David J. Norris, MD

s blog features contributions from members of the medical community. These blogs are an opportunity for professionals to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions are that of the writers and do not necessarily reflect the opinions of 

Every June, I observe residents who have grown over the past few years prepare to finish their training and formally start their career. You can see excitement mixed with a pinch of dread on their faces.

New beginnings are always challenging, and starting a career you've spent seven or more years preparing for is quite stressful. The first few years of your practice are the most formative and crucial. Starting off on the right foot will help you lay a solid bedrock for your success. Those years will be challenging, but they don’t have to be difficult.

When I was preparing to graduate residency, a few mentors shared their wisdom with me. Some of it they learned the hard way, and some of it they learned the advice of their mentors. I followed their advice and have been quite content. I now share with you the wisdom that has helped me so much.

There’s a famous psychological study that involved a marshmallow. They offered young children one marshmallow they could have now or two if they waited. The researchers followed these children as they grew up. Those who could delay their gratification in the present for a more significant reward in the future did better in life. When you get into practice, you’ll be exposed to a large pool of marshmallows. Resist the temptation to buy a bunch of marshmallows and other goodies. Invest your money wisely, and pay down your debt. You’ll be glad you did in a few years.

Get comfortable with being uncomfortable.

You might be the smartest you ever will be after all those years of intense studying. But going by the book will only get you so far. Experience is what will make you a better doctor. While you’re gaining that experience, it’s OK to be uncomfortable with some of your decisions. That self-doubt means you have a servant mentality for caring for another human being. Don’t feel bad if you aren’t confident about what you should do with a patient. Even the most experienced physicians find themselves at a loss from time to time. Be humble enough to consult your textbooks, colleagues, and supervisors to ensure you are providing appropriate care, even if you don’t initially know what that should be.

Don’t sacrifice family for your practice.

Do what you can to prevent your career from engulfing everything that you are. When you retire, your career won’t be there for you. Your family will be. Invest in your loved ones more than you invest in your career. You will miss some family events-it’s part of the job. But make it a priority to attend every family event you can. I’ve seen too many physicians miss their kids as they grew up and didn’t really get to know them as adults.

Part of staying sane in the ever-changing world of medicine is knowing the 

 of what you do. This is an excellent way to avoid burnout. The 

 is your mission, the tasks you perform, and the decisions you make for your patients. The 

 is the purpose for your mission. Write down your mission and purpose and refer to them frequently. These will help you stay focused on the bigger picture and make the minutia and tedious stuff more tolerable.

I think all physicians should have business knowledge if they are to deliver exemplary patient care. You’ll make better and more effective decisions if you have some financial intelligence. Read books, attend seminars, and network with other business-minded physicians. Share ideas and help each other solve problems. If you want to be a leader, obtain business intelligence. Personally, I feel my book, 

The Financially Intelligent Physician: What They Didn’t Teach You in Medical School

David J. Norris, MD, MBA, is a physician at Wichita Anesthesiology, Chartered, in Wichita, Kansas. He is also an author, practice and negotiation consultant, and founder of The Center for Professional Business Development. 

Articles

Advice for new physicians as they enter the field.

How to have a successful life

A few years ago, my father was diagnosed with metastatic cancer. Today, after all his rounds of chemotherapy, he still has cancer. At first, he was disappointed that his cancer was not cured. He now understands his cancer is contained and his life has dramatically shifted. When he and my mom discussed their disappointment with their physician, they were very satisfied with his answers.

My father, who isn't particularly outgoing and touchy-feely, noted that the doctor took the time to listen to and answer all of their questions. He told me, "Dr. Blake understood me." I asked my father how he knew Dr. Blake understood him. He replied, "He asked me questions before I told him what was going on. He showed me he knew what I was going through." My dad said Dr. Blake said things like, "It sounds like you are feeling …" and "It appears you're upset and frustrated about …." My father would confirm those feelings and Dr. Blake would share his thoughts on the matter and ask a follow-up question.

