Archive | February, 2013

Some Thoughts on the Patient-Doctor Relationship

25 Feb

There is an inherent power differential in the patient-doctor relationship: The patient comes to the doctor as an authority on his/her physical or emotional state and is thus either intellectually or emotionally dependent on the doctor’s treatment plan and advice. It is therefore absolutely essential that the doctor respect the patient as an equal participant in the treatment. Although the doctor certainly has knowledge about how similar conditions were successfully treated in the past, hopefully a medical professional will display an attitude of respect and mutual collaboration with the patient to resolve his/her problem.

Listening is a key component of conveying an attitude of respect toward the patient. Nowadays practitioners are most often taking notes at their computers while speaking with the patient. This is certainly time-efficient and may in fact be necessary in order for a medical practice to remain solvent with the demands of insurance companies and CMS. However, multitasking does not convey to the patient that s/he is connecting with the doctor. Listening is a complex action which not only involves the ears, but the eyes, the kinesthetic responses of the whole body and attention to the patient’s nonverbal communication.

Some of the key faux pas to avoid when listening to the patient include:

• Not centering oneself before engaging in a “crucial conversation”
• Not listening because one is thinking ahead to his/her own response
• Not maintaining eye contact
• Not being aware of when one feels challenged and/or defensive
• Discouraging the patient from contributing his/her own ideas
• Not allowing the patient to give feedback on what s/he heard as instructions
• Taking phone calls or allowing interruptions during a consultation

It is always helpful to give a patient clear, written instructions about medications, diet, exercise, etc., which result from the consultation. Some doctors send this report via secure e-mail to the patient for review, which is an excellent technique.

The art of apology is another topic which greatly impacts the doctor-patient relationship, as well as the doctor’s relationship with the patient’s family members. In my book, Soft Skills for Tough Issues: Fostering Interpersonal Communication in the Workplace, I note that this art is a “process that has recently emerged in the medical and medical insurance industries.” Kaiser Permanente’s director of medical-legal affairs has adopted the practice of asking permission to videotape the actual conversation in which a physician apologizes to a patient for a mistake in a procedure. These conversations are meant to help medical professionals learn how to admit mistakes and ask for forgiveness. Oftentimes patients are looking for just such a communication, which may allow them to put to rest feelings of resentment, bitterness and regret. Our patients’ well-being is our ideal goal. Knowing that they have been heard and their feelings understood may in the long run allow patients and their families to heal mind/body/soul more powerfully than we had ever thought. Of course, in our litigious society this may well be an art that remains to be developed over the long term.

Note: Jean Eva Thumm is a licensed Marriage and Family Therapist in New Mexico and in Delaware. She works with people from all walks of life, including professionals from a variety of fields. As a Management and Employee Assistance Professional, she has conducted numerous mediations, seminars and Critical Incident Stress Debriefings.

All in a Day’s Work for Board Certified Coach

25 Feb

BCC Works with Teams and Individuals

Jean Eva Thumm, Principal of Beyond the Horizons Consulting, works with teams and individuals. She often finds that the Myers-Briggs Type Indicator is helpful in both situations. She typically spends over one hour debriefing the MBTI with an individual client. After making sure the “portrait” fits the individual by putting all the preferences together, she discusses

• The degree of preference for each of the four chosen preferences
• How the Introvert or Extrovert preference affects the order of the functions (S-N, F-T)
• The relative frequency of each of the preferences in the U.S. population
• How the person is likely to communicate
• What types of stressors will particularly affect an individual

and many other aspects of the MBTI affecting professional and personal relationships. Most helpful to all clients are two things:

1. The fact that they will instantly feel bonding with a person of the exact same personality type; and
2. That the affirmations received through debriefing an essentially positive “self-portrait” are always tempered (no matter what the individual’s MBTI type) by the caveat to develop the opposites.

