Oh, Well! - Part II

A reader of Footzine sent the following message after our “Gem” written in last week’s issue:

"Dr. Ornstein, I agree that 'Oh Well' says 'I don’t care', but what if it’s not staff that is saying it?  In our office it’s the physician who is constantly saying 'Oh Well'.  And how does staff motivate a physician who appears to be burned out and really doesn’t care?  It seems that it is bringing the whole staff down.  If the doctor doesn’t care then why should the staff?"

This is a very interesting question and one too often asked with the pressures of the current healthcare environment.  If you were to sit and make a list of additional stresses that have been added over the past two decades to a physician’s life at work the list may include:
*  Increase in malpractice lawsuits
*  Increase is employee lawsuits
*  OSHA
*  Medicare Compliance
*  HIPAA
*  Increased skepticism and less trust by our patients
*  Reduced compliance of patients due to busier lifestyle
*  Higher number of continuing medical education (CME) credits required
*  Additional licenses and permits from state and federal government
*  Emphasis on board certification
*  Significant increase in overhead expenses
*  Significant decrease in reimbursements
*  Exponential growth of paperwork and need for documentation
*  Increased number of audits by Medicare and insurance companies
*  Being led by managed care on how we treat certain conditions in our office
*  Pre-certification and pre-authorization requirements
*  Higher taxes and fewer allowed write-offs
*  Managed care applications
*  Building relationships with Gatekeepers
*  More demands for meetings at the hospitals
*  Keeping up with the rapid pace of technological advances in medicine and office administration
*  Etc…etc…etc

The purpose of this long list is not to provide an excuse for this doctor’s attitude, but to help create some understanding than will ultimately lead to open, continuous dialogue in the office, to shed some sunshine and brighten all your lives.  The secret in the case of “Dr.Oh Well” is for the staff to have a heightened appreciation of what may have driven this doctor down this road of humdrum.  By no means is it the responsibility of the staff to serve as this doctor’s counselor or to get involved with their private life, which may be part of the equation.

Your understanding of the doctor’s woes still does not change their attitude, but an open dialogue between him/her and your staff may be just what the doctor ordered.  First of all, you will naturally feel better if you understand what is causing the “Oh Well's.”  Next, creating awareness in the doctor about their attitude may just be the wake up call you were waiting for.  In addition, there may be a significant number of issues that the doctor has with the staff which they keep bottled up, because of either lack of communication or the fear that they may upset some staff, causing them to leave.  This “fear of confrontation” trait is more common than we often realize.  It is imperative that the doctor clearly understands that as the CEO in the office they control the “attitude thermostat.”  Let the doctor know that they make it a rainy day; the staff feels drenched, as do the patients, resulting in less productivity and profitability.

Start with an office meeting.  The staff should relate what they have noted with the doctor’s attitude and how it affects them, the patients, and the reputation of the practice throughout the community.  Be open and honest!  It is okay to candy-coat but make the point clear.  Let the doctor know you understand the pressures of practicing medicine today (use the list above), but that the best defense is an offense of positive thinking.  Inquire as to how the doctor truly feels about the staff and what every one of you can do to help the office and address the needs of the doctor.  Stress that you really enjoy the practice and patients and have the utmost respect for the doctor and that is why you are having this discussion.  Have a meeting to discuss this matter and related issues every two weeks without exception.  Create a suggestion box for the staff to put ideas and comments for the doctor, either signed or anonymous.

We will ask John Guiliana, DPM, MS, a FootZine Advisory Board member to also provide his insight on this question for the next issue.  And finally, have your staff work as a team along with the doctor to effect the necessary changes.  Be open, honest, and sincere. 

(One last hint, purchase small smile pins (www.orientaltrading.com) for the doctor and staff to wear on their lab coats at all time.)