The Optimized Doctor

 

In this month’s column, I am providing my recommendations of what I consider were the best books published in 2017, starting with “Attending: Medicine, Mindfulness and Humanity” by Ronald Epstein, MD, (New York: Simon & Schuster, 2017). These days, it’s difficult to have a conversation about medicine without mention of mindfulness. Most mindfulness and medicine articles are nothing more than a list of bromides written by people who’ve never seen a patient. Ronald Epstein is not one of them. A practicing family physician and professor of medicine, he is “The Attending,” and uses a play on words to encourage us to attend, or be present. Like a good instructor, he uses stories supported by studies in this book (there are nearly 25 pages of references) to argue why being mindful is essential and how you can strengthen your mindfulness muscles in your practice. Mastering these skills will help you become a better diagnostician and reduce the chance you’ll become a burnout statistic. We physicians “miss more by not seeing than by not knowing,” said physician William Osler, and Dr. Epstein helps us to see.

“The Leading Brain,” by Friederike Fabritius, MS, and Hans W. Hagemann, PhD, (New York: TarcherPerigee, 2017). If you’ve ever wanted to browse the self-help aisle of your nearby bookstore, let me save you the trip. Most of what’s there is empty word calories. What is of nutritional value has been summarized in a hundred or so pages in “The Leading Brain.” The book is an easily digestible summary of research and recommendations packaged for executives and professionals like us. The first two-thirds of the book focus on how to achieve your optimal performance, while the remaining third focuses on teams. You might not think about how our environment affects our performance or why surprise helps motivate teams. You will after reading this.

“Astrophysics for People in a Hurry,” by Neil de Grasse Tyson, (New York: W.W. Norton & Company, 2017). For no other reason than you’d like to be the compelling conversationalist at your next party, get this book. It is the lightest take I’ve read on the heaviest of subject matters. One can’t help but be fascinated by the universe we call home (there may be others, but you’ll have to get the book to find out). If ever you find yourself the victim of a bad outcome or serious error, reread his last chapter on the cosmic perspective. We all share a mere speck of dust as our home.

“The Power of Moments: Why Certain Experiences Have Extraordinary Impact,” by Chip Heath and Dan Heath, (New York: Simon & Schuster, 2017). The Heath brothers are back at it. This book, which focuses on experiences, is closest to our daily lives in medicine. Patient experience surveys are ubiquitous, and more often than not, public, fairly or not. Fortunately, service experiences have key factors that are common and modifiable. In their usual engaging prose, they make those key factors easy to understand and hard to forget. They end each chapter fittingly with a clinic to get you practicing. You and your patients will benefit from what you learn here.

“The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine,” by Lindsey Fitzharris, PhD, (New York: Farrar, Straus, and Giroux, 2017). This book is a real treat: a good old-fashioned medical history spiced with a bit of gore. The story of Dr. Joseph Lister’s discovery of antisepsis is a compelling and critical milestone in our history. (Yes, the germ-killing mouthwash, Listerine, was named in his honor.) Dr. Fitzharris, an Oxford scholar on the history of science and medicine, vividly re-creates the world of Victorian medicine with its gritty and sometimes messy pursuit of the truth. Lister was mocked and ostracized for his controversial ideas on the role of microbes in surgical infection before he was lionized. In a year dominated by “fake news,” it’s refreshing to read a story about how truth not only wins in the end but also saves lives.

“Autumn,” by Ali Smith, (New York: Pantheon Books, 2017). At the heart of this eloquent novel is the deeply felt, platonic 25-year-long relationship between Elisabeth Demand, a 32-year-old art history lecturer and 101-year-old Daniel Gluck, who is living out his final days in a nursing home. Set in post-Brexit Britain, the book jumps back and forth in time touching on many relevant issues including xenophobia and neo-nationalism, art and beauty, and the ever-evolving definitions of love of family. Some of the most touching moments occur in scenes when Elizabeth and Daniel discuss art and literature and the profound impact it has on their lives. The novel has got me thinking ... perhaps by better understanding art, we can better understand our patients and our roles in their lives.

“Salt, Fat, Acid, Heat: Mastering the Elements of Good Cooking,” by Samin Nosrat, (New York: Simon & Schuster, 2017). If like me, you prefer good old-fashioned cooking to meal replacements and food delivery apps, get this book. Though I don’t plan to dethrone my wife as our family’s chef, I am a much better sous chef after having perused this enlightening and charmingly illustrated cookbook. Ms. Nosrat, who learned how to cook at the famed Chez Panisse in Berkeley, Calif., demystifies cooking by breaking it down to four essential elements: salt, fat, acid and heat. Master these fundamentals, and you’ll be able to cook good food just about every time.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

In this month’s column, I am providing my recommendations of what I consider were the best books published in 2017, starting with “Attending: Medicine, Mindfulness and Humanity” by Ronald Epstein, MD, (New York: Simon & Schuster, 2017). These days, it’s difficult to have a conversation about medicine without mention of mindfulness. Most mindfulness and medicine articles are nothing more than a list of bromides written by people who’ve never seen a patient. Ronald Epstein is not one of them. A practicing family physician and professor of medicine, he is “The Attending,” and uses a play on words to encourage us to attend, or be present. Like a good instructor, he uses stories supported by studies in this book (there are nearly 25 pages of references) to argue why being mindful is essential and how you can strengthen your mindfulness muscles in your practice. Mastering these skills will help you become a better diagnostician and reduce the chance you’ll become a burnout statistic. We physicians “miss more by not seeing than by not knowing,” said physician William Osler, and Dr. Epstein helps us to see.

“The Leading Brain,” by Friederike Fabritius, MS, and Hans W. Hagemann, PhD, (New York: TarcherPerigee, 2017). If you’ve ever wanted to browse the self-help aisle of your nearby bookstore, let me save you the trip. Most of what’s there is empty word calories. What is of nutritional value has been summarized in a hundred or so pages in “The Leading Brain.” The book is an easily digestible summary of research and recommendations packaged for executives and professionals like us. The first two-thirds of the book focus on how to achieve your optimal performance, while the remaining third focuses on teams. You might not think about how our environment affects our performance or why surprise helps motivate teams. You will after reading this.

“Astrophysics for People in a Hurry,” by Neil de Grasse Tyson, (New York: W.W. Norton & Company, 2017). For no other reason than you’d like to be the compelling conversationalist at your next party, get this book. It is the lightest take I’ve read on the heaviest of subject matters. One can’t help but be fascinated by the universe we call home (there may be others, but you’ll have to get the book to find out). If ever you find yourself the victim of a bad outcome or serious error, reread his last chapter on the cosmic perspective. We all share a mere speck of dust as our home.

“The Power of Moments: Why Certain Experiences Have Extraordinary Impact,” by Chip Heath and Dan Heath, (New York: Simon & Schuster, 2017). The Heath brothers are back at it. This book, which focuses on experiences, is closest to our daily lives in medicine. Patient experience surveys are ubiquitous, and more often than not, public, fairly or not. Fortunately, service experiences have key factors that are common and modifiable. In their usual engaging prose, they make those key factors easy to understand and hard to forget. They end each chapter fittingly with a clinic to get you practicing. You and your patients will benefit from what you learn here.

“The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine,” by Lindsey Fitzharris, PhD, (New York: Farrar, Straus, and Giroux, 2017). This book is a real treat: a good old-fashioned medical history spiced with a bit of gore. The story of Dr. Joseph Lister’s discovery of antisepsis is a compelling and critical milestone in our history. (Yes, the germ-killing mouthwash, Listerine, was named in his honor.) Dr. Fitzharris, an Oxford scholar on the history of science and medicine, vividly re-creates the world of Victorian medicine with its gritty and sometimes messy pursuit of the truth. Lister was mocked and ostracized for his controversial ideas on the role of microbes in surgical infection before he was lionized. In a year dominated by “fake news,” it’s refreshing to read a story about how truth not only wins in the end but also saves lives.

“Autumn,” by Ali Smith, (New York: Pantheon Books, 2017). At the heart of this eloquent novel is the deeply felt, platonic 25-year-long relationship between Elisabeth Demand, a 32-year-old art history lecturer and 101-year-old Daniel Gluck, who is living out his final days in a nursing home. Set in post-Brexit Britain, the book jumps back and forth in time touching on many relevant issues including xenophobia and neo-nationalism, art and beauty, and the ever-evolving definitions of love of family. Some of the most touching moments occur in scenes when Elizabeth and Daniel discuss art and literature and the profound impact it has on their lives. The novel has got me thinking ... perhaps by better understanding art, we can better understand our patients and our roles in their lives.

“Salt, Fat, Acid, Heat: Mastering the Elements of Good Cooking,” by Samin Nosrat, (New York: Simon & Schuster, 2017). If like me, you prefer good old-fashioned cooking to meal replacements and food delivery apps, get this book. Though I don’t plan to dethrone my wife as our family’s chef, I am a much better sous chef after having perused this enlightening and charmingly illustrated cookbook. Ms. Nosrat, who learned how to cook at the famed Chez Panisse in Berkeley, Calif., demystifies cooking by breaking it down to four essential elements: salt, fat, acid and heat. Master these fundamentals, and you’ll be able to cook good food just about every time.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

In this month’s column, I am providing my recommendations of what I consider were the best books published in 2017, starting with “Attending: Medicine, Mindfulness and Humanity” by Ronald Epstein, MD, (New York: Simon & Schuster, 2017). These days, it’s difficult to have a conversation about medicine without mention of mindfulness. Most mindfulness and medicine articles are nothing more than a list of bromides written by people who’ve never seen a patient. Ronald Epstein is not one of them. A practicing family physician and professor of medicine, he is “The Attending,” and uses a play on words to encourage us to attend, or be present. Like a good instructor, he uses stories supported by studies in this book (there are nearly 25 pages of references) to argue why being mindful is essential and how you can strengthen your mindfulness muscles in your practice. Mastering these skills will help you become a better diagnostician and reduce the chance you’ll become a burnout statistic. We physicians “miss more by not seeing than by not knowing,” said physician William Osler, and Dr. Epstein helps us to see.

“The Leading Brain,” by Friederike Fabritius, MS, and Hans W. Hagemann, PhD, (New York: TarcherPerigee, 2017). If you’ve ever wanted to browse the self-help aisle of your nearby bookstore, let me save you the trip. Most of what’s there is empty word calories. What is of nutritional value has been summarized in a hundred or so pages in “The Leading Brain.” The book is an easily digestible summary of research and recommendations packaged for executives and professionals like us. The first two-thirds of the book focus on how to achieve your optimal performance, while the remaining third focuses on teams. You might not think about how our environment affects our performance or why surprise helps motivate teams. You will after reading this.

“Astrophysics for People in a Hurry,” by Neil de Grasse Tyson, (New York: W.W. Norton & Company, 2017). For no other reason than you’d like to be the compelling conversationalist at your next party, get this book. It is the lightest take I’ve read on the heaviest of subject matters. One can’t help but be fascinated by the universe we call home (there may be others, but you’ll have to get the book to find out). If ever you find yourself the victim of a bad outcome or serious error, reread his last chapter on the cosmic perspective. We all share a mere speck of dust as our home.

“The Power of Moments: Why Certain Experiences Have Extraordinary Impact,” by Chip Heath and Dan Heath, (New York: Simon & Schuster, 2017). The Heath brothers are back at it. This book, which focuses on experiences, is closest to our daily lives in medicine. Patient experience surveys are ubiquitous, and more often than not, public, fairly or not. Fortunately, service experiences have key factors that are common and modifiable. In their usual engaging prose, they make those key factors easy to understand and hard to forget. They end each chapter fittingly with a clinic to get you practicing. You and your patients will benefit from what you learn here.