My dad left the office disappointed and satisfied. Disappointed he was not cured, but satisfied that his doctor cared about him and had done all he could. All it took was five extra minutes, starting with the person, and demonstrating he was connecting with my father.

Dealing with a disappointed patient is always challenging. Some physicians do not want to deal with them. They might minimize these patients or avoid addressing the issue altogether. Avoidance and minimization never solve problems. Rather than avoiding these issues, here are some tips for dealing with disappointed patients.

Your patient is disappointed. Do you know why? What event happened that led to their disappointment? What assumptions do you hold as you assess the situation? Do you understand what their expectations were? I suggest you approach patient encounters with a blank slate. Walk into the conversation with an open mind. Recognize you don't have all the answers. You might have the answers regarding the best therapy for a particular diagnosis, but you may not have all the answers as it relates to how your patient currently feels. The first step in dealing with a disappointed patient occurs before your conversation with them begins.

Too often when we deal with people and issues, we bring along our personal experiences. These experiences are valuable. In fact, most of our medical practice is based on past experience. We can cite cases we've seen that we use to justify our clinical decisions. But when we deal with people, we mustn't let our past experiences cloud the nonclinical issues. We need to separate the real problems from the baggage.

Baggage are our life experiences that we use to construct our world vision. Sometimes the baggage helps, but it can also hinder us. Everyone has baggage, and your patient is carrying baggage with them as well. Perhaps they've had bad experiences with physicians. Maybe those past experiences have led them to believe all doctors are short on time and compassion. They might, unfairly, apply their world vision, created by their baggage, to you. That's okay because you've considered their baggage before you start the conversation. Beware of the baggage you carry too. It can hurt how you perceive people and their problems.

Doctors must keep in mind patients have both clinical and nonclinical problems. The best way to stay focused on finding the real problem with your patient is to remember your what and why. What is it you're trying to help them with and why are you doing it?

You might want to get their blood pressure or diabetes under control because you want them to have a long and disease-free life. That's the clinical side. There are also nonclinical problems our patients face. Perhaps they don't fully understand how to take their medicine, or they cannot afford it. Maybe they don't have the support they need at home to manage their disease. They might be disappointed in their treatment for reasons that are outside of your control. Your job is to discover where those problems are.

We as physicians get so focused on the task - doing things, watching numbers and trends - that we can forget the people we are treating. A mentor of mine shared some excellent advice with me, and it has helped tremendously during my career. He said, "Always start with people, then move to task. You might not need to spend a lot of time focusing on people, but you need to invest a little time doing it. Otherwise, whatever task you want to accomplish will be in jeopardy."

Starting with people is easy. Just acknowledge their humanity, emotions, fears, and needs. Once you do that, their defenses and barriers will come down. If you jump right to the task as soon as you enter the room, you'll come across as cold and uncaring. You will need to move to the task at some point, but don't rush there if time permits. Most people only need a few minutes of you focusing on them to make them feel comfortable.

I'm a fan of an FBI hostage negotiator Chris Voss. In his book, 

Never Split the Difference: Negotiating As If Your Life Depended On It

, he describes a tool called labeling. It's a great way to build empathy and the 

 connection. You directly label the emotions and feelings the other side is showing. "It seems like you're …" and "It sounds like you're …" are great ways to label the emotion the patient is demonstrating. Labeling will have an excellent effect of connecting with them on an emotional level by showing them you recognize the importance of their feelings.

Once you've dumped your baggage and assumptions, approached patients with humanity and compassion, and discovered the real problem, what's your next step? That depends upon what the real problem you discovered is. Is the problem something that is your fault or one you can solve? Did the patient have expectations that weren't correct? Have an honest and forthright discussion with them. If you can do that, you'll be getting thank you cards from your patients for a very long time.

A physician offers advice on dealing with disappointed patients, offering advice from his real-life experiences.

