EMR Power Training - Two Ways to Lower Your TITO

Posted by Dike Drummond MD

EMR Power Training

Two ways to consistently lower you TITO week to week

TITO = Time In The Office

How can you build an office day where you spend more face time with your patients than keyboard time with your EMR?

Too often I speak with physicians who are spending hours after the last patient on EMR documentation and - tragically - even more hours grinding away at the keyboard from home after they tuck the kids into bed. If that feels familiar to you, I promise it does not have to be that way.

Here are two ways to start permanently lowering your own personal TITO week after week by cutting down the amount of time you spend typing into your EMR. These are two pieces of a comprehensive strategy to address the dilemma of EMR.

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Tags: Physician burnout, emr, electronic medical records, ehr, medical scribe, ehr template, emr template

Doctor Patient Communication - Stop the "Oh By the Way ..."

Posted by Dike Drummond MD

Doctor Patient Communication - how to stop "Oh, by the way ..." at the end of the visit and build patient satisfaction at the same time.

You know the visit ... 

You work hard helping your patient adjust the three meds she takes for diabetes and heart failure. You are 20 minutes into this visit, feeling like you have done a good job ... wondering when you will get the chance to write your note because now you are a full 30 minutes behind.

As you are neatly wrapping things up, your patient smiles at you and says, "Oh .. by the way doctor ..." and rummages around in her purse, eventually pulling out "THE LIST".

You sigh, your shoulders slump, it feels as if the wind has been knocked out of you. You didn't see it coming and you just fell into the Tiger Trap of "Oh .. by the way" at what should have been the end of this patient encounter. You would give anything to have been able to prevent this happening ... again.

In this post, let me show you how to fill this hole in your doctor patient communication skill set. When you learn to actually ask for the list up front, your energy and patient satisfaction ratings will go way up.

Three steps to stop , "Oh ... by the way"

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Tags: doctor patient communication, physician patient communication, btw, by the way

Physician Burnout Vulnerability and Group Culture

Posted by Dike Drummond MD

Physician Burnout, Vulnerability and Your Group's Culture

I am often asked if I am familiar with the work of Brene Brown and especially her tremendously popular TED videos "The power of vulnerability" and "Listening to shame"

I highly recommend these videos to all physicians because vulnerability and shame are woven through any authentic healing encounter. It is important to understand and navigate shame and vulnerability when they accompany a patient into the exam room.

Brene Brown's work is also immediately relevant to physician burnout. This is especially true for male physicians because of our habit of not reaching out for help.

I love Brene Brown's work and it is incomplete

She points out the willingness to be vulnerable is an act of courage. This is true for most of us. If you speak your truth openly and with transparency, you will probably feel like you are being brave ... like you are taking a risk. Why is that?

Dr. Brown believes it is an innate feature of our human nature. We naturally feel vulnerable when we tell our truth. I disagree. There are outside forces that create this fear of shame. The source of this sense of vulnerability is hidden in plain sight if you remember that you speak the truth within a larger context.

Being open and transparent is only "vulnerable" within an abusive culture

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Tags: Physician burnout, physician communication, medical group culture, physician bullying, vulnerability, Brene Brown

Patient Satisfaction should never be 100%

Posted by Dike Drummond MD

Patient Satisfaction should NEVER be 100%

Patient satisfaction is all the rage these days. It is also a never ending ethical bind for doctors. If your administration thinks you can run your practice like Disney, I know you can feel the heat of the inappropriate pressure to make everyone happy.

I am all for having a supremely satisfying visit to my doctor. It will never be like a 90 minute hot rocks, full body massage ... and when I'm the patient, I will take what I can get.

The problem with comparing a visit to my healthcare provider and
- a massage
- or a meal
- or a hotel stay
- or a trip to Disney World

... is simple. They are not comparable ... for heaven's sake.

If you think you can run a healthcare organization like Disney, you are setting up a battle between Patient Satisfaction on one side and Quality and Safety on the other


In health care, 100% Patient Satisfaction is 

- Dangerous for the physician and the patient

- Unethical and a violation of "Primum Non Nocere"

- If your employer expects this of you as a physician, it is a glaring sign of a physician leadership vacuum

If you are doing your job well ...
There will always be a small minority of patients who must leave disappointed 


How Patient Satisfaction is Measured

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Tags: physician leadership, patient satisfaction

Physician Burnout - How to Turn the Corner

Posted by Dike Drummond MD

Physician burnout: How to turn the corner in your life and practice

No matter how exhausted and overworked you may feel right now -- no matter how frustrated with your practice or your out-of-balance life you may be -- there is a way to turn this corner.

Working harder is not the answer though

If you want different results in your life, you must take different actions

What got you here won't get you there

Don't fall into this trap

You can get to a place where you are running so fast - just to keep up with your current reality - that you don't have time to do anything more or anything different. I have heard people say over and over, "I am too busy to even think about doing things differently". 

Here is the key to getting out of this Catch 22, the key to getting out of this mind trap.

You have to find a way to step out of the flow of your life - in order to see things from a more strategic point of view - where the things you want to change can come into sharp focus

This lesson actually came to me from the world of the entrepreneur. 

You see, a person starting a small business can often end up overwhelmed by the details of being a solo entrepreneur. There is so much to do to coordinate your product/service, marketing, accounting and payroll and managing employees. It is a fairly close match for all the balls a physician has to keep up in the air -- and it can get equally unbalanced. 