“The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine,” by Lindsey Fitzharris, PhD, (New York: Farrar, Straus, and Giroux, 2017). This book is a real treat: a good old-fashioned medical history spiced with a bit of gore. The story of Dr. Joseph Lister’s discovery of antisepsis is a compelling and critical milestone in our history. (Yes, the germ-killing mouthwash, Listerine, was named in his honor.) Dr. Fitzharris, an Oxford scholar on the history of science and medicine, vividly re-creates the world of Victorian medicine with its gritty and sometimes messy pursuit of the truth. Lister was mocked and ostracized for his controversial ideas on the role of microbes in surgical infection before he was lionized. In a year dominated by “fake news,” it’s refreshing to read a story about how truth not only wins in the end but also saves lives.

“Autumn,” by Ali Smith, (New York: Pantheon Books, 2017). At the heart of this eloquent novel is the deeply felt, platonic 25-year-long relationship between Elisabeth Demand, a 32-year-old art history lecturer and 101-year-old Daniel Gluck, who is living out his final days in a nursing home. Set in post-Brexit Britain, the book jumps back and forth in time touching on many relevant issues including xenophobia and neo-nationalism, art and beauty, and the ever-evolving definitions of love of family. Some of the most touching moments occur in scenes when Elizabeth and Daniel discuss art and literature and the profound impact it has on their lives. The novel has got me thinking ... perhaps by better understanding art, we can better understand our patients and our roles in their lives.

“Salt, Fat, Acid, Heat: Mastering the Elements of Good Cooking,” by Samin Nosrat, (New York: Simon & Schuster, 2017). If like me, you prefer good old-fashioned cooking to meal replacements and food delivery apps, get this book. Though I don’t plan to dethrone my wife as our family’s chef, I am a much better sous chef after having perused this enlightening and charmingly illustrated cookbook. Ms. Nosrat, who learned how to cook at the famed Chez Panisse in Berkeley, Calif., demystifies cooking by breaking it down to four essential elements: salt, fat, acid and heat. Master these fundamentals, and you’ll be able to cook good food just about every time.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

My chest and back are sore this week because I was on call last week. It’s my secret to beating burnout. Just keep reading.

The phrase “dermatologist burnout” may seem as oxymoronic as jumbo shrimp, yet both are real. Our work is easier than some other physicians’. Dermatologists don’t sleep in the hospital, and we have many fewer dope-seeking or dying patients. Yet we suffer the same EHR frustrations as any physician. We struggle with an ever-increasing volume of patients and regulations which stultify our ability to care for patients.

[polldaddy:9875293]

According to a recent Mayo Clinic Proceedings study, dermatologists had the highest increase in burnout from 32% to 57% (Mayo Clin Proc. 2015 Dec;90[12]:1600-13). Although some have it worse than others, all physicians today are at high risk. Changing external factors is difficult, but modifying internal aspects of burnout can help.

In my department, we take call a week at a time. While on call, doctors from hospitals, clinics, and ERs call and text us. There are also urgent patients to be added on. If there is ever a time to be burned out, it’s during call weeks. Through the years I’ve developed a strategy that has helped me make the most of call week and any other difficult period. I think of the three C’s: Challenges, Colleagues, Charging.
 

Challenges

First, I mark difficult weeks on my calendar in red. Do I have extra clinics? Is it post vacation? Am I giving a talk? Then, I set up challenges. For example, I knew last week’s call was going to be tough. So, each morning I challenged myself to do 100 push-ups in 2 minutes, 12 pull-ups, and run 2 miles. I also set goals of plowing through my backlog of journals and upgrading my EHR shortcuts and order sets.

Colleagues

A Navy SEAL training instructor once told me the key to success in BUD/S (the grueling 6-month SEAL training course), is to take care of your teammates:“When you’re focused on the guy to your right and the guy to your left, you find inner strength to endure suffering.” No matter how busy I am, when my phone rings or I get a text, I think to myself, Good, one of my partners needs my help. Framing it that way makes any added work feel lighter.

(Re)Charging

Lastly, I schedule time to recharge and recover. For example, this morning instead of going to the gym, I had a cappuccino and read the entire Sunday New York Times. Later today, my wife and I are going to see Thor: Ragnarok. In reclining seats. With a craft beer.

My call week was sometimes easy and occasionally arduous. Yet, I taught an ER resident how to recognize zoster in its very early stages. I learned the difference between erythema multiforme major and mycoplasma-induced rash with mucositis, and I reassured a family that their hospitalized 9-year-old was going to be just fine. I didn’t miss a workout (however, no SEAL instructor would have credited my pathetic pull-ups #11 and #12).

My next call isn’t long off, and soon, I must work on a big presentation. Medicine is a marathon, punctuated by sprinting. During stressful periods, I challenge myself physically and mentally, focus on helping others, and take the time to rest and recharge after. I think it has helped me beat burnout, I hope it helps you too.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com

 

My chest and back are sore this week because I was on call last week. It’s my secret to beating burnout. Just keep reading.

The phrase “dermatologist burnout” may seem as oxymoronic as jumbo shrimp, yet both are real. Our work is easier than some other physicians’. Dermatologists don’t sleep in the hospital, and we have many fewer dope-seeking or dying patients. Yet we suffer the same EHR frustrations as any physician. We struggle with an ever-increasing volume of patients and regulations which stultify our ability to care for patients.

[polldaddy:9875293]

According to a recent Mayo Clinic Proceedings study, dermatologists had the highest increase in burnout from 32% to 57% (Mayo Clin Proc. 2015 Dec;90[12]:1600-13). Although some have it worse than others, all physicians today are at high risk. Changing external factors is difficult, but modifying internal aspects of burnout can help.

In my department, we take call a week at a time. While on call, doctors from hospitals, clinics, and ERs call and text us. There are also urgent patients to be added on. If there is ever a time to be burned out, it’s during call weeks. Through the years I’ve developed a strategy that has helped me make the most of call week and any other difficult period. I think of the three C’s: Challenges, Colleagues, Charging.
 

Challenges

First, I mark difficult weeks on my calendar in red. Do I have extra clinics? Is it post vacation? Am I giving a talk? Then, I set up challenges. For example, I knew last week’s call was going to be tough. So, each morning I challenged myself to do 100 push-ups in 2 minutes, 12 pull-ups, and run 2 miles. I also set goals of plowing through my backlog of journals and upgrading my EHR shortcuts and order sets.

Colleagues

A Navy SEAL training instructor once told me the key to success in BUD/S (the grueling 6-month SEAL training course), is to take care of your teammates:“When you’re focused on the guy to your right and the guy to your left, you find inner strength to endure suffering.” No matter how busy I am, when my phone rings or I get a text, I think to myself, Good, one of my partners needs my help. Framing it that way makes any added work feel lighter.

(Re)Charging

Lastly, I schedule time to recharge and recover. For example, this morning instead of going to the gym, I had a cappuccino and read the entire Sunday New York Times. Later today, my wife and I are going to see Thor: Ragnarok. In reclining seats. With a craft beer.

My call week was sometimes easy and occasionally arduous. Yet, I taught an ER resident how to recognize zoster in its very early stages. I learned the difference between erythema multiforme major and mycoplasma-induced rash with mucositis, and I reassured a family that their hospitalized 9-year-old was going to be just fine. I didn’t miss a workout (however, no SEAL instructor would have credited my pathetic pull-ups #11 and #12).

My next call isn’t long off, and soon, I must work on a big presentation. Medicine is a marathon, punctuated by sprinting. During stressful periods, I challenge myself physically and mentally, focus on helping others, and take the time to rest and recharge after. I think it has helped me beat burnout, I hope it helps you too.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com

 

My chest and back are sore this week because I was on call last week. It’s my secret to beating burnout. Just keep reading.

The phrase “dermatologist burnout” may seem as oxymoronic as jumbo shrimp, yet both are real. Our work is easier than some other physicians’. Dermatologists don’t sleep in the hospital, and we have many fewer dope-seeking or dying patients. Yet we suffer the same EHR frustrations as any physician. We struggle with an ever-increasing volume of patients and regulations which stultify our ability to care for patients.

[polldaddy:9875293]

According to a recent Mayo Clinic Proceedings study, dermatologists had the highest increase in burnout from 32% to 57% (Mayo Clin Proc. 2015 Dec;90[12]:1600-13). Although some have it worse than others, all physicians today are at high risk. Changing external factors is difficult, but modifying internal aspects of burnout can help.

In my department, we take call a week at a time. While on call, doctors from hospitals, clinics, and ERs call and text us. There are also urgent patients to be added on. If there is ever a time to be burned out, it’s during call weeks. Through the years I’ve developed a strategy that has helped me make the most of call week and any other difficult period. I think of the three C’s: Challenges, Colleagues, Charging.
 

Challenges

First, I mark difficult weeks on my calendar in red. Do I have extra clinics? Is it post vacation? Am I giving a talk? Then, I set up challenges. For example, I knew last week’s call was going to be tough. So, each morning I challenged myself to do 100 push-ups in 2 minutes, 12 pull-ups, and run 2 miles. I also set goals of plowing through my backlog of journals and upgrading my EHR shortcuts and order sets.

Colleagues

A Navy SEAL training instructor once told me the key to success in BUD/S (the grueling 6-month SEAL training course), is to take care of your teammates:“When you’re focused on the guy to your right and the guy to your left, you find inner strength to endure suffering.” No matter how busy I am, when my phone rings or I get a text, I think to myself, Good, one of my partners needs my help. Framing it that way makes any added work feel lighter.

(Re)Charging

Lastly, I schedule time to recharge and recover. For example, this morning instead of going to the gym, I had a cappuccino and read the entire Sunday New York Times. Later today, my wife and I are going to see Thor: Ragnarok. In reclining seats. With a craft beer.

My call week was sometimes easy and occasionally arduous. Yet, I taught an ER resident how to recognize zoster in its very early stages. I learned the difference between erythema multiforme major and mycoplasma-induced rash with mucositis, and I reassured a family that their hospitalized 9-year-old was going to be just fine. I didn’t miss a workout (however, no SEAL instructor would have credited my pathetic pull-ups #11 and #12).

My next call isn’t long off, and soon, I must work on a big presentation. Medicine is a marathon, punctuated by sprinting. During stressful periods, I challenge myself physically and mentally, focus on helping others, and take the time to rest and recharge after. I think it has helped me beat burnout, I hope it helps you too.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com

 

Compliant patients are all alike; every noncompliant patient is obstinate in his or her own way. Because of this, persuading patients to make good choices is rarely easy and never universal.

At Kaiser Permanente, we have begun in earnest providing flu shots. Every department participates (even dermatology) with a goal of vaccinating every eligible patient. Most patients want their shot. When patients decline, it’s game on. A rare few decline for justifiable reasons such as an allergy. Most say “no” for flawed reasons: “I never get the flu,” “The shot always gives me the flu,” and “I don’t believe in vaccines,” are common ones.

jabkitticha/Thinkstock

There is no single way to persuade patients, even when they are wrong. Most of us learn successful techniques only through years of experience. What if there were methods that could help? There are: The field of behavioral economics, made mainstream by people like 2017 Nobel Laureate Richard Thaler, have much to offer us in medicine. We now understand that patients, like all people, don’t always behave rationally. They sometimes make decisions based on misinformation and fall prey to cognitive biases and pitfalls. In particular, patients often fail to weigh future consequences, called present-bias, and choose to continue their past behavior even when detrimental to their health, called status quo bias.