How to Deal with Disappointed Patients

Earlier this spring, I attended a flight safety review lecture on flying in turbulence. When I reviewed my notes afterwards, I noticed a powerful analogy for leading change.

When turbulence is encountered, there are two things pilots do to safely fly through it. First, they pull back on the throttle and reduce their airspeed. They want to slow down in order to minimize the risk of damaging the airframe. Second, they only worry about maintaining the correct attitude. Their goal is to keep the wings and nose level and concentrate on staying the course. They don't worry so much about their altitude. They go along with the bumps as best they can. They avoid fighting the turbulence with large corrective actions. Instead, they make small adjustments to maintain their attitude and course heading. Finally, they make certain they're buckled up in their seat because it's going to be a bumpy ride.

I think leading change for physicians is similar to flying in turbulence. They are some important things to keep in mind if you wish to successfully lead change in your organization.

Change is uncomfortable and challenging. No one really likes change. When you experience bumps in your change initiatives, slow down. Take time to determine the reason for the turbulence and why and where it might be coming form. Pilots use weather forecasts to plan their flights. They know when turbulence might be encountered. As a physician, it's valuable to plan out your change process for your practice and be prepared. An important question to ask is "Is it more important the change was accomplished or that the organization is intact after transitioning the change?" For unplanned turbulence, slow down and talk with your people. As a physician leader in your organization, it's your job to guide it through change so that they exit it intact and better for it. Ask questions and try to identify what is causing the turbulence. What's the source of the bumps - a personnel or personal issue or is it an operational issue? Slowing down will give you time to adjust the controls and focus on your attitude.

Your Attitude - The Most Important Thing to Focus On

After you've slowed down a bit, you then want to carefully monitor and manage your 

 is wonderful in this context because it has two distinct and important meanings. First, as with flying, maintaining your attitude means staying on course and continuing to move towards your goal. In flight, you want to keep your wings and nose level. Otherwise, the plane might get into a dangerous position such as a steep turn, stall, or nosedive. If you're not careful, you'll eventually crash. When leading change, stay focused on your attitude and heading. Use small corrections to keep the organization level as you keep it moving towards the intended destination. The second meaning refers to managing yourself.

 means controlling how you think and feel about the change and the people you're trying to help change. Thoughts and behaviors always precede any actions you may take. That's why it's critical you monitor, manage, and display the proper attitude to those you are leading. Don't forget the importance of the example we set for others. We lead not only with our words, but our actions, behaviors, and 

. Others will follow our lead so have a good 

 and serve as a good role model for your people. One way to help you maintain the proper 

During turbulence inflight, items frequently will get tossed around the cockpit. As a leader, one of things being tossed around cannot be you. Take time to prepare yourself mentally and emotionally for the upcoming bumpy ride. Understand and accept you'll be shaken and jarred by others during the change process. You'll get through it easier if you have planned for it. It's a lot easier to maintain your attitude and attitude if you're securely fastened in your own seat. If you are ready for it mentally and emotionally, then you have more energy to focus on maintaining your course.

Pilots will issues reports to air traffic control about the turbulence they experience. Air traffic control then passes this information on other pilots flying in the same area. One of the best things you can do for yourself and your organization is to get involved in leadership and trade organizations. Look for other practices who have been where you're headed or are going through the same bumpy areas. Learn from them and more importantly, share what you've learned. Help each other out when you can. It'll pay you dividends in the future. If you fly commercially, you might feel the plane slow down and the seatbelt sign illuminates before any bumps are encountered. The reason is because someone ahead of you shared important information. With the right information, you can warn people of the upcoming bumps. Their orange juice might be spilled but you can make certain they aren't surprised. 

Remember, when you hit bumpy times in your change, slow down, maintain a proper attitude, buckle up, and share what you've learned from your experience. If you do these things, you'll be a better leader and more effective in implementing your change.

Navigating a change in your practice is a lot like going through turbulence in a plane. What can physicians learn from pilots?

