisfaction is largely decided by the quality of answers & explanation given by doctors Understand the question clearly, answer fully, & clearly but briefly Avoid major technical terms
  37. 37. Barriers to communication Wor k over load on doctor s Shor ta ge of man power- less time for individual patient Lack of tr aining in communication skills during medical education Individual attitude & per sonality traits Under utilization of par amedical staf f
  38. 38. Communication 7% - Spoken words 38% - Voice quality like Tone, Tempo, intonation 55% - Body language
  39. 39. How to perfect non verbal signal  Smile  Open Posture  Forward lean  Touch  Eye contact  Nod
  40. 40. Information sharing & decision making Most important when there is life threatening illness When different management options exist with varying costs, benefits & when outcome is unpredictable Discuss risks & benefits of each option It not only increases patient satisfaction but also reduces the chance of litigation if any adverse outcome results While prescribing any drug with life threatening side effects- informed consent to be taken
  41. 41. Communicating prognosis, hope & risk Misunderstandings in these areas can lead to patient dissatisfaction & litigation Prognostication is like weather forecasting uncertain but based on sound scientific principles St of ilness atpr age l esent ion of pat at ient Cur it of disease abil y In face of uncertainty there is nothing wrong with providing hope Provide evidence based risks Never create guilt for negligence on part of patient
  42. 42. Dealing with relatives during resuscitation Routinely relatives are excluded Studieshave found no adverse psychological effects if some mature person observes the process One of the doctors of team should explain the procedure being done to relatives- it builds better rapport & communication regarding adverse outcome easy Remember that bereaved relatives are also your patients- counsel them & give medical help
  43. 43. Anticipate & handle common reactions  Disbelief- Is he really gone- for their satisfaction show them proof- eg. ECG  Guilt- by giving logical & rational explanation & saying that he tried his best  Offer help to manage transport  In case of Violence & Aggression-  Remain calm & show sympathy  Talk to some elder & mature person  Call police if situation is out of control
  44. 44. Do’s If too many anxious attendants, send them one or another job. eg. Bringing medicines, arranging blood- Energy utilization Never argue with attendants Argument will trigger them, at the same time your calmness and promptness will even calm down a triggered person. If patient is sick, attend patient periodically and talk to attendants. Check emergency tray for drugs. Try to solve/resolve crisis immediately
  45. 45. Do’s Patients should be attended promptly: - Error in Decision making is Excusable but not attending patients timely is not. Identify a Prominent Person: - Important person/relative and explain initial assessment of patient immediately. - Explain them management has started. Ask if they have any questions Call senior consultant as per requirement, talk to them telephonically if possible delay in arrival.
  46. 46. Don’ts Never argue with attendants. this situation teaches you how to remain calm in provocative circumstances. No book in the world can teach this. Never overlook a call, especially if call is by a attendant.
  47. 47. Have positive attitude
  48. 48. Attitude• Way a person feels, thinks & behaves towards aparticular issue. - half full-hall empty
  49. 49. Positive Attitude - Benefits• Pleasing personality• Energizing• Inspiring• Problem Solving• Increase work output
  50. 50. Attitude Job/promotion/success- 85% Attitude- 15 % Intelligence & knowledge of specific facts $ figures 12__suraj_ki_garmi_se.mp3• Education - Almost 100% teach facts & figure
  51. 51. Elements of success AttitudeKnowledge Skill
  52. 52. Attitude formation of a Physician  Medical student  Altruism  Role models behavior  Prevailing commercialism  Work environment  Social and political environment
  53. 53. Positive Mindset• Look for Positive in every person.• Develop an immunity to negative criticism.• Learn to find pleasure in every little things.• Remamber ups and downs are part of life.• Keep yourself continuously occupied. Spend somuch time improving yourself that no time left tocriticize others• Be equally enthusiastic about other success• forgive yourself & others.
  54. 54. Identify & avoid negative people
  55. 55. How value system change Intolerable Constant ExposureAcceptable Constant Exposure Self justificationInvolvement
  56. 56. ‘Fr enemies’
  57. 57. Positive Negative• Part of the answer • Part of the problem• Has Program • Has excuse• Let me do it for you • Its not my job• Difficult but possible • Possible but to difficult• I must do something • Something must be done• See the gain • See the pain• See possibilities. • See problem.• Hard arguments, • Soft arguments, HardSoft words words
  58. 58. Positive Negative• Firm on values, • Firm on petty things,Compromise on Compromise on valuespetty things• Don’t do it to • Do it to othersothers what you before they do it towould not want to youdo to you• Make it happen • Let it happen
  59. 59. Use common sense with knowledge
  60. 60. Knowledge Vs Wisdom• Common sense – 6th sense - Ability to see things as they are and do them as ought to be done.• Abundance of Common sense - Wisdom
  61. 61. Knowledge Vs Wisdom• Knowledge - Piling up facts Wisdom - Simplifying it•Knowledge - Potential power Wisdom - Real power• To attain knowledge - Add things everyday To attain Wisdom - delete things everyday
  62. 62. Believe in reasoning & have critical thinking
  63. 63. Reasoning• Cognitive process of looking for reason, Beliefs, conclusion, actions & feeling• Why reasoning – What we should believe - What we should do
  64. 64. Critical Thinking• Involve determining the meaning & significance of what is observed & expressed•If adequate justification to accept argument,inference and conclusion as true
  65. 65. Lord Buddha : 6 centaury B.C. Rely not a teacher/person, but on the teaching Rely not on the words of teaching but on spirit of words Don’t believe in any thing simply b’cos you have heard it Don’t believe in traditions because they have been handed over for many generations
  66. 66. Lord Buddha : 6 centaury B.C. Don’t believe anything because it is spoken & rumored by many Don’t believe in anything because it is written in religious books Analyze & observe -apply reasons, if any thing is good & beneficial to one &all agree to it.