Fortunately, we can help them. Here are techniques I learned while working on my MBA that I’ve found useful in persuading patients to make better choices:
 

• The “everyone is doing it” technique. At KP, we’ve put up boards with the iconic goal thermometer showing how many flu shots we need to reach our objective. When patients see we’ve given over 1,000 shots in dermatology in just 2 weeks, this technique helps convince them. Patients prefer to be like others rather than to stand out, particularly when there is uncertainty.
• The “this is who you are technique.” Patients hate to be seen as inconsistent. In fact, we are all more likely to make a choice seen as consistent with who we are rather than change our mind, even if doing so is a better choice. Highlight how they have previously shown good decision making and healthy behaviors and point out how getting vaccinated is consonant with who they are. For example: “Being a vegan, you are clearly someone who takes care of her health. Getting the vaccine is similar to choosing to eat plants. It’s what healthy people like you do.”
• The “well, that’s not like you” technique. Here, you point out how their choice is inconsistent with their previous choices. You might say, “Why would you get the hepatitis A vaccine last week and not the flu shot today?” Like the previous technique, this creates cognitive dissonance. You might soften the approach by saying, “You might have thought this,” or “I’m sure you didn’t realize.”
• The emotional decision approach. Making the risk seem real and imminent can combat future discounting. One example might be: “We have had several people hospitalized and one death from the flu in San Diego already.” Use stories and descriptive language to make the risk salient.
• The use your authority approach. The long coat does matter. A more modern version of the paternalistic physician is referred to as “asymmetric” or “light paternalism,” and we should recognize that it might be used to save a life. One example is: “I advise you to get the flu shot because I care about you, and I’m worried you might end up in the hospital or worse if you don’t get it.” There’s a reason why tobacco companies once used doctors in white coats to sell cigarettes – we can be quite persuasive.

Patients are free to make choices, however good or poor. Persuading them to choose good is our work as doctors. I found these techniques can help patients make any number of good choices and aren’t limited to vaccines. They can be used for smoking cessation, exercise, physical therapy, unhealthy drinking, and medication adherence to name a few. I hope using them makes you a little better at your work, too.

“A great deal of literature has been distributed, casting discredit upon the value of vaccination ... I do not see how any one ... who is familiar with the history of the subject, and who has any capacity left for clear judgment, can doubt its value.” – William Osler

Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

Compliant patients are all alike; every noncompliant patient is obstinate in his or her own way. Because of this, persuading patients to make good choices is rarely easy and never universal.

At Kaiser Permanente, we have begun in earnest providing flu shots. Every department participates (even dermatology) with a goal of vaccinating every eligible patient. Most patients want their shot. When patients decline, it’s game on. A rare few decline for justifiable reasons such as an allergy. Most say “no” for flawed reasons: “I never get the flu,” “The shot always gives me the flu,” and “I don’t believe in vaccines,” are common ones.

jabkitticha/Thinkstock

There is no single way to persuade patients, even when they are wrong. Most of us learn successful techniques only through years of experience. What if there were methods that could help? There are: The field of behavioral economics, made mainstream by people like 2017 Nobel Laureate Richard Thaler, have much to offer us in medicine. We now understand that patients, like all people, don’t always behave rationally. They sometimes make decisions based on misinformation and fall prey to cognitive biases and pitfalls. In particular, patients often fail to weigh future consequences, called present-bias, and choose to continue their past behavior even when detrimental to their health, called status quo bias.

Fortunately, we can help them. Here are techniques I learned while working on my MBA that I’ve found useful in persuading patients to make better choices:
 

• The “everyone is doing it” technique. At KP, we’ve put up boards with the iconic goal thermometer showing how many flu shots we need to reach our objective. When patients see we’ve given over 1,000 shots in dermatology in just 2 weeks, this technique helps convince them. Patients prefer to be like others rather than to stand out, particularly when there is uncertainty.
• The “this is who you are technique.” Patients hate to be seen as inconsistent. In fact, we are all more likely to make a choice seen as consistent with who we are rather than change our mind, even if doing so is a better choice. Highlight how they have previously shown good decision making and healthy behaviors and point out how getting vaccinated is consonant with who they are. For example: “Being a vegan, you are clearly someone who takes care of her health. Getting the vaccine is similar to choosing to eat plants. It’s what healthy people like you do.”
• The “well, that’s not like you” technique. Here, you point out how their choice is inconsistent with their previous choices. You might say, “Why would you get the hepatitis A vaccine last week and not the flu shot today?” Like the previous technique, this creates cognitive dissonance. You might soften the approach by saying, “You might have thought this,” or “I’m sure you didn’t realize.”
• The emotional decision approach. Making the risk seem real and imminent can combat future discounting. One example might be: “We have had several people hospitalized and one death from the flu in San Diego already.” Use stories and descriptive language to make the risk salient.
• The use your authority approach. The long coat does matter. A more modern version of the paternalistic physician is referred to as “asymmetric” or “light paternalism,” and we should recognize that it might be used to save a life. One example is: “I advise you to get the flu shot because I care about you, and I’m worried you might end up in the hospital or worse if you don’t get it.” There’s a reason why tobacco companies once used doctors in white coats to sell cigarettes – we can be quite persuasive.

Patients are free to make choices, however good or poor. Persuading them to choose good is our work as doctors. I found these techniques can help patients make any number of good choices and aren’t limited to vaccines. They can be used for smoking cessation, exercise, physical therapy, unhealthy drinking, and medication adherence to name a few. I hope using them makes you a little better at your work, too.

“A great deal of literature has been distributed, casting discredit upon the value of vaccination ... I do not see how any one ... who is familiar with the history of the subject, and who has any capacity left for clear judgment, can doubt its value.” – William Osler

Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

Compliant patients are all alike; every noncompliant patient is obstinate in his or her own way. Because of this, persuading patients to make good choices is rarely easy and never universal.

At Kaiser Permanente, we have begun in earnest providing flu shots. Every department participates (even dermatology) with a goal of vaccinating every eligible patient. Most patients want their shot. When patients decline, it’s game on. A rare few decline for justifiable reasons such as an allergy. Most say “no” for flawed reasons: “I never get the flu,” “The shot always gives me the flu,” and “I don’t believe in vaccines,” are common ones.

jabkitticha/Thinkstock

There is no single way to persuade patients, even when they are wrong. Most of us learn successful techniques only through years of experience. What if there were methods that could help? There are: The field of behavioral economics, made mainstream by people like 2017 Nobel Laureate Richard Thaler, have much to offer us in medicine. We now understand that patients, like all people, don’t always behave rationally. They sometimes make decisions based on misinformation and fall prey to cognitive biases and pitfalls. In particular, patients often fail to weigh future consequences, called present-bias, and choose to continue their past behavior even when detrimental to their health, called status quo bias.

Fortunately, we can help them. Here are techniques I learned while working on my MBA that I’ve found useful in persuading patients to make better choices:
 

• The “everyone is doing it” technique. At KP, we’ve put up boards with the iconic goal thermometer showing how many flu shots we need to reach our objective. When patients see we’ve given over 1,000 shots in dermatology in just 2 weeks, this technique helps convince them. Patients prefer to be like others rather than to stand out, particularly when there is uncertainty.
• The “this is who you are technique.” Patients hate to be seen as inconsistent. In fact, we are all more likely to make a choice seen as consistent with who we are rather than change our mind, even if doing so is a better choice. Highlight how they have previously shown good decision making and healthy behaviors and point out how getting vaccinated is consonant with who they are. For example: “Being a vegan, you are clearly someone who takes care of her health. Getting the vaccine is similar to choosing to eat plants. It’s what healthy people like you do.”
• The “well, that’s not like you” technique. Here, you point out how their choice is inconsistent with their previous choices. You might say, “Why would you get the hepatitis A vaccine last week and not the flu shot today?” Like the previous technique, this creates cognitive dissonance. You might soften the approach by saying, “You might have thought this,” or “I’m sure you didn’t realize.”
• The emotional decision approach. Making the risk seem real and imminent can combat future discounting. One example might be: “We have had several people hospitalized and one death from the flu in San Diego already.” Use stories and descriptive language to make the risk salient.
• The use your authority approach. The long coat does matter. A more modern version of the paternalistic physician is referred to as “asymmetric” or “light paternalism,” and we should recognize that it might be used to save a life. One example is: “I advise you to get the flu shot because I care about you, and I’m worried you might end up in the hospital or worse if you don’t get it.” There’s a reason why tobacco companies once used doctors in white coats to sell cigarettes – we can be quite persuasive.

Patients are free to make choices, however good or poor. Persuading them to choose good is our work as doctors. I found these techniques can help patients make any number of good choices and aren’t limited to vaccines. They can be used for smoking cessation, exercise, physical therapy, unhealthy drinking, and medication adherence to name a few. I hope using them makes you a little better at your work, too.

“A great deal of literature has been distributed, casting discredit upon the value of vaccination ... I do not see how any one ... who is familiar with the history of the subject, and who has any capacity left for clear judgment, can doubt its value.” – William Osler

Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

I have to give a talk. Get this – the topic is how to give a good talk. Very meta.

I’ve given a hundred or so presentations in my career, including a couple of TEDx talks. With each one, I try to get a little better. Effective speaking is always simple but never easy. Let me share with you a few things I’ve learned.

Even if you don’t want to become a TEDMED phenom, you should know a few fundamentals. Giving good talks enhances your reputation and can jump-start your practice or career. For any talk, you must master three things: preparation, content, and delivery.

First, prepare. Just as no football team, no matter how dominant, would play without exhaustive preparation, no presenter should speak without thoroughly preparing. No matter how slick your slides, if the audience is not interested, you’ll lose. The purpose of a presentation is to affect your audience – to teach them, to move them, to inspire them. Therefore, you must know your audience. A seasoned private practice dermatologist will care about different issues than a second-year resident or an academic psoriasis expert. Ask yourself, Who will attend? Why are they coming? What do they hope to get out of your lecture? Perusing the agenda and seeing other speakers’ topics can also help you understand your audience. These factors should help determine both your content and delivery style.

Just as we choose movies with actors we like, people choose speakers they want to see. Who you are matters. If you are introduced by an emcee, then be sure he or she bills you as a star. However, don’t try to be someone you aren’t – If I gave a talk on robotic prostate surgery, I’d be sure to lose no matter how witty I was. That’s why writing your own intro can sometimes be your best option.

Next up: content. It’s the king of speaking as well as marketing. Although you can pick up points for style, if you want to be remembered, you have to deliver something worth remembering. This starts with your preparation. Resist the temptation to focus exclusively on your slides. As in writing, it is best to brainstorm what you want to cover, then outline your ideas, then fill in content with slides.

Most presentations require visuals; however, there are times when you can do without. Go for it! Nothing is more freeing or more intimate than you one-on-one with your audience. If you must have slides, then follow the one-idea one-slide rule. Slides crammed with information actually detract from your presentation. Here’s a tip: Write only what you can fit with a marker on a Post-it pad. Then, laying out the Post-its, you can rearrange slides getting a feel for the flow or argument of the talk.

Did you ever wonder why headlines like, “Why I never use this suture” and “How I cut my EMR documentation time in half” work so well? They tap into a core human instinct: curiosity. Your opening should introduce some sense of wonder. What is she going to share? Really, how does he do that? Starting with a problem and taking them to a solution is also a great game plan that will often yield success.

When it comes to slides, be clean and concise. Taking a cue from wildly popular TED talks, use images and art instead of words. Use sentence fragments, not sentences, and limit content to the width of the slide (no easy feat). Sometimes you need the slide to prompt your talking point. Put only the data or fact you need and leave the rest at the bottom in your notes section.

