Practicing medicine “in the zone”

© lenetsnikolai - stock.adobe.com

We often hear the expression "being in the zone" when referring to finely tuned athletes and athletic teams. Elite athletes like Tiger Woods, Michael Jordan, and Rafael Nadal discuss being in the zone, that magical place where mind and body work harmoniously and movements seem to flow without conscious effort. Major-league pitchers, NBA stars, pro golfers, and Olympic hopefuls dedicate their careers to the search for this elusive state of performance, devoting hours of training to "listening" to their body and "reading" their muscles—trying to construct a bridge between mind and body sturdy enough to lead them straight to athletic nirvana.¹

Athletes who are in the zone identify seven characteristics of a zone experience. Athletes reported:

• Being totally absorbed in the activity
• Experiencing inner clarity
• Having a sense of ecstasy and being outside of everyday reality
• Being focused on the present
• Feeling a deep passion for the activity
• Having a sense of serenity, no anxiety about their performance
• Feeling no sense of effort²

Any athlete in this mental state of being in the zone is unbeatable at their respective level of competition—and at the elite level, you often witness world records being broken.

It is possible to practice medicine by being in the zone. Being in the zone means effortlessly practicing medicine, increasing productivity, improving efficiency, having a staff that enjoys caring for your patients, and, at the end of the day, walking away with a sense of joy, gratification, and contentment.

This sounds like a pipe dream. Especially in this era of healthcare reform, there is so much uncertainty, stress, and anxiety associated with the practice of medicine.

What can you consciously do to put your practice in the zone? This article will discuss 15 examples for practicing in the zone and making your practice more efficient and productive.

1. You know your practice is in the zone when there are no patient cancellations or no-shows, leaving holes in the schedule. Zone practices use either automated phone reminders or have an employee in the office call the patients and remind of their appointments.
2. Zone practices don't double-book patients for the same time slots, thinking that some patients will not show up or cancel their appointments. Instead, zone practices leave time slots each day to accommodate emergencies or patients who need same-day appointments. You know you are in the zone when you don't have any no-show patients.
3. A zone practice has most of their account receivables less than 30 days. You have a problem when more than 5% of your ARs are more than 90 days.
4. Consider your practice in the zone when your receptionist collects 100% of the co-pays. It becomes costly to send out bills for small amounts of money. It is also expensive to submit a bill and then collect small co-pays after you have seen the patient and they leave the office. A zone practice collects the co-pays before the patient sees the doctor.
5. A zone practice submits "clean" and "scrubbed" claims, and as a result, there are very few or no claim denials.
6. Your practice can be considered in the zone if you can see patients within 15 minutes of their designated appointment time. If patients wait longer than 15 minutes, patient satisfaction will deteriorate, and patients will leave the practice if you are chronically late.
7. When you are doing what you enjoy and are good at, you know you will be in the zone. If you don't like seeing Workman's Compensation patients or taking care of patients who have STDs, then don't accept those patients and refer them to colleagues who enjoy those patients.
8. A practice will thrive and be in the zone when it has an abundance of new patients. A new patient who needs a procedure or a workup is far more profitable than a patient who returns for a PSA test and a rectal examination. Your practice will be in the zone if you can accommodate new patients when they call for an appointment.
9. Practices are in the zone when patients are requested to complete demographic information and the health questionnaire online or before they come to the office. When this happens, patients are not kept in the reception area for long periods of time and are delayed in being taken from the reception area to the exam room.
10. You have a zone practice when their insurance eligibility is verified before the patient comes to the office. Patients whose eligibility has yet to be verified are notified and informed that they must pay for their visit or obtain eligibility.
11. A practice in the zone has all the patient's information, reports, and X-rays available during the visit. Nothing is more disheartening and anxious than to have a patient who is to discuss the results of a biopsy and find that the report isn't in the medical record. Locating take 30 minutes or more. Now only does this delay result in loss of efficiency and productivity, but also results in anxiety and stress in patients waiting for the report.
12. Zone practices have little to no staff turnover. Staff turnover is costly and results in a temporary loss of efficiency as the new staff member needs to be brought up to speed. Waiting to have a position filled when a staff member leaves results in added work and stress on your existing staff.
13. Being in the zone means ending the day at the designated time without the doctor or the staff staying in the office and incurring overtime expenses. When you have an efficient practice, all the patients can be seen in the allotted time, and the staff leaves at the expected time. This makes for a happy staff and a happy doctor.
14. Practices in the zone have satisfied patients whose expectations are not only achieved but exceeded. What better feeling can you have at the end of the day than to know that you have helped people achieve good health, feel a sense of accomplishment, and feel rewarded for your services? Practicing in the zone is an achievable objective. All of us can reach it regardless of the geographic location, size of the practice, and the makeup of the patients we see.
15. Using visualization to enter the zone. What one can conceive; one can achieve.3 You might have heard this before but probably haven't practiced it like most physicians. Goals are essential for providing you with something specific to constantly work toward. Another essential to growing a successful practice is your vision. Being a visionary requires picturing what you want and seeing how it would happen.