  67. 67. Emotional Intelligence (EQ)Def – “The ability to monitor one’s own & other feelings & emotion to discriminate among them, and to use this information to guide one’s thinking and action” IQ Average citizen - 100 Doctor - 120 EQ Average citizen - 100 Doctor - 90
  68. 68. EQ Components Knowing your own emotions (Self awareness) Managing your own emotion (Self regulation) Motivating yourself Recognizing and understand other people’s emotion ( Empathy) Managing relationships or social skills- Skills in managing emotions in others determines popularity, leadership & interpersonal effectiveness.
  69. 69. EQ Physician cannot perform his job without understanding his emotion & those of patients IQ - Technical Competence EQ - People’s Competence IQ - Gets you job EQ - Gets you promoted IQ - Gets you higher marks EQ - Makes you happy & Productive
  70. 70. Keeping updated : Managing knowledge Medical books -- Become outdated fast Medical journals -- Costly Conference Medical representative InternetMedical knowledge problem – Mammoth size - Short half life
  71. 71. Keeping updated Imitation Structure your knowledge around patients Learn from your past mistakes Master clinical protocols & Flow charts Concentrate on carry home massages
  72. 72. “ The education of the doctor which goes on after he has his degree is the most important part of his education” John Shaw Billings
  73. 73. TRADITIONAL CME Vs CPD 73 www.cpdindia.in
  74. 74. www.cpdindia.in 74
  75. 75. www.cpdindia.in 75
  76. 76. Develop friends & interest outside medicine
  77. 77. Vulner able times for mistakes Tired, lazy, sleepy Angry Overconfident Patient irritating Complex medical Problem
  78. 78. Mistake : Response Blaming the system Blaming the colleagues, even patients Disconnecting of importance ( No Clinical effectiveness) Emotionally Distancing (Everyone makes mistakes)
  79. 79. Dealing with mistake Accept responsibility for the mistake Discuss with trusted friend, colleague or spouse Disclose & Apologize to the patients Error analysis Measures to reduce similar mistake in future
  80. 80. Mar keting in medicine “Marketing is Practice building not advertising”
  81. 81. Pr acticebuilding/Mar keting Satisfied patients Volunteering at community medical service. Organizing an event – like conference Attracting Media attention Contributing article on health to magazine Public lecture News letter Website Marketing to referral base
  82. 82. Informing patient in information agePrinted material Broachers
  83. 83. Exercise has life transforming benefits
  84. 84. Regular exercise: benefits Improves cardio vascular fitness Improves mood Reduces stress Loses fat, not lean muscle Decrease back & joint pain Decrease loss of bone density Decrease chol., Ht, insulin senstivity, incidence & mortality from CAD, risk of colonic cancer
  85. 85. Physicians: problematic spouse?
  86. 86. Mar riages Perfectionism, compulsiveness & wor k holism – good doctor but problematic spouse Many mar ried to Profession – no time to cultivate intimacy with spouse
  87. 87. Mar riages Stage 1 -- Romance – you are perfect Stage 2 -- Fault finding Stage 3 -- Blaming Stage 4 -- Acceptance Transfor mation – Growing together
  88. 88. Issues Threatening marriage Money & Financial arrangements Infidelity Boredom Career crisis Empty nest syndrome Retirement.
  89. 89. Mar ria ges Spend time together Respect each other Have fun together Treat your spouse as your most impor tant VIP patient -- A loved spouse is also loving spouse
  90. 90. childr en and jealous mistress A meal together ever yday Fun together once a week One holiday ever y year together Make sure children meet grand parents, relatives periodically Help childr en honor family traditions
  91. 91. Physicians: personal crisis
  92. 92. Doctor : Personal crisis Illness Divorce Financial Loss Being Sued Bereavement
  93. 93. Doctor: Personal crisisQualities make you better equipped to handle Self confidence Optimism Sense of humor Resilience Faith in God
  94. 94. Litigation Patient dissatisfaction Mistrust Medical litigation
  95. 95. Litigation Professional failure in diagnosis or treatment Lack of communication Some form of insensitivity by the doctor to upset them emotionally – insult adding to injury.