Humor is almost always a good idea and more difficult to execute than most realize. Cartoons with captions don’t work. I know that’s hard for many of you to hear, but it’s true. Delete them from your decks. Go ahead, I’ll wait.

Instead, try finding something relevant to the audience that only they will find funny. Inside jokes not only have a higher chance of success, but will also help you bond with your audience. A joke about ICD10 as it relates to neurology is better than the funniest Calvin and Hobbes strip. Self-deprecating humor is always appreciated. I’m not among the gifted who can come up with a great one-liner on the spot. It’s OK to plan it ahead.

Once you’ve got your talk built, it’s time to run it. This is hard, as it requires planning to have your content done in time to rehearse. Find the discipline to do it. The first time you run it, you’ll likely realize that 1/3 of the content needs to be cut. Cut it. Indeed, plan to run 10% less than the time allotted. Leave your audience wanting for more rather than wishing for less.

As I’ve learned, your talking points and slides will always be most appreciated in your own head. Keeping to time shows your respect for your audience and makes you appear polished.

The day of, get to the venue well ahead of time and check the sound, lights, and temperature. All of your preparation will be for naught if they can’t hear you, see your slides, or feel their fingers due to the frigid AC.

One of the reasons I love giving talks is because they are live. You and your audience are intimately engaged, and like any conversation, you’ll sense how it’s going. Are they looking at you or at their phones? Do they seem bored? Do they laugh easily, even when you weren’t expecting them to? Observe what is happening and adjust your performance accordingly. Are you losing them? Pause. Let them catch up. Are you putting them to sleep? Pick up the pace. Try that bit of humor now.

Your delivery is critical to your success. If you’re on the dais and behind the podium of a large audience, then be big, Greek theatre big, which means bigger facial expressions and bigger arm and hand gestures. Vary the tone and pace of your voice. Speed it up to build excitement. Slow down and lower your pitch for gravity and authority. Pause for 3-4 seconds to create suspense and drama.

Leave time for discussion when possible. Invite the audience to engage by asking, What do you think? Finally, on the plane ride home, or even as you walk back from the auditorium to your clinic, think about your presentation: What worked? What fell flat? What roused the audience? How can you deliver it better next time?

Even if it didn’t go well, remember, there’s always next week. It’s on to Cincinnati.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

I have to give a talk. Get this – the topic is how to give a good talk. Very meta.

I’ve given a hundred or so presentations in my career, including a couple of TEDx talks. With each one, I try to get a little better. Effective speaking is always simple but never easy. Let me share with you a few things I’ve learned.

Even if you don’t want to become a TEDMED phenom, you should know a few fundamentals. Giving good talks enhances your reputation and can jump-start your practice or career. For any talk, you must master three things: preparation, content, and delivery.

First, prepare. Just as no football team, no matter how dominant, would play without exhaustive preparation, no presenter should speak without thoroughly preparing. No matter how slick your slides, if the audience is not interested, you’ll lose. The purpose of a presentation is to affect your audience – to teach them, to move them, to inspire them. Therefore, you must know your audience. A seasoned private practice dermatologist will care about different issues than a second-year resident or an academic psoriasis expert. Ask yourself, Who will attend? Why are they coming? What do they hope to get out of your lecture? Perusing the agenda and seeing other speakers’ topics can also help you understand your audience. These factors should help determine both your content and delivery style.

Just as we choose movies with actors we like, people choose speakers they want to see. Who you are matters. If you are introduced by an emcee, then be sure he or she bills you as a star. However, don’t try to be someone you aren’t – If I gave a talk on robotic prostate surgery, I’d be sure to lose no matter how witty I was. That’s why writing your own intro can sometimes be your best option.

Next up: content. It’s the king of speaking as well as marketing. Although you can pick up points for style, if you want to be remembered, you have to deliver something worth remembering. This starts with your preparation. Resist the temptation to focus exclusively on your slides. As in writing, it is best to brainstorm what you want to cover, then outline your ideas, then fill in content with slides.

Most presentations require visuals; however, there are times when you can do without. Go for it! Nothing is more freeing or more intimate than you one-on-one with your audience. If you must have slides, then follow the one-idea one-slide rule. Slides crammed with information actually detract from your presentation. Here’s a tip: Write only what you can fit with a marker on a Post-it pad. Then, laying out the Post-its, you can rearrange slides getting a feel for the flow or argument of the talk.

Did you ever wonder why headlines like, “Why I never use this suture” and “How I cut my EMR documentation time in half” work so well? They tap into a core human instinct: curiosity. Your opening should introduce some sense of wonder. What is she going to share? Really, how does he do that? Starting with a problem and taking them to a solution is also a great game plan that will often yield success.

When it comes to slides, be clean and concise. Taking a cue from wildly popular TED talks, use images and art instead of words. Use sentence fragments, not sentences, and limit content to the width of the slide (no easy feat). Sometimes you need the slide to prompt your talking point. Put only the data or fact you need and leave the rest at the bottom in your notes section.

Humor is almost always a good idea and more difficult to execute than most realize. Cartoons with captions don’t work. I know that’s hard for many of you to hear, but it’s true. Delete them from your decks. Go ahead, I’ll wait.

Instead, try finding something relevant to the audience that only they will find funny. Inside jokes not only have a higher chance of success, but will also help you bond with your audience. A joke about ICD10 as it relates to neurology is better than the funniest Calvin and Hobbes strip. Self-deprecating humor is always appreciated. I’m not among the gifted who can come up with a great one-liner on the spot. It’s OK to plan it ahead.

Once you’ve got your talk built, it’s time to run it. This is hard, as it requires planning to have your content done in time to rehearse. Find the discipline to do it. The first time you run it, you’ll likely realize that 1/3 of the content needs to be cut. Cut it. Indeed, plan to run 10% less than the time allotted. Leave your audience wanting for more rather than wishing for less.

As I’ve learned, your talking points and slides will always be most appreciated in your own head. Keeping to time shows your respect for your audience and makes you appear polished.

The day of, get to the venue well ahead of time and check the sound, lights, and temperature. All of your preparation will be for naught if they can’t hear you, see your slides, or feel their fingers due to the frigid AC.

One of the reasons I love giving talks is because they are live. You and your audience are intimately engaged, and like any conversation, you’ll sense how it’s going. Are they looking at you or at their phones? Do they seem bored? Do they laugh easily, even when you weren’t expecting them to? Observe what is happening and adjust your performance accordingly. Are you losing them? Pause. Let them catch up. Are you putting them to sleep? Pick up the pace. Try that bit of humor now.

Your delivery is critical to your success. If you’re on the dais and behind the podium of a large audience, then be big, Greek theatre big, which means bigger facial expressions and bigger arm and hand gestures. Vary the tone and pace of your voice. Speed it up to build excitement. Slow down and lower your pitch for gravity and authority. Pause for 3-4 seconds to create suspense and drama.

Leave time for discussion when possible. Invite the audience to engage by asking, What do you think? Finally, on the plane ride home, or even as you walk back from the auditorium to your clinic, think about your presentation: What worked? What fell flat? What roused the audience? How can you deliver it better next time?

Even if it didn’t go well, remember, there’s always next week. It’s on to Cincinnati.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

I have to give a talk. Get this – the topic is how to give a good talk. Very meta.

I’ve given a hundred or so presentations in my career, including a couple of TEDx talks. With each one, I try to get a little better. Effective speaking is always simple but never easy. Let me share with you a few things I’ve learned.

Even if you don’t want to become a TEDMED phenom, you should know a few fundamentals. Giving good talks enhances your reputation and can jump-start your practice or career. For any talk, you must master three things: preparation, content, and delivery.

First, prepare. Just as no football team, no matter how dominant, would play without exhaustive preparation, no presenter should speak without thoroughly preparing. No matter how slick your slides, if the audience is not interested, you’ll lose. The purpose of a presentation is to affect your audience – to teach them, to move them, to inspire them. Therefore, you must know your audience. A seasoned private practice dermatologist will care about different issues than a second-year resident or an academic psoriasis expert. Ask yourself, Who will attend? Why are they coming? What do they hope to get out of your lecture? Perusing the agenda and seeing other speakers’ topics can also help you understand your audience. These factors should help determine both your content and delivery style.

Just as we choose movies with actors we like, people choose speakers they want to see. Who you are matters. If you are introduced by an emcee, then be sure he or she bills you as a star. However, don’t try to be someone you aren’t – If I gave a talk on robotic prostate surgery, I’d be sure to lose no matter how witty I was. That’s why writing your own intro can sometimes be your best option.

Next up: content. It’s the king of speaking as well as marketing. Although you can pick up points for style, if you want to be remembered, you have to deliver something worth remembering. This starts with your preparation. Resist the temptation to focus exclusively on your slides. As in writing, it is best to brainstorm what you want to cover, then outline your ideas, then fill in content with slides.

Most presentations require visuals; however, there are times when you can do without. Go for it! Nothing is more freeing or more intimate than you one-on-one with your audience. If you must have slides, then follow the one-idea one-slide rule. Slides crammed with information actually detract from your presentation. Here’s a tip: Write only what you can fit with a marker on a Post-it pad. Then, laying out the Post-its, you can rearrange slides getting a feel for the flow or argument of the talk.

Did you ever wonder why headlines like, “Why I never use this suture” and “How I cut my EMR documentation time in half” work so well? They tap into a core human instinct: curiosity. Your opening should introduce some sense of wonder. What is she going to share? Really, how does he do that? Starting with a problem and taking them to a solution is also a great game plan that will often yield success.

When it comes to slides, be clean and concise. Taking a cue from wildly popular TED talks, use images and art instead of words. Use sentence fragments, not sentences, and limit content to the width of the slide (no easy feat). Sometimes you need the slide to prompt your talking point. Put only the data or fact you need and leave the rest at the bottom in your notes section.

Humor is almost always a good idea and more difficult to execute than most realize. Cartoons with captions don’t work. I know that’s hard for many of you to hear, but it’s true. Delete them from your decks. Go ahead, I’ll wait.

Instead, try finding something relevant to the audience that only they will find funny. Inside jokes not only have a higher chance of success, but will also help you bond with your audience. A joke about ICD10 as it relates to neurology is better than the funniest Calvin and Hobbes strip. Self-deprecating humor is always appreciated. I’m not among the gifted who can come up with a great one-liner on the spot. It’s OK to plan it ahead.

Once you’ve got your talk built, it’s time to run it. This is hard, as it requires planning to have your content done in time to rehearse. Find the discipline to do it. The first time you run it, you’ll likely realize that 1/3 of the content needs to be cut. Cut it. Indeed, plan to run 10% less than the time allotted. Leave your audience wanting for more rather than wishing for less.

As I’ve learned, your talking points and slides will always be most appreciated in your own head. Keeping to time shows your respect for your audience and makes you appear polished.

The day of, get to the venue well ahead of time and check the sound, lights, and temperature. All of your preparation will be for naught if they can’t hear you, see your slides, or feel their fingers due to the frigid AC.

One of the reasons I love giving talks is because they are live. You and your audience are intimately engaged, and like any conversation, you’ll sense how it’s going. Are they looking at you or at their phones? Do they seem bored? Do they laugh easily, even when you weren’t expecting them to? Observe what is happening and adjust your performance accordingly. Are you losing them? Pause. Let them catch up. Are you putting them to sleep? Pick up the pace. Try that bit of humor now.