How Physicians Can Navigate the Turbulence of Change 

Burnout is a real issue that every industry faces. Lately, it appears to be growing among physicians. I would like to take a few moments to share how I work to avoid burnout.

I focus on what is important and ignore what it isn't - concentrating on what I can control and not worrying about what I can't. I hate Computerized Provider Order Entry (CPOE) as much as anyone. However, I've realized it probably isn't going anywhere anytime soon. I can either spend time and energy complaining about it or I can save that energy for something more meaningful. Knowing what really matters allows me to conserve energy for more important things in my life.

Take time to find or rekindle your passion. What drives you? What inspires you? Hopefully you remember the reason you went to medical school and still feel that way. I know my mission and purpose and every decision I make is based upon them. It helps me identify what's important. Any action that doesn't help me pursue my mission and purpose is ignored.

I only take steps that will push me forward to my goals. Everything else is secondary in my life. Set your goals and make a plan to achieve them. Work on them every day. They should be tied to your passion, your mission, and purpose. There are some things that don't move you toward your goals, but must be dealt with - I'm not talking about those. I speaking about those things we waste time and energy on that don't yield us anything of real value. Ignore those things in your life.

4. Be stingy with your most precious resource.

I schedule time to spend with family and friends. I literally block it out on the calendar. It's protected time. During my family time, my kids know I won't let distractions occur. They also know when I'm working or on call, they must tolerate my divided attention. It's the nature of our business. The same goes with our friends. We all have 24 hours each day to spend. Spend them wisely. Spend them on what really matters.

I exercise and spend time reading and thinking. It's a way I recharge. Pick a way that is good for you to recharge. It might be physical activity, going out with friends, solving puzzles or games, or spending time doing nothing at all. What matters is that you spend time relaxing and recharging. Again, schedule and block it out on a regular basis if possible.

I give to the community. I look for ways to help others outside my field of medicine. I help people at work but it does feel different, as I'm compensated for the care. Outside of medicine, the services I offer are free of charge. In a way, it's refreshing and relaxing. Look for a charitable organization you can get involved with. You'll be surprised how well and energized you will feel.

is an anesthesiologist at Wichita Anesthesiology Chartered in Wichita, Kan., and the owner of the Center for Professional Business Development. What do you do to relieve burnout? Tell us in the comment section below.

Burnout is a real issue that every industry faces. Lately, it appears to be growing among physicians. Here's how I work to avoid burnout.

How I Avoid Burnout

I have discovered that effective leaders possess six basic characteristics. Whether you are dealing with patients, negotiating contracts, or working to improve a process or system, if you work to develop these six characteristics, your effectiveness will increase.

 Effective leaders don't procrastinate and they aren't worried about making a bad decision. They realize life is just one decision after another. If you happen to make a wrong decision, make another decision to correct the previous one. Don't let the fear of being wrong cloud your judgement.

 Effective leaders know what the mission and purpose is for their business, division, or office. They also possess a mission and purpose for their own life. Mission is the "what" portion of their actions and purpose is the "why." Each and every decision or action is based upon the what and why - their mission and purpose.

 Good leaders know what they can control. They can control how they submit their claims. They cannot control what happens when the claim hits the payer's desk. They also realize it is wasted time worrying about things which are out of their hands. They learn from their past experiences and adjust their future actions in order to avoid missing the objectives they have set.

 Good leaders set out to solve the real problems. They recognize that not everything that hurts is a problem. Sometimes those pains are really just symptoms. Without knowing the real problems at hand, the best one can hope for is to put a Band-Aid on the problem. Leaders use lots of questions to discover the real problems. Their favorite questions begin with what, how, and why.

 Good leaders are focused on the problems at hand. They do not let superficial issues distract them. Knowing their mission and purpose helps them to remain focused on solving the current problem. They continually reassess where their focus is and whether or not they have taken their eye off the ball.