  96. 96. Litigations Reasons related to clinical competence Failure to perform adeq clinical assessment Omission of necessary tests Improper diagnosis Failure to treat
  97. 97. Legal battlePhases Denial Anger Bargaining Depression Acceptance
  98. 98. Legal battle Single law suit doesn’t mean you are a bad doctor. Usually results from unavoidable bad outcome, communication gap, misunderstanding with patients/attendants, anger rather than actual negligence.
  99. 99. Legal battlePatients has to prove 4 things Duty Breach of standard care Injury Proximal Cause
  100. 100. Legal battle Inform your professional indemnity insurance company Discuss with your spouse Don’t discuss with colleagues, staff, & reporters Ask for the details, if you don’t remember the detail of the patient.
  101. 101. How to reduce chances of litigation  Be a nice person  Be honest  Be open  Be accessible  Keep up to date professionally  Insurance
  102. 102. BurnoutLoss of Physical, Emotional & Mental Energy
  103. 103. Doctor - BurnoutPersonality Traits Perfectionists Want to do anything themselves Often act as if infallible
  104. 104. Burnout : Symptoms Behavioral – Angry/Depressed, poor concentration, Chronically late or psychologically absent, work avoidance Excessive drinking/Drugs Tiredness, lethargy, sleep disorders
  105. 105. Burnout – Things to do Learn to take care of yourself – learn to rest - learn to Exercise Learn to say No Have fulfilling life outside of clinic-develop your hobbies & activities Learn to cut routine work Develop strong support system
  106. 106. Doctors are not organized or united
  107. 107. Physicians: well equipped but don’t venture in leadership
  108. 108. Physician : lets take lead Leadership – genes, charisma, education, wealth, luck, training, experience Ethics do right Reality Greatness vision Have no think big & new Illusion Courage act with sustained initiation
  109. 109. Physician – lets take a leadphysicians well groomed to be good leaders  Educated  Articulated  Affluential  Respected  Deal with human emotion daily  Deal with cross section of society  think scientifically.
  110. 110. Physician : Lets take a lead Lets make a professional bodies strong More representation of Professionals in policy making team e.g. Secy. Medical Education Chandigarh a Doctor
  111. 111. Patients spiritualitySoft definition – “The way you find meaning, hope, comfort & inner peace in your life’’ Spirituality Vs Religion one may be spiritual without being religious illness triggers – spiritual distress in patients & family members.
  112. 112. It pays to address spiritual belief of patients Religion belongs to spiritual needs are common among patient Religion belief sometimes influence decision making Spirituality is related to positive health in some areas Better patient doctor relationship
  113. 113. Patients & Spirituality Spirituality concept not scientific Few physician are hard core religious/spiritual Spiritual concepts are thought private not worth discussion.
  114. 114. Doctor & Spirituality HOPE Hope Organized religion Personal spirituality & practices Effect or medical care issues
  115. 115. Doctor & Spirituality No Further Action Spirituality as adjuvant care
  116. 116. Impaired Physician “ one who is unable to practice medicine with reasonable skill and safety of patients” Physical or mental illness. Ageing process Loss of motor skill Drugs/alcohol abuse
  117. 117. Impaired physician Denial Physician Health Programme Peer assistance committee- early identification, treatment & rehabilitations of physicians.
  118. 118. Think of retiring when you feel time is right
  119. 119. Preparing to retire What would you do if you didn’t have to work for living Where do you want to live How will you use your time so that you remain productive & inspired Want to be close to children or away What role the family will play Arrangement for possible decline in health
  120. 120. Retirement Don’t retire unless you have enough financial security Studies-Retirement has Predominantly positive impact on emotional state Explore you hobbies Explore your spirituality Serve other selflessly-do charity work/volunteer work Physical activity/light exercise
  121. 121. Think of retiring when you feel time is right
  122. 122. Preparing to retire What would you do if you didn’t have to work for living Where do you want to live How will you use your time so that you remain productive & inspired Want to be close to children or away What role the family will play Arrangement for possible decline in health
  123. 123. Retirement First year is difficult, adjustment subsequently Old spouse is the best friend around Grand children keep you busy & happy Reduce the workload to the extent of enjoying it.
  124. 124. Take home Let us enjoy being a doctor/physician, let us work for joy of working, nor for a home, car or vacation Don’t find faults in medicine, Identify happy doctor & follow their secrets Lets love what we do, and do what we love Watching dying patients should remind us about our own mortality enabling us to live each day well.
  125. 125. Take Home Social capital is more important than financial capital at end of the day. Work & practice with Medical professionalism Use common sense. Identify local socio-cultural practices & integrate in your working style People prefer those doctors with average clinical skills but good communication skills rather than those with excellent clinical but poor communication skills
  126. 126. Visualised your self Visualize your funeral with these speakers – A family Member, a Friend, a colleague & a patient.
  127. 127. T hanks

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