Your delivery is critical to your success. If you’re on the dais and behind the podium of a large audience, then be big, Greek theatre big, which means bigger facial expressions and bigger arm and hand gestures. Vary the tone and pace of your voice. Speed it up to build excitement. Slow down and lower your pitch for gravity and authority. Pause for 3-4 seconds to create suspense and drama.

Leave time for discussion when possible. Invite the audience to engage by asking, What do you think? Finally, on the plane ride home, or even as you walk back from the auditorium to your clinic, think about your presentation: What worked? What fell flat? What roused the audience? How can you deliver it better next time?

Even if it didn’t go well, remember, there’s always next week. It’s on to Cincinnati.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

“How we spend our days is, of course, how we spend our lives.” – Annie Dillard

It’s 4:40 a.m. and I’ve got two items checked off my list. As I stir my coffee, made the same way each day, I’m engaged in my morning ritual. It begins at 4:30 a.m. and ends with me ready for whatever comes that day.

In our life-hacking world, morning rituals are hotter than my mug of Italian roast. Blog posts, magazine articles, podcasts, and books, such as the New York Times best-selling “Make Your Bed,” (New York: Hachette Book Group, 2017) written by a former Navy SEAL, all argue that the secret to a successful day, and life, lies in the start. But do morning rituals apply to us doctors?

Unlike entrepreneurs, coders, or creatives whose days are self-directed, doctors’ days are dictated by rigid clinic schedules and OR times. For many physicians, the morning ritual consists of signing out last night’s admissions or previewing scans for this morning’s cases. And unlike career tyros, you’ve already developed habits that yield achievement. Yet, it isn’t enough. Doctors are consistently focused on getting faster, better, smarter. How can I keep up with my journals, squeeze in one more consult, round faster? To deal with the ever-expanding demands of medicine, you’ll need a framework upon which to build your day. We needn’t look to blogs for advice.

Dr. William Osler, the father of modern medicine, had the answer a century ago: “The day [can] be predicted from the first waking hour. The start is everything,” he advised Yale medical students in his “Way of Life” address. “Live with day-tight compartments,” and focus on “what lies clearly at hand.” He encouraged them to develop focus so they might avoid “indecision and worry,” and fluster and flurry. Today, we call it “mindfulness,” so we might avoid “burnout.”

Dr. Osler, who read Ben Franklin, no doubt would have been familiar with Franklin’s recommendations: 5 a.m.: “Rise, wash, and address Powerful Goodness [prayer]! Contrive day’s business and take the resolution of the day; prosecute the present study, and breakfast.” Tested by over 200 years of self-help seekers, this is a good start. Through years of research and experimentation, I’ve refined this to the five morning activities that matter most:
 

Hue/amanaimagesRF/Thinkstock

1. Wake up early. You can’t walk into a patient’s room without reviewing their chart or into an operating room without prepping. Don’t walk into your day unprepared. I start 2 hours before arriving at clinic; you might need only 20 minutes. Experiment to find what works for you.

2. Reflect on yesterday. Your brain is coming online in the few minutes after waking; while booting, review what happened yesterday. According to an article on-line in the Harvard Business Review (hbr.org), top CEOs make a habit of reviewing their actions and decisions to deconstruct both successes and failures. Replaying your day, like reviewing game film, is key to getting better.

3. Exercise. Physical activity improves memory, and cognition and aerobics are particularly effective. I vary both my activities and length of time in the gym. Ten minutes, if done all-out, might be all you need.

4. Preview and plan. In the excellent “How to Have a Good Day,” (New York: Penguin Random House, 2016) author Caroline Webb recommends an approach from three angles: “Aim, Attitude, and Attention.” Aim: What are the most important activities today? Who will you meet? What might you say to be successful? Attitude is key and often overlooked. Perhaps you have a patient you’d prefer not to see or a colleague with whom you need to have a difficult conversation. Reflect on how your attitude will impact the outcome. Lastly, attention must be paid. It’s as relevant today as when Dr. Osler recommended it. What must you focus on today to be successful?

5. Breathe deeply. Developing the habit of mindful breathing can help you become more resilient and focused. Spend 10-30 minutes breathing deeply and mindfully. You can take this time to pray as Franklin did or for priming as self-help guru Tony Robbins recommends today. Whichever you choose, be deliberate and consistent.

I’m invariably energized when I finish my morning routine. Even on my worst procrastination days, I have the satisfaction of getting at least five things done. Much of today will be out of my control: Patients will arrive late and surgeries might run over. But this morning was all mine. By faithfully carrying out this ritual I’m not only ready each day, I’m better each day.

What’s your morning ritual?
 

 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

“How we spend our days is, of course, how we spend our lives.” – Annie Dillard

It’s 4:40 a.m. and I’ve got two items checked off my list. As I stir my coffee, made the same way each day, I’m engaged in my morning ritual. It begins at 4:30 a.m. and ends with me ready for whatever comes that day.

In our life-hacking world, morning rituals are hotter than my mug of Italian roast. Blog posts, magazine articles, podcasts, and books, such as the New York Times best-selling “Make Your Bed,” (New York: Hachette Book Group, 2017) written by a former Navy SEAL, all argue that the secret to a successful day, and life, lies in the start. But do morning rituals apply to us doctors?

Unlike entrepreneurs, coders, or creatives whose days are self-directed, doctors’ days are dictated by rigid clinic schedules and OR times. For many physicians, the morning ritual consists of signing out last night’s admissions or previewing scans for this morning’s cases. And unlike career tyros, you’ve already developed habits that yield achievement. Yet, it isn’t enough. Doctors are consistently focused on getting faster, better, smarter. How can I keep up with my journals, squeeze in one more consult, round faster? To deal with the ever-expanding demands of medicine, you’ll need a framework upon which to build your day. We needn’t look to blogs for advice.

Dr. William Osler, the father of modern medicine, had the answer a century ago: “The day [can] be predicted from the first waking hour. The start is everything,” he advised Yale medical students in his “Way of Life” address. “Live with day-tight compartments,” and focus on “what lies clearly at hand.” He encouraged them to develop focus so they might avoid “indecision and worry,” and fluster and flurry. Today, we call it “mindfulness,” so we might avoid “burnout.”

Dr. Osler, who read Ben Franklin, no doubt would have been familiar with Franklin’s recommendations: 5 a.m.: “Rise, wash, and address Powerful Goodness [prayer]! Contrive day’s business and take the resolution of the day; prosecute the present study, and breakfast.” Tested by over 200 years of self-help seekers, this is a good start. Through years of research and experimentation, I’ve refined this to the five morning activities that matter most:
 

Hue/amanaimagesRF/Thinkstock

1. Wake up early. You can’t walk into a patient’s room without reviewing their chart or into an operating room without prepping. Don’t walk into your day unprepared. I start 2 hours before arriving at clinic; you might need only 20 minutes. Experiment to find what works for you.

2. Reflect on yesterday. Your brain is coming online in the few minutes after waking; while booting, review what happened yesterday. According to an article on-line in the Harvard Business Review (hbr.org), top CEOs make a habit of reviewing their actions and decisions to deconstruct both successes and failures. Replaying your day, like reviewing game film, is key to getting better.

3. Exercise. Physical activity improves memory, and cognition and aerobics are particularly effective. I vary both my activities and length of time in the gym. Ten minutes, if done all-out, might be all you need.

4. Preview and plan. In the excellent “How to Have a Good Day,” (New York: Penguin Random House, 2016) author Caroline Webb recommends an approach from three angles: “Aim, Attitude, and Attention.” Aim: What are the most important activities today? Who will you meet? What might you say to be successful? Attitude is key and often overlooked. Perhaps you have a patient you’d prefer not to see or a colleague with whom you need to have a difficult conversation. Reflect on how your attitude will impact the outcome. Lastly, attention must be paid. It’s as relevant today as when Dr. Osler recommended it. What must you focus on today to be successful?

5. Breathe deeply. Developing the habit of mindful breathing can help you become more resilient and focused. Spend 10-30 minutes breathing deeply and mindfully. You can take this time to pray as Franklin did or for priming as self-help guru Tony Robbins recommends today. Whichever you choose, be deliberate and consistent.

I’m invariably energized when I finish my morning routine. Even on my worst procrastination days, I have the satisfaction of getting at least five things done. Much of today will be out of my control: Patients will arrive late and surgeries might run over. But this morning was all mine. By faithfully carrying out this ritual I’m not only ready each day, I’m better each day.

What’s your morning ritual?
 

 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

“How we spend our days is, of course, how we spend our lives.” – Annie Dillard

It’s 4:40 a.m. and I’ve got two items checked off my list. As I stir my coffee, made the same way each day, I’m engaged in my morning ritual. It begins at 4:30 a.m. and ends with me ready for whatever comes that day.

In our life-hacking world, morning rituals are hotter than my mug of Italian roast. Blog posts, magazine articles, podcasts, and books, such as the New York Times best-selling “Make Your Bed,” (New York: Hachette Book Group, 2017) written by a former Navy SEAL, all argue that the secret to a successful day, and life, lies in the start. But do morning rituals apply to us doctors?

Unlike entrepreneurs, coders, or creatives whose days are self-directed, doctors’ days are dictated by rigid clinic schedules and OR times. For many physicians, the morning ritual consists of signing out last night’s admissions or previewing scans for this morning’s cases. And unlike career tyros, you’ve already developed habits that yield achievement. Yet, it isn’t enough. Doctors are consistently focused on getting faster, better, smarter. How can I keep up with my journals, squeeze in one more consult, round faster? To deal with the ever-expanding demands of medicine, you’ll need a framework upon which to build your day. We needn’t look to blogs for advice.

Dr. William Osler, the father of modern medicine, had the answer a century ago: “The day [can] be predicted from the first waking hour. The start is everything,” he advised Yale medical students in his “Way of Life” address. “Live with day-tight compartments,” and focus on “what lies clearly at hand.” He encouraged them to develop focus so they might avoid “indecision and worry,” and fluster and flurry. Today, we call it “mindfulness,” so we might avoid “burnout.”

Dr. Osler, who read Ben Franklin, no doubt would have been familiar with Franklin’s recommendations: 5 a.m.: “Rise, wash, and address Powerful Goodness [prayer]! Contrive day’s business and take the resolution of the day; prosecute the present study, and breakfast.” Tested by over 200 years of self-help seekers, this is a good start. Through years of research and experimentation, I’ve refined this to the five morning activities that matter most:
 

Hue/amanaimagesRF/Thinkstock

1. Wake up early. You can’t walk into a patient’s room without reviewing their chart or into an operating room without prepping. Don’t walk into your day unprepared. I start 2 hours before arriving at clinic; you might need only 20 minutes. Experiment to find what works for you.

2. Reflect on yesterday. Your brain is coming online in the few minutes after waking; while booting, review what happened yesterday. According to an article on-line in the Harvard Business Review (hbr.org), top CEOs make a habit of reviewing their actions and decisions to deconstruct both successes and failures. Replaying your day, like reviewing game film, is key to getting better.

3. Exercise. Physical activity improves memory, and cognition and aerobics are particularly effective. I vary both my activities and length of time in the gym. Ten minutes, if done all-out, might be all you need.

4. Preview and plan. In the excellent “How to Have a Good Day,” (New York: Penguin Random House, 2016) author Caroline Webb recommends an approach from three angles: “Aim, Attitude, and Attention.” Aim: What are the most important activities today? Who will you meet? What might you say to be successful? Attitude is key and often overlooked. Perhaps you have a patient you’d prefer not to see or a colleague with whom you need to have a difficult conversation. Reflect on how your attitude will impact the outcome. Lastly, attention must be paid. It’s as relevant today as when Dr. Osler recommended it. What must you focus on today to be successful?