 Effective leaders and decision makers understand that a growth mindset is critical to achieving one's goals and objectives. They recognize they might not have all the answers. They will approach problems with an open mind, refraining from making assumptions, and use questions to either confirm or reject what they objectively observe. Having an open mind is beneficial because it allows leaders to continually discover new information.

If you're attempting to improve a process or solve a problem, I would encourage to take this list and review these items. Ask yourself the following questions: Am I making good decisions? Am I willing to fix wrong ones? What is it we are trying to accomplish and why? What are the goals and objectives that must be met? Have I found the real problems? Am I working with a growth mindset and refraining from making any assumptions? Once you begin to answer these questions, you will find yourself becoming a more effective leader.

is an anesthesiologist at Wichita Anesthesiology Chartered in Wichita, Kan., and the owner of the Center for Professional Business Development. Do you know what it takes to be an effective leader?  Tell us in the comment section below.

This article was originally published in the April 2016 issue of

Whether you are dealing with patients or staff, if you work to develop these six leadership characteristics, your effectiveness will increase.

Six Characteristics of an Effective Leader

As 2015 approaches, many physicians are wondering what new changes are headed our way. We've seen what feels like a gazillion different changes to the Affordable Care Act. At times, it can feel hard to firmly plant your feet on such unstable ground. However, we must remember we can only manage what we can manage. We mustn't worry about that which we cannot control. We should concentrate our energies on those areas of our practice that will support our ultimate goal of exemplary patient care. I believe I am the one responsible for doing everything I can to maximize my revenue. This can be accomplished by focusing on specific areas of my practice, or what I call the four P's of exemplary patient care:

 Ask yourself, "Do we have the right people in the right jobs at the right time?" We should hire "A" players and coach or train "B" players to "A" performance. Healthcare is a service industry and it is the people of our clinic that deliver the care. If we want to deliver the best care, then we must hire and train the best people we can find.

 I focus on the work flow of our people. Do they have what they need to be most effective and efficient in delivering patient care? Does the practice's IT solution help or hinder them? Are we making choices simply to satisfy a checkbox on someone's list? Or, are we making decisions that benefit our people and ultimately our patients? We should be constantly monitoring and changing the practice work flow to maximize the care we provide.

 Exemplary performance is about delivering the right care to the right patient at the right time. How often are we able to get the right diagnosis? How much time are we spending sorting out the data? Do we really need all the data? Most importantly, is the patient satisfied with the care we have delivered? Do they feel important and valued by each one of the staff members that interact with them?

Our compensation will slowly begin to reflect these very important questions over the next few years. As "transparency" begins to evolve in the marketplace, patients will know what we charge for services. That doesn't really matter as much as the perceived value of what patients are receiving for that fee. Our people and systems should work together to ensure we have a high performing practice that is capable of delivering exemplary patient care.

 Earning a profit isn't evil or bad. In fact, it is a necessity. How long can the doors be kept open if the practice is losing money? How many patients can be cared for when the practice closes? Can quality compassionate care be delivered if the people of the practice are struggling because there aren't financial resources available to support them in doing their job?

It is my responsibility to ensure I take control of my practice and its performance. My goal is to provide exemplary patient care. If I focus on the four P's, control those aspects of each area that I can control and effect change in, I will be able to ensure my income will remain stable, if not grow. The value I offer the public and my patients is completely dependent upon the four P's. Having a model like this makes me less concerned about coming changes and more empowered as I look to the future.

 is an anesthesiologist at Wichita Anesthesiology Chartered in Kansas, the owner of the Center for Professional Business Development, as well as a member of the 

What strategies do you use to maximize your compensation? 

Unless you say otherwise, we'll assume that we're free to publish your comments in upcoming issues of Physicians Practice, in print and online. 

This article originally appeared in the November/December 2014 issue of 

This physician takes full responsibility for maximizing his practice revenue, by focusing on what he calls the four P's of exemplary patient care.