Entrepreneurs have to learn this mantra sooner or later

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Tags: physician burnout prevention, dike drummond, physician wellness retreat, Physician burnout, the happy md, physician coaching, intention journaling, work on your business

Physician Burnout's Highest and Best Use

Posted by Dike Drummond MD

Physician Burnout's highest and best use

From within the misery of physician burnout it is difficult to see, but there is a purpose to this suffering. Burnout actually has a highest and best use. When you do a good job of burning out, you will look back on this as an important turning point in your life. A turning point for the better.

I have worked with hundreds of burned out doctors and physician leaders at this point and a clear and universal pattern has emerged. Let's see if you can see it too.

Try this snippet of anthropologic research

Think of a physician you respect and look up to - someone you feel has their act together in their practice and private life. Ask if you can have a cup of coffee and a conversation with them. When you are together, try this question.

"Please, tell me your burnout story."

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Multitasking makes you stupid - do these 3 things instead

Posted by Dike Drummond MD

Multitasking makes you stupid 

The neuroscience is clear, multitasking does not work. It is not a "skill" you can develop. It is not something you can possibly get good at. Multitasking is an urban myth in my opinion. In a healthcare setting, it can actually threaten patient's lives.

The reason multitasking does not work is simple to explain

Your attention - the bandwidth of your awareness - has a finite capacity. There is only so much attention to go around. You get the best results when you give ALL of it to a single task or observation.

If you are doing one thing ... say reading an MRI report on one of your patients

And you add in a second activity at the same time ... say taking a phone call (and trying to continue to read the MRI report)

Your available attention for each individual activity has instantly been cut in half. You are now half as good at reviewing an MRI report -- and your phone conversation will have half the quality it would if that was the only thing you were doing.

Congratulations - your multitasking (just two tasks in this case) has allowed you to instantly do a half-assed job. Unfortunately we are just getting started.

Here is the mathmatical relationship between multitasking and quality

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Tags: dike drummond, the happy md, physician leadership, batch processing, multitasking makes you stupid, multitasking

Physician Burnout - Why Working Harder Never Works

Posted by Dike Drummond MD

Physician Burnout - Why working harder never works

In my coaching practice, working with hundreds of over stressed physicians, every single one is a supremely hard worker.

Our residency training values hard work above all else ... to the point of nearly working each of us to death at some point. If there is anything a physician knows how to do ... it is work hard.

It is our default reaction to any challenge. We put our nose to the grindstone and try to overwhelm it by the sheer volume of our effort.

Unfortunately when you come to the dead end of burnout, working harder never works.

Here is why ...

If you work harder doing more of what you are already doing - you will just get more of what you've already got

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Tags: Physician burnout, work life balance, life balance, prevent physician burnout, physician leadership, einsteins insanity

Physician Burnout - Who Will Save Us

Posted by Dike Drummond MD

Physician Burnout - Who will Save Us?

In this article you will learn why Physician Burnout is a Physician Leadership Issue and what to do when you realize no one is coming to rescue you.


In articles and comments all over the internet, physicians do the same thing - blame, justify and complain about the work stresses we are under.

It is a futile show of frustration despite the fact that our concerns are legitimate.

On average 1 in 3 physicians are suffering from symptomatic burnout on any give office day. New levels of work stress seem to pile on each week. You can feel the longing to be rescued.

It is as if we are locked high in the castle tower, at the mercy of our evil captors - EMR, ICD-10 and Obamacare. Surely the king of everything that is right has dispatched a brave night to free us.

We shake our fists and ask "who is going to do something about this?" We dream of being rescued from these days of drudgery. This is not what we thought our practice would be like back in training.

All of these concerns are true and valid. AND understand one thing ...

Complaining and dreaming of a rescue is Playing the Victim - Pure and Simple

There is no brave knight coming to save you or anyone else

This only distracts you from Saving Yourself

Let me set a framework for addressing burnout effectively - the straightest path to meaningful change in your work day and your organization.

In the end you will see that Burnout is a Physician Leadership issue.

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Tags: physician burnout prevention, dike drummond, Physician burnout, physician stress, physician leadership, physician stress management, disruptive innovation in healthcare

Patient Communication - What to do when a patient says thank you

Posted by Dike Drummond MD

Patient Communication - What to do when a patient says thank you

I have asked hundreds of doctors to tell me a story of their most recent rewarding patient encounter. That patient interaction where, at the end of the day, they look back and said to themselves, "oh yeah, that's why I became a doctor."

These stories all have one thing in common.

No matter what the details of the case, each story always ends with the patient and/or their family and caregivers saying, "thank you."

Unfortunately, that same doctor can often miss the critical importance of these brief moments.

When a patient says thank you - no matter how rare an occassion this is in your practice - it is an opportunity for you to do two fundamental things:

1) Reconnect you with your purpose and sense of fulfillment in your practice and simultaneously inject energy to all three of your energetic bank accounts.

2) Give the patient and their caregivers the opportunity to connect with you in a whole new way.

If you don't take advantage of these brief moments of gratitude, they are quickly swallowed up by the pile of tasks in your practice day - and the opportunity is lost.

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Tags: Physician burnout, patient communication, doctor patient communication, physician patient communication