5. Breathe deeply. Developing the habit of mindful breathing can help you become more resilient and focused. Spend 10-30 minutes breathing deeply and mindfully. You can take this time to pray as Franklin did or for priming as self-help guru Tony Robbins recommends today. Whichever you choose, be deliberate and consistent.

I’m invariably energized when I finish my morning routine. Even on my worst procrastination days, I have the satisfaction of getting at least five things done. Much of today will be out of my control: Patients will arrive late and surgeries might run over. But this morning was all mine. By faithfully carrying out this ritual I’m not only ready each day, I’m better each day.

What’s your morning ritual?
 

 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

Ten years ago, I was flying back from my last job interview – I did nearly 20 – and my wife and I were stuck: Should I take a lucrative private practice gig, an academic position, or join a group? We listed the pros and cons on several condensation-soaked Southwest Air napkins and agreed to make a decision before landing. (Fortunately, it was a cross country, BWI to SAN, flight).

I don’t know if I made the right decision. I’m sure I’d have enjoyed either a cosmetic practice or walking the halls with medical students in tow. I chose to join a medical group at Kaiser Permanente, and I’ve loved it. Working here has helped me become a better dermatologist, teammate, friend, and husband. It has also allowed me to embrace digital medicine a bit earlier and with less difficulty than most. You wouldn’t be reading my “Digital Doctor” column if I hadn’t.

When I started practicing, digital medicine referred only to EMRs and rare patient portals. I had a hunch that digital health might be a big deal. I didn’t realize, though, that the impact could be as big as the introduction of stethoscopes, perhaps more so. Digital has changed how patients receive care. It has changed how doctors deliver care. It has changed what it means to care. Touch is no longer a requirement to practice medicine, and, as a result, there are good and bad consequences.

Digital made medicine more accessible than ever. It also made medicine more of a commodity than ever. It turned us into the highest paid data entry clerks in the world. It changed the sacrosanct doctor-patient relationship. It has also presented us with the greatest opportunity in a thousand years. An opportunity to create a new medicine, one that is patient-centric, smart, affordable, efficient, and human. I started this column to explore the digital devices we doctors have and to find ways they might improve the care we give.

I’ve been in practice for 10 years, and I’m now the chief of service for a large dermatology group, as well as physician director for Healthcare Transformation for Kaiser Permanente, San Diego. My job is to help our physicians perform at their best both at work and in life. Through research, interviews, and my own practice, I’ve learned a lot and would like to share it with you.

Starting in September, I’ll broaden the scope of this column. No longer will it be just digital. Rather, it will be about you and how you can be the best you can be. We’ll explore tools, techniques, diet, exercise, and Jedi mind tricks to make you the fastest, smartest, happiest, healthiest, funniest (results may vary) doctor you can be. It’s time to take this column, and you, to the next level – the Optimized Doctor. I can hardly wait.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente, San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

Ten years ago, I was flying back from my last job interview – I did nearly 20 – and my wife and I were stuck: Should I take a lucrative private practice gig, an academic position, or join a group? We listed the pros and cons on several condensation-soaked Southwest Air napkins and agreed to make a decision before landing. (Fortunately, it was a cross country, BWI to SAN, flight).

I don’t know if I made the right decision. I’m sure I’d have enjoyed either a cosmetic practice or walking the halls with medical students in tow. I chose to join a medical group at Kaiser Permanente, and I’ve loved it. Working here has helped me become a better dermatologist, teammate, friend, and husband. It has also allowed me to embrace digital medicine a bit earlier and with less difficulty than most. You wouldn’t be reading my “Digital Doctor” column if I hadn’t.

When I started practicing, digital medicine referred only to EMRs and rare patient portals. I had a hunch that digital health might be a big deal. I didn’t realize, though, that the impact could be as big as the introduction of stethoscopes, perhaps more so. Digital has changed how patients receive care. It has changed how doctors deliver care. It has changed what it means to care. Touch is no longer a requirement to practice medicine, and, as a result, there are good and bad consequences.

Digital made medicine more accessible than ever. It also made medicine more of a commodity than ever. It turned us into the highest paid data entry clerks in the world. It changed the sacrosanct doctor-patient relationship. It has also presented us with the greatest opportunity in a thousand years. An opportunity to create a new medicine, one that is patient-centric, smart, affordable, efficient, and human. I started this column to explore the digital devices we doctors have and to find ways they might improve the care we give.

I’ve been in practice for 10 years, and I’m now the chief of service for a large dermatology group, as well as physician director for Healthcare Transformation for Kaiser Permanente, San Diego. My job is to help our physicians perform at their best both at work and in life. Through research, interviews, and my own practice, I’ve learned a lot and would like to share it with you.

Starting in September, I’ll broaden the scope of this column. No longer will it be just digital. Rather, it will be about you and how you can be the best you can be. We’ll explore tools, techniques, diet, exercise, and Jedi mind tricks to make you the fastest, smartest, happiest, healthiest, funniest (results may vary) doctor you can be. It’s time to take this column, and you, to the next level – the Optimized Doctor. I can hardly wait.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente, San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

Ten years ago, I was flying back from my last job interview – I did nearly 20 – and my wife and I were stuck: Should I take a lucrative private practice gig, an academic position, or join a group? We listed the pros and cons on several condensation-soaked Southwest Air napkins and agreed to make a decision before landing. (Fortunately, it was a cross country, BWI to SAN, flight).

I don’t know if I made the right decision. I’m sure I’d have enjoyed either a cosmetic practice or walking the halls with medical students in tow. I chose to join a medical group at Kaiser Permanente, and I’ve loved it. Working here has helped me become a better dermatologist, teammate, friend, and husband. It has also allowed me to embrace digital medicine a bit earlier and with less difficulty than most. You wouldn’t be reading my “Digital Doctor” column if I hadn’t.

When I started practicing, digital medicine referred only to EMRs and rare patient portals. I had a hunch that digital health might be a big deal. I didn’t realize, though, that the impact could be as big as the introduction of stethoscopes, perhaps more so. Digital has changed how patients receive care. It has changed how doctors deliver care. It has changed what it means to care. Touch is no longer a requirement to practice medicine, and, as a result, there are good and bad consequences.

Digital made medicine more accessible than ever. It also made medicine more of a commodity than ever. It turned us into the highest paid data entry clerks in the world. It changed the sacrosanct doctor-patient relationship. It has also presented us with the greatest opportunity in a thousand years. An opportunity to create a new medicine, one that is patient-centric, smart, affordable, efficient, and human. I started this column to explore the digital devices we doctors have and to find ways they might improve the care we give.

I’ve been in practice for 10 years, and I’m now the chief of service for a large dermatology group, as well as physician director for Healthcare Transformation for Kaiser Permanente, San Diego. My job is to help our physicians perform at their best both at work and in life. Through research, interviews, and my own practice, I’ve learned a lot and would like to share it with you.

Starting in September, I’ll broaden the scope of this column. No longer will it be just digital. Rather, it will be about you and how you can be the best you can be. We’ll explore tools, techniques, diet, exercise, and Jedi mind tricks to make you the fastest, smartest, happiest, healthiest, funniest (results may vary) doctor you can be. It’s time to take this column, and you, to the next level – the Optimized Doctor. I can hardly wait.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente, San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

I had just done an ED&C, scraping the friable tumor gently from her tissue paper–thin skin. “Yes,” I replied more loudly than our close proximity would warrant. “This is probably another basal cell carcinoma. When I get the pathology back, I’ll call you.” As my medical assistant was putting on the Band-Aid, my patient exclaimed, “Oh, no! “Don’t call me! Just send me an email, honey.”

At the time of the biopsy, she was 84 years old. My 84-year-old patient just chastised me for not using her preferred method of communication. She didn’t want a follow-up visit or a phone call. She wanted an email.

This reminded me of a recent study in the American Journal of Managed Care. The authors found that 83% of patients wanted to receive laboratory results online regardless of whether if the result was normal or abnormal (Am J Manag Care. 2017;23[4]:e113-e119). Their findings were skewed toward digital, which contrasts with a JAMA Dermatology study from 2015 that found more patients (67%) preferred a phone call to learn their skin biopsy results (JAMA Dermatol. 2015;151[5]:513-521). Pathology results might be different than lab results in patients’ views.

A certain trend is that patients want speed and convenience. Patients, like all humans, hate to wait. They hate to wait for an appointment. They hate to wait in waiting rooms. They hate to wait for answers. They also hate phone tag and long lines at the TSA (the latter will not be covered in this column).

For most of my biopsy results, I send a secure message – essentially an email – to my patients. I do this for benign results, as well as for treated cancerous growths. For serious diagnoses such as melanoma, I call them and sometimes arrange for a follow-up appointment.

Securely emailing results saves my patients, and me, bags of time. In fact, I not only send them the diagnosis, I include the pathology report. This might seem risky: What will patients make of “atypical melanocytic hyperplasia” or “cannot rule out invasive carcinoma” in their result? I can tell you, not much. After thousands of such emails, I’ve learned that follow-up replies are rare. And I cannot recall any follow-up question that was unhelpful. I’ve even had one correct our report (“Doc, it was on the left arm, not the right”) and at least one that led to a great discussion of different treatments based on my patient’s research.

If nothing else, I hope sending path reports directly to patients will eradicate the unhelpful past medical history of “skin cancer of unknown type or stage.” One biopsy result at a time, thousands of results later, each of my patients has his or her own copy to print and share with their next dermatologist, who might just be you.

“Yes, ma’am, I’ll email the result as soon as it’s back,” I replied, trying to save face. “Great!” she said, showing me her new iPhone, which was one generation advanced from my own. “I’ll get it right here!”

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

I had just done an ED&C, scraping the friable tumor gently from her tissue paper–thin skin. “Yes,” I replied more loudly than our close proximity would warrant. “This is probably another basal cell carcinoma. When I get the pathology back, I’ll call you.” As my medical assistant was putting on the Band-Aid, my patient exclaimed, “Oh, no! “Don’t call me! Just send me an email, honey.”

At the time of the biopsy, she was 84 years old. My 84-year-old patient just chastised me for not using her preferred method of communication. She didn’t want a follow-up visit or a phone call. She wanted an email.

This reminded me of a recent study in the American Journal of Managed Care. The authors found that 83% of patients wanted to receive laboratory results online regardless of whether if the result was normal or abnormal (Am J Manag Care. 2017;23[4]:e113-e119). Their findings were skewed toward digital, which contrasts with a JAMA Dermatology study from 2015 that found more patients (67%) preferred a phone call to learn their skin biopsy results (JAMA Dermatol. 2015;151[5]:513-521). Pathology results might be different than lab results in patients’ views.

A certain trend is that patients want speed and convenience. Patients, like all humans, hate to wait. They hate to wait for an appointment. They hate to wait in waiting rooms. They hate to wait for answers. They also hate phone tag and long lines at the TSA (the latter will not be covered in this column).

For most of my biopsy results, I send a secure message – essentially an email – to my patients. I do this for benign results, as well as for treated cancerous growths. For serious diagnoses such as melanoma, I call them and sometimes arrange for a follow-up appointment.

Securely emailing results saves my patients, and me, bags of time. In fact, I not only send them the diagnosis, I include the pathology report. This might seem risky: What will patients make of “atypical melanocytic hyperplasia” or “cannot rule out invasive carcinoma” in their result? I can tell you, not much. After thousands of such emails, I’ve learned that follow-up replies are rare. And I cannot recall any follow-up question that was unhelpful. I’ve even had one correct our report (“Doc, it was on the left arm, not the right”) and at least one that led to a great discussion of different treatments based on my patient’s research.