In the 1984 Olympics, Mary Lou Retton needed a perfect ten on the vault to secure the all-around women's gymnastics gold medal. She paused and took her time before she was ready to do the vault. Mary Lou closed her eyes before starting and visualized the full vault in her mind. She pictured herself running towards the vault, executing her routine, and sticking a perfect landing. When she opened her eyes, she took off running. Her routine—and well-deserved perfect ten—earned her a standing ovation and a gold medal.

Jack Nicklaus, winner of 18 PGA championships, stated he also employed visualization techniques before every golf shot. He said that he played an entire game in his head and would picture making the perfect swing, imagining how the golf club would strike the ball. He visualized the ball's flight, landing, and even how it rolled on the green.

Other famous people have used visualization techniques to help them see their paths forward and pursue them, including:

• Actors Jim Carrey and Will Smith.
• Top athletes Misty May-Treanor and Kerri Walsh (Olympians in beach volleyball), Lindsey Vonn (World Cup Alpine ski racer).
• Media personality Oprah Winfrey.
• Body builder/actor/politician Arnold Schwarzenegger.

The fact is visualization works in tandem with your goals. It paints a picture of the "end" you're supposed to keep in mind, that all your goals are working toward. It provides you with a path forward. Much like with your goal setting, the best way to start visualizing what you want for your practice is to write it down. Start with what you have, then move to the details of your perfect practice.

What does your future practice look like, particularly compared to what you have now? Picture the walls. Will you have wallpaper or paint? Imagine the color schemes. What kind of flooring does your perfect office have? Do you have enough storage, or will you need a better organizational system for the ideal office? Don't stop there, either. How does your office smell? Will it have a fresh, just-cleaned smell? Will you have coffee brewing to have a pleasant aroma instead of the usual medicinal order?

Now, consider how your patients are greeted. Is your receptionist warm and friendly? Do they hide behind a big wooden window? Are they a perfect hostess, assisting the patients in filling out forms and offering a snack or a beverage? How do they answer the phone? Could it be better? Many medical office receptionists answer by saying, "Doctor's office" or "Dr. Jones's office." But a better way to answer the phone is by saying, "Welcome to Ocean County Medical Practice; this is Jane; how may I help you?" This makes a huge difference and creates a positive first impression on the patient.

Imagine the patient's experience in the exam room and what it would take for the patient to leave feeling like they had a fantastic visit. How can you give them that "wow" experience that makes them go out and tell others about you and your practice? What happens when the patient leaves the office? Do you call all your new patients the next day to see how they are doing and ask them if they have any questions they might have thought of since their visit? Do you send a thank you note to patients who refer a patient? Do you send a note to the referring physician with a report of your management of their patient?

The visualization process isn't just for your practice, either. It's part of working toward all your goals, whether for your family, health, finances, hobbies, or anything else. Take time to really picture what you want your life to look like and the goals that will get you there. What kind of life do you want? Do you have children? Do you want to pay for their tuition, so they don't graduate with debt?

Dream big, as this will help get you into the zone.

Bottom Line: If you talk to a finely tuned athlete and ask about their performance on a day when they have done exceptionally well, were victorious, and seemed to exceed their baseline skills, they will tell you about being in the zone. Physicians are also professionals who work harder and longer than most athletes to reach their station in life. We, too, can get into the zone and have an idealized practice where it is still fun to practice medicine.

Dr. Neil Baum is a physician in New Orleans and the author of The Business of Building and Managing a Healthcare Practice, Springer 2023

References

• Park, A. Staying Sharp: Getting and Staying in the Zone, http://www.time.com/time/magazine/article/0,9171,1147173,00.html
• Can We Train To Get In The Zone? http://www.fitness-programs-for-life.com/in_the_zone.html
• Hill N. Think and Grow Rich, Meriden. Ralston Society, Meriden CN. 1937