Thursday, June 7, 2012

On Being Nice

As you may know, I have been spending a great deal of the last 6 months in Las Vegas, working with an amazing team to get the Culinary Extra Clinic up and running.  This is the first Iora Health practice that we have opened, and it has been a whirlwind.  Amongst the many lessons, observations, and strange moments in the trenches of health care innovation--one situation has struck me a number of times, and is frankly quite troubling:

I have been told by multiple patients, home health services, and even our call center, that I am the "Nicest doctor they have ever worked with."

Humblebrag aside, this notion actually confuses the heck out of me.  For those of you that know me, I think I am fairly pleasant and polite, as my parents taught me to be, but not the nicest anything anyone has ever met.  So I figured I am just nice compared to the competition.

I started asking folks why they thought I was nice; more specifically, how were my colleagues from the world of medicine acting towards our partners far away and in patient homes?  The answers I received were downright appalling:

From a home health nurse (roughly paraphrased): "Oh, most of the doctors don't call us back.  When they do, they are very short with us as though a patient being sick were our fault.  They usually just tell us to send the patient to the emergency room and won't speak to them. No one has ever called me back twice like you did"

From our call answering service: "Most of our doctors don't call us back.  Many who do yell at us for calling them, letting the patient through, etc."

This troubles me greatly, on professional and practical levels.  Professionally- our entire job is the care of our patients.  Here are members of the loosely defined team of care for our patients, and we are yelling at them?  In some cases, like the answering service, we are paying for a service and then ignoring those that are providing it?  Frankly this type of behavior is nonsensical, makes us look foolish, and destroys whatever sense of team and trust we have with our patients and their caregivers.  From a group of vaunted professionals, it is fairly immature behavior.

Practically-- we are really cutting off our nose to spite our face.  In the case of the home health nurse, the very existence of this service creates less work for good doctors.  If it weren't them in the patient's home, it would have to be us--a level of demand we cannot currently meet.  And the answering service?  They are able to filter and triage calls, and more importantly establish an agenda for the call with the patient and provide translation services as needed.  They will get patients on the phone for me (saving me countless attempts, phone ringing, etc.) and expedite the care of my patients in various ways.  The value of these types of services cannot be overstated.

So why be mean?  I am going to intentionally sidestep the reasons why doctors might be mean to their colleagues, because frankly, none of them are all too valid.  I am going to offer some advice, instead.

Be Nice.  Be patient, listen, and always be polite.  (Do what your parents taught you to do, or at least mine taught me).  Do these things not only because they are the right thing to do, a worthy end in itself, but because they are incredibly useful.  When you are nice to your team members, they want to work hard to care for our patients.  They think of new ideas, share information that you would otherwise miss about our patients.  They know they can rely on you, and bolstered with this confidence can take much better care of patients.

While it saddens me greatly that so many have experienced doctors so vile that I come out as "the nicest," there is a real, simple opportunity here for us to improve the practice of our craft.