If nothing else, I hope sending path reports directly to patients will eradicate the unhelpful past medical history of “skin cancer of unknown type or stage.” One biopsy result at a time, thousands of results later, each of my patients has his or her own copy to print and share with their next dermatologist, who might just be you.

“Yes, ma’am, I’ll email the result as soon as it’s back,” I replied, trying to save face. “Great!” she said, showing me her new iPhone, which was one generation advanced from my own. “I’ll get it right here!”

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

I had just done an ED&C, scraping the friable tumor gently from her tissue paper–thin skin. “Yes,” I replied more loudly than our close proximity would warrant. “This is probably another basal cell carcinoma. When I get the pathology back, I’ll call you.” As my medical assistant was putting on the Band-Aid, my patient exclaimed, “Oh, no! “Don’t call me! Just send me an email, honey.”

At the time of the biopsy, she was 84 years old. My 84-year-old patient just chastised me for not using her preferred method of communication. She didn’t want a follow-up visit or a phone call. She wanted an email.

This reminded me of a recent study in the American Journal of Managed Care. The authors found that 83% of patients wanted to receive laboratory results online regardless of whether if the result was normal or abnormal (Am J Manag Care. 2017;23[4]:e113-e119). Their findings were skewed toward digital, which contrasts with a JAMA Dermatology study from 2015 that found more patients (67%) preferred a phone call to learn their skin biopsy results (JAMA Dermatol. 2015;151[5]:513-521). Pathology results might be different than lab results in patients’ views.

A certain trend is that patients want speed and convenience. Patients, like all humans, hate to wait. They hate to wait for an appointment. They hate to wait in waiting rooms. They hate to wait for answers. They also hate phone tag and long lines at the TSA (the latter will not be covered in this column).

For most of my biopsy results, I send a secure message – essentially an email – to my patients. I do this for benign results, as well as for treated cancerous growths. For serious diagnoses such as melanoma, I call them and sometimes arrange for a follow-up appointment.

Securely emailing results saves my patients, and me, bags of time. In fact, I not only send them the diagnosis, I include the pathology report. This might seem risky: What will patients make of “atypical melanocytic hyperplasia” or “cannot rule out invasive carcinoma” in their result? I can tell you, not much. After thousands of such emails, I’ve learned that follow-up replies are rare. And I cannot recall any follow-up question that was unhelpful. I’ve even had one correct our report (“Doc, it was on the left arm, not the right”) and at least one that led to a great discussion of different treatments based on my patient’s research.

If nothing else, I hope sending path reports directly to patients will eradicate the unhelpful past medical history of “skin cancer of unknown type or stage.” One biopsy result at a time, thousands of results later, each of my patients has his or her own copy to print and share with their next dermatologist, who might just be you.

“Yes, ma’am, I’ll email the result as soon as it’s back,” I replied, trying to save face. “Great!” she said, showing me her new iPhone, which was one generation advanced from my own. “I’ll get it right here!”

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

“He is a frequent flyer.” This is a term we reserve for patients who consume a lot of services. In the outpatient clinic, it’s the type of patient who comes for frequent visits, perhaps more often than medically necessary. Oftentimes, more than we’d like. They can be demanding. They can also be an invaluable resource: None of your patients will likely be more forthright with you than those who are so motivated.

I saw one of my frequent flyer patients recently. He, like all patients, has medical problems, but, unlike most, he never misses an opportunity to schedule an appointment to solve them. A once red-, now gray-haired engineer, he has quite a record of skin issues and has meticulously documented all of them himself.

“I read what you said about me,” he said, “in your last note ... It was not exactly what happened.” Oh. I suddenly realized that this wasn’t going to be an easy 10 minutes. “You wrote that we discussed the risks and benefits of freezing my keratoses. But you didn’t. You just froze them,” he pointed out.

I felt myself stiffening. I added him on to my schedule today because I’m a good guy, yet he wants a piece of me? Bring it.

“So, you can read my notes online?” I asked. “Yes,” he replied, “for some reason I can read all of my charts for dermatology visits.”

“Well, that’s because I volunteered for our OpenNotes program,” I said. As a participant, all of my patients are able to read all of my notes, if they choose to do so. They can access them but cannot make any changes.

Yeah, great idea, Jeff.

“I just want to know, why would you put that if you didn’t do it?” he asked.

“Well, it’s not a lie. We did discuss the risks and benefits of my freezing your AKs previously, right?” “Yes, we did,” he replied. “Did you not want me to freeze them?” I asked. “No, I did,” he answered. “I just wanted you to know that I can see what you write about me, and I don’t want you to say anything you don’t want me to read because I really trust you.”

“I won’t,” I said.

That’s because I understand that you are my patient, and all patients deserve my unmitigated care. It’s what makes me a doctor.

I’ve since added to my EMR template: “Previously discussed risks and benefits.” Not because it really matters. But because it matters to him. And that matters to me.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

“He is a frequent flyer.” This is a term we reserve for patients who consume a lot of services. In the outpatient clinic, it’s the type of patient who comes for frequent visits, perhaps more often than medically necessary. Oftentimes, more than we’d like. They can be demanding. They can also be an invaluable resource: None of your patients will likely be more forthright with you than those who are so motivated.

I saw one of my frequent flyer patients recently. He, like all patients, has medical problems, but, unlike most, he never misses an opportunity to schedule an appointment to solve them. A once red-, now gray-haired engineer, he has quite a record of skin issues and has meticulously documented all of them himself.

“I read what you said about me,” he said, “in your last note ... It was not exactly what happened.” Oh. I suddenly realized that this wasn’t going to be an easy 10 minutes. “You wrote that we discussed the risks and benefits of freezing my keratoses. But you didn’t. You just froze them,” he pointed out.

I felt myself stiffening. I added him on to my schedule today because I’m a good guy, yet he wants a piece of me? Bring it.

“So, you can read my notes online?” I asked. “Yes,” he replied, “for some reason I can read all of my charts for dermatology visits.”

“Well, that’s because I volunteered for our OpenNotes program,” I said. As a participant, all of my patients are able to read all of my notes, if they choose to do so. They can access them but cannot make any changes.

Yeah, great idea, Jeff.

“I just want to know, why would you put that if you didn’t do it?” he asked.

“Well, it’s not a lie. We did discuss the risks and benefits of my freezing your AKs previously, right?” “Yes, we did,” he replied. “Did you not want me to freeze them?” I asked. “No, I did,” he answered. “I just wanted you to know that I can see what you write about me, and I don’t want you to say anything you don’t want me to read because I really trust you.”

“I won’t,” I said.

That’s because I understand that you are my patient, and all patients deserve my unmitigated care. It’s what makes me a doctor.

I’ve since added to my EMR template: “Previously discussed risks and benefits.” Not because it really matters. But because it matters to him. And that matters to me.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

“He is a frequent flyer.” This is a term we reserve for patients who consume a lot of services. In the outpatient clinic, it’s the type of patient who comes for frequent visits, perhaps more often than medically necessary. Oftentimes, more than we’d like. They can be demanding. They can also be an invaluable resource: None of your patients will likely be more forthright with you than those who are so motivated.

I saw one of my frequent flyer patients recently. He, like all patients, has medical problems, but, unlike most, he never misses an opportunity to schedule an appointment to solve them. A once red-, now gray-haired engineer, he has quite a record of skin issues and has meticulously documented all of them himself.

“I read what you said about me,” he said, “in your last note ... It was not exactly what happened.” Oh. I suddenly realized that this wasn’t going to be an easy 10 minutes. “You wrote that we discussed the risks and benefits of freezing my keratoses. But you didn’t. You just froze them,” he pointed out.

I felt myself stiffening. I added him on to my schedule today because I’m a good guy, yet he wants a piece of me? Bring it.

“So, you can read my notes online?” I asked. “Yes,” he replied, “for some reason I can read all of my charts for dermatology visits.”

“Well, that’s because I volunteered for our OpenNotes program,” I said. As a participant, all of my patients are able to read all of my notes, if they choose to do so. They can access them but cannot make any changes.

Yeah, great idea, Jeff.

“I just want to know, why would you put that if you didn’t do it?” he asked.

“Well, it’s not a lie. We did discuss the risks and benefits of my freezing your AKs previously, right?” “Yes, we did,” he replied. “Did you not want me to freeze them?” I asked. “No, I did,” he answered. “I just wanted you to know that I can see what you write about me, and I don’t want you to say anything you don’t want me to read because I really trust you.”

“I won’t,” I said.

That’s because I understand that you are my patient, and all patients deserve my unmitigated care. It’s what makes me a doctor.

I’ve since added to my EMR template: “Previously discussed risks and benefits.” Not because it really matters. But because it matters to him. And that matters to me.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

I’m the new chief of service for the department of dermatology at Kaiser Permanente San Diego. We are hiring, so I’ve been working on my answers to astute questions about how we at Kaiser Permanente differ from other health systems and why I love our medical group. Many points of differentiation involve how we work as an integrated system and how we are compensated for effective care instead of simply volume of care.

Unfortunately, this week I’ve developed a better answer. A tragedy struck one of our doctors. As I reflect on how we recovered as a team, I’ve found that this story captures what it means to be a Permanente physician.

There are more than 70 dermatologists and staff in our department, and we all play a role in meeting the access needs of our patients. When one of our docs emailed me at 4 a.m. to tell me of a terrible catastrophe that struck her family, it set off a somber day for our team. In addition to offering our sympathy to her, we got right to work to help her. She needed time off to be with her family, and like all of us, she had full schedules booked for weeks ahead.

By 6 a.m., our administrative team was aware and working to recover. We canceled her clinic, and, using scheduling software, identified dermatologists in our department who might be able to help. With a few clicks, we reassigned patients from her to me and others who immediately volunteered. This was seamless as far as the patients would be concerned. Patients coming in within hours that morning were picked up by other doctors; one by one, they added them to their schedules.

Every doctor in San Diego has a Kaiser Permanente–issued smartphone. These allowed us to quickly email, text, and message to coordinate our efforts. Each of us dermatologists connected to her in-basket in our electronic medical record and set to work sending out her biopsy results, answering her secure email messages, and calling her patients. Others volunteered to cover her call, and we reassigned her teledermatology shifts with just a click. By noon, all her responsibilities as a dermatologist had been accounted for, allowing her to focus on her family. Teamwork was enabled by our digital system of care.

This story isn’t a sales pitch. We wish it had never happened. But it might be the best answer to the question of why we love working here. When we combine team plus technology to care for our patients and to care for each other, there’s no medical group we’d rather be.

I hope this is the last tragedy to befall us as a department. And if it is not, I hope to have just this same team around me to cope.

I’m sure others have similar stories of how technology helped them work as a team. Please send them to me at dermnews@frontlinemedcom.com; I’d like to write a follow-up piece.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. He is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

I’m the new chief of service for the department of dermatology at Kaiser Permanente San Diego. We are hiring, so I’ve been working on my answers to astute questions about how we at Kaiser Permanente differ from other health systems and why I love our medical group. Many points of differentiation involve how we work as an integrated system and how we are compensated for effective care instead of simply volume of care.

Unfortunately, this week I’ve developed a better answer. A tragedy struck one of our doctors. As I reflect on how we recovered as a team, I’ve found that this story captures what it means to be a Permanente physician.

There are more than 70 dermatologists and staff in our department, and we all play a role in meeting the access needs of our patients. When one of our docs emailed me at 4 a.m. to tell me of a terrible catastrophe that struck her family, it set off a somber day for our team. In addition to offering our sympathy to her, we got right to work to help her. She needed time off to be with her family, and like all of us, she had full schedules booked for weeks ahead.