Developing the opposites is a task which begins around midlife. During the first half of life (up until age 35 – 40), the individual is busy establishing him/herself in life through completing an education, beginning a career, possibly establishing a relationship with a significant other, setting up a home base, and so on. Ideally the years after age 40 offer the challenge of developing the opposite preferences. Thus, if a person’s basic preference is Introversion (quiet, reflective types who derive their psychological energy from within), during the second half of life this person will utilize Extroverted behaviors to some degree, such as getting more socially involved, giving talks to professional organizations, or speaking up more in personal and professional situations. In the same way, those who have utilized the Thinking function, making their decisions by means of impersonal logic, will hopefully find themselves bringing into their decision-making process more of the Feeling function. This would mean that they would independently decide which values (for example, courage, honesty, compassion, caring, etc.) are most important to them and utilize these values in their dealings with others.

At Beyond the Horizons Consulting, Jean Eva has successfully used the Myers-Briggs Type Indicator to help couples learn to respect each other as unique individuals. It is often quite difficult to help couples of exact opposite types to develop a working relationship. One example of working with an ISTJ husband and an ENFP wife involved helping the husband, who was an accomplished young lawyer, to appreciate his wife’s considerable talents. She was a stay-at-home mom with one child who could never seem to please her exacting and detailed husband. The household tasks were never performed exactly to his liking. He could not appreciate her considerable gifts in dealing with people.
She was able to demonstrate to him her persistence (utilizing the J function) when she signed up for a graduate program in teaching. Not only was she able to complete that program with a very demanding internship, she did it while she was pregnant! Two children later, she is clearly garnering the respect she deserves and is having the time of her life. Our young lawyer is so grateful for his wife and the life they share. I still get Christmas cards from them, so I enjoy seeing the family grow.

Another successful case that was helped through use of the Myers-Briggs Type Indicator involved an older couple who had taken over the family home, which needed considerable remodeling. The husband had managed a theater so his work hours often went late into the evening. The wife had been a nurse who had been lucky enough to have a day shift. They were like “ships passing in the night” while their children were growing up. Now they found that they really didn’t know one another, and the tasks they faced were monumental. She got a job in their new location and worked hard and steadily with 12-hour days. She quickly became known as one of the most responsible and hard-working members of the team. No wonder! – She turned out to be an ISTJ. However, there was no way she could imagine what this home of theirs would look like when it was completed, and the completion never seemed to come quick enough for her (remember the J in her portrait). He could easily imagine the finished product and was actually quite emotional about his commitment to the project. He talked readily with me about it and was totally in the moment as he imagined improving some aspect of the work. Can you guess his portrait? It was ENFP, the exact opposite of his wife’s! With greater understanding of how each of them worked and confidence in each other’s style, they not only completed the project but fell in love with each other all over again.

In the workplace one of the differences that often surfaces early is that of Introversion – Extroversion. With customer service being a prevalent function across all industries, we often see folks who are Introverts being forced into the proverbial Procrustean bed; that is, being forced to conduct themselves like Extroverts. One perfect example was a state agency where I was called in to help reduce hostility and bring about better teamwork. The team leader was a top-down authoritarian personality who was to boot frightened of losing her power. Thus she tried to divide and rule the team of 10 persons. One particularly salient maneuver she tried was to force an employee to drive to customers’ headquarters in order to teach them new computer skills onsite. The clincher was that the employee was a rather extreme Introvert. Not only did she not prefer to make these extended auto trips (which increased her anxiety about the upcoming presentation) she also could not imagine herself delivering this information in a confident, extroverted manner.

Fortunately, in this particular segment of the mediation, we were able to work with software developers to create a tool which the employee could use in a webinar mode from her desk, utilizing the telephone and computer to deliver the information to the customers. Working with the supervisor required coaching her over several sessions on a collaborative work style and supporting her both as a viable supervisor and as someone who could gain the confidence and appreciation of her subordinates.

Jean Eva Thumm is a Licensed Marriage and Family Therapist in the State of New Mexico. She is an accomplished mediator, having begun her training with the Magistrate Court Mediation Training Program in 2005. Her book, Soft Skills for Tough Issues: Fostering Interpersonal Communication in the Workplace, has been well received in New Mexico and is available at Amazon in paper form or through Kindle. She is a BCC#820 with the Center for Credentialing & Education.