By 6 a.m., our administrative team was aware and working to recover. We canceled her clinic, and, using scheduling software, identified dermatologists in our department who might be able to help. With a few clicks, we reassigned patients from her to me and others who immediately volunteered. This was seamless as far as the patients would be concerned. Patients coming in within hours that morning were picked up by other doctors; one by one, they added them to their schedules.

Every doctor in San Diego has a Kaiser Permanente–issued smartphone. These allowed us to quickly email, text, and message to coordinate our efforts. Each of us dermatologists connected to her in-basket in our electronic medical record and set to work sending out her biopsy results, answering her secure email messages, and calling her patients. Others volunteered to cover her call, and we reassigned her teledermatology shifts with just a click. By noon, all her responsibilities as a dermatologist had been accounted for, allowing her to focus on her family. Teamwork was enabled by our digital system of care.

This story isn’t a sales pitch. We wish it had never happened. But it might be the best answer to the question of why we love working here. When we combine team plus technology to care for our patients and to care for each other, there’s no medical group we’d rather be.

I hope this is the last tragedy to befall us as a department. And if it is not, I hope to have just this same team around me to cope.

I’m sure others have similar stories of how technology helped them work as a team. Please send them to me at dermnews@frontlinemedcom.com; I’d like to write a follow-up piece.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. He is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

I’m the new chief of service for the department of dermatology at Kaiser Permanente San Diego. We are hiring, so I’ve been working on my answers to astute questions about how we at Kaiser Permanente differ from other health systems and why I love our medical group. Many points of differentiation involve how we work as an integrated system and how we are compensated for effective care instead of simply volume of care.

Unfortunately, this week I’ve developed a better answer. A tragedy struck one of our doctors. As I reflect on how we recovered as a team, I’ve found that this story captures what it means to be a Permanente physician.

There are more than 70 dermatologists and staff in our department, and we all play a role in meeting the access needs of our patients. When one of our docs emailed me at 4 a.m. to tell me of a terrible catastrophe that struck her family, it set off a somber day for our team. In addition to offering our sympathy to her, we got right to work to help her. She needed time off to be with her family, and like all of us, she had full schedules booked for weeks ahead.

By 6 a.m., our administrative team was aware and working to recover. We canceled her clinic, and, using scheduling software, identified dermatologists in our department who might be able to help. With a few clicks, we reassigned patients from her to me and others who immediately volunteered. This was seamless as far as the patients would be concerned. Patients coming in within hours that morning were picked up by other doctors; one by one, they added them to their schedules.

Every doctor in San Diego has a Kaiser Permanente–issued smartphone. These allowed us to quickly email, text, and message to coordinate our efforts. Each of us dermatologists connected to her in-basket in our electronic medical record and set to work sending out her biopsy results, answering her secure email messages, and calling her patients. Others volunteered to cover her call, and we reassigned her teledermatology shifts with just a click. By noon, all her responsibilities as a dermatologist had been accounted for, allowing her to focus on her family. Teamwork was enabled by our digital system of care.

This story isn’t a sales pitch. We wish it had never happened. But it might be the best answer to the question of why we love working here. When we combine team plus technology to care for our patients and to care for each other, there’s no medical group we’d rather be.

I hope this is the last tragedy to befall us as a department. And if it is not, I hope to have just this same team around me to cope.

I’m sure others have similar stories of how technology helped them work as a team. Please send them to me at dermnews@frontlinemedcom.com; I’d like to write a follow-up piece.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. He is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

 

What if an app could diagnose melanoma from a photo? That was my idea. In December 2009, Google introduced Google Goggles, an application that recognized images. At the time, I thought, “Wouldn’t it be neat if we could use this with telederm?” I even pitched it to a friend at the search giant. “Great idea!” he wrote back, placating me. For those uninitiated in innovation, “Great idea!” is a euphemism for “Yeah, we thought of that.”

Yes, it isn’t only mine; no doubt, many of you had this same idea: Let’s use amazing image interpretation capabilities from companies like Google or Apple to help us make diagnoses. Sounds simple. It isn’t. This is why most melanoma-finding apps are for entertainment purposes only – they don’t work.

To reliably get this right takes immense experience and intuition, things we do better than computers. Or do we? Since 2009, processors have sped up and machine learning has become exponentially better. Now cars drive themselves and software can ID someone even in a grainy video. The two are related: Both require tremendous processing power and sophisticated algorithms to achieve artificial intelligence (AI). You’ve likely heard about AI or machine learning lately. If you’re unsure what all the fuss is about, read my previous column (Dermatology News, March 2017, p. 30).

So can melanoma be diagnosed from an app? A Stanford University team believes so. They trained a machine learning system to make dermatologic diagnoses from photos of skin lesions. To overcome previous barriers, they used open-sourced software from Google and awesome processors. For a start, they pretrained the program on over 1.28 million images. Then they fed it 128,450 images of known diagnoses.

Then, just as when Google’s AlphaGo algorithm challenged Lee Sedol, the world Go champion, the Stanford research team challenged 21 dermatologists. They had to choose if they would biopsy/treat or reassure patients based on photos of benign lesions, keratinocyte carcinomas, clinical melanomas, and dermoscopic melanomas. Guess who won?

In a stunning victory (or defeat, if you’re rooting for our team), the trained algorithm matched or outperformed all the dermatologists when scored on sensitivity-specificity curves. While we dermatologists, of course, use more than just a photo to diagnose skin cancer, many around the globe don’t have access to us. Based on these findings, they might need access only to a smartphone to get potentially life-saving advice.

But, what does this mean? Will we someday be outsourced to AI? Will a future POTUS promise to “bring back the doctor industry?” Not if we adapt. The future is bright – if we learn to apply machine learning in ways that can have an impact. (Brain + Computer > Brain.) Consider the following: An optimized ophthalmologist who reads retinal scans prediagnosed by a computer. A teledermatologist who uses AI to perform perfectly in diagnosing melanoma.

Patients have always wanted high quality and high touch care. In the history of medicine, we’ve never been better at both than we are today. Until tomorrow, when we’ll be better still.


 

Jeff Benabio, MD, MBA, is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com. He has no disclosures related to this column.

 

What if an app could diagnose melanoma from a photo? That was my idea. In December 2009, Google introduced Google Goggles, an application that recognized images. At the time, I thought, “Wouldn’t it be neat if we could use this with telederm?” I even pitched it to a friend at the search giant. “Great idea!” he wrote back, placating me. For those uninitiated in innovation, “Great idea!” is a euphemism for “Yeah, we thought of that.”

Yes, it isn’t only mine; no doubt, many of you had this same idea: Let’s use amazing image interpretation capabilities from companies like Google or Apple to help us make diagnoses. Sounds simple. It isn’t. This is why most melanoma-finding apps are for entertainment purposes only – they don’t work.

To reliably get this right takes immense experience and intuition, things we do better than computers. Or do we? Since 2009, processors have sped up and machine learning has become exponentially better. Now cars drive themselves and software can ID someone even in a grainy video. The two are related: Both require tremendous processing power and sophisticated algorithms to achieve artificial intelligence (AI). You’ve likely heard about AI or machine learning lately. If you’re unsure what all the fuss is about, read my previous column (Dermatology News, March 2017, p. 30).

So can melanoma be diagnosed from an app? A Stanford University team believes so. They trained a machine learning system to make dermatologic diagnoses from photos of skin lesions. To overcome previous barriers, they used open-sourced software from Google and awesome processors. For a start, they pretrained the program on over 1.28 million images. Then they fed it 128,450 images of known diagnoses.

Then, just as when Google’s AlphaGo algorithm challenged Lee Sedol, the world Go champion, the Stanford research team challenged 21 dermatologists. They had to choose if they would biopsy/treat or reassure patients based on photos of benign lesions, keratinocyte carcinomas, clinical melanomas, and dermoscopic melanomas. Guess who won?

In a stunning victory (or defeat, if you’re rooting for our team), the trained algorithm matched or outperformed all the dermatologists when scored on sensitivity-specificity curves. While we dermatologists, of course, use more than just a photo to diagnose skin cancer, many around the globe don’t have access to us. Based on these findings, they might need access only to a smartphone to get potentially life-saving advice.

But, what does this mean? Will we someday be outsourced to AI? Will a future POTUS promise to “bring back the doctor industry?” Not if we adapt. The future is bright – if we learn to apply machine learning in ways that can have an impact. (Brain + Computer > Brain.) Consider the following: An optimized ophthalmologist who reads retinal scans prediagnosed by a computer. A teledermatologist who uses AI to perform perfectly in diagnosing melanoma.

Patients have always wanted high quality and high touch care. In the history of medicine, we’ve never been better at both than we are today. Until tomorrow, when we’ll be better still.


 

Jeff Benabio, MD, MBA, is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com. He has no disclosures related to this column.

 

What if an app could diagnose melanoma from a photo? That was my idea. In December 2009, Google introduced Google Goggles, an application that recognized images. At the time, I thought, “Wouldn’t it be neat if we could use this with telederm?” I even pitched it to a friend at the search giant. “Great idea!” he wrote back, placating me. For those uninitiated in innovation, “Great idea!” is a euphemism for “Yeah, we thought of that.”

Yes, it isn’t only mine; no doubt, many of you had this same idea: Let’s use amazing image interpretation capabilities from companies like Google or Apple to help us make diagnoses. Sounds simple. It isn’t. This is why most melanoma-finding apps are for entertainment purposes only – they don’t work.

To reliably get this right takes immense experience and intuition, things we do better than computers. Or do we? Since 2009, processors have sped up and machine learning has become exponentially better. Now cars drive themselves and software can ID someone even in a grainy video. The two are related: Both require tremendous processing power and sophisticated algorithms to achieve artificial intelligence (AI). You’ve likely heard about AI or machine learning lately. If you’re unsure what all the fuss is about, read my previous column (Dermatology News, March 2017, p. 30).

So can melanoma be diagnosed from an app? A Stanford University team believes so. They trained a machine learning system to make dermatologic diagnoses from photos of skin lesions. To overcome previous barriers, they used open-sourced software from Google and awesome processors. For a start, they pretrained the program on over 1.28 million images. Then they fed it 128,450 images of known diagnoses.

Then, just as when Google’s AlphaGo algorithm challenged Lee Sedol, the world Go champion, the Stanford research team challenged 21 dermatologists. They had to choose if they would biopsy/treat or reassure patients based on photos of benign lesions, keratinocyte carcinomas, clinical melanomas, and dermoscopic melanomas. Guess who won?

In a stunning victory (or defeat, if you’re rooting for our team), the trained algorithm matched or outperformed all the dermatologists when scored on sensitivity-specificity curves. While we dermatologists, of course, use more than just a photo to diagnose skin cancer, many around the globe don’t have access to us. Based on these findings, they might need access only to a smartphone to get potentially life-saving advice.

But, what does this mean? Will we someday be outsourced to AI? Will a future POTUS promise to “bring back the doctor industry?” Not if we adapt. The future is bright – if we learn to apply machine learning in ways that can have an impact. (Brain + Computer > Brain.) Consider the following: An optimized ophthalmologist who reads retinal scans prediagnosed by a computer. A teledermatologist who uses AI to perform perfectly in diagnosing melanoma.

Patients have always wanted high quality and high touch care. In the history of medicine, we’ve never been better at both than we are today. Until tomorrow, when we’ll be better still.


 

Jeff Benabio, MD, MBA, is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com. He has no disclosures related to this column.