Tune Into What Matters Most
For Ed Paul, MD, practicing and teaching medicine isn’t a job. It’s not even a career — it is a calling. Sir William Osler said, “We must promote compassion, courage, and wisdom among our physicians.” We believe Osler might have had Dr. Paul in mind when he uttered those words. A family physician of over 30 years, Dr. Paul’s role goes well beyond practicing compassionate care. As you’ll see, Dr. Paul believes medicine represents an opportunity for lifelong learning and teaching. His passion and beliefs have inspired so many of us at PracticingExcellence — and we think you’ll be inspired too.
PE: You speak to “getting the bar back up” when it comes to the physician-patient relationship. In your view, how do we become more effective at providing what matters most to patients?
Dr. Paul: A key part of the triple aim is focusing on the patient experience. We have not, in general, become accomplished at understanding this yet. In my experience, we continue to focus on what is most convenient for existing health systems and still languishing in a largely fee-for-service, volume-based world. We have come a long way in considering whole person care and recognizing social determinants of health, but have yet to nail this at a system level with interventions that help. One good example is the simple concept of “medication reconciliation.” This is still a real challenge. Communicating effectively with patients and families about medication upon discharge is not done well and remains a major reason for hospital readmissions. From a distance, this is just ridiculous considering the technology and communication options that we have at our fingertips. This should be routine by now, however effective communication with patients and families about critical information like this often gets dropped.
Many great achievements in medicine continue to occur but rarely trickle down to taking care of communities and populations. Disparities in medicine remain despite very good work at defining what they are. There are some best practices out there and it is simply restructuring the majority of local systems to focus on what matters to patients.
PE: Your dedication to teaching residents, and desire to create a culture of learning throughout your organization, is inspiring. When it comes to teaching not only residents, but each other, what can we do to infuse more of it in our day-to-day work? And what will the benefits be?
Dr. Paul: Physician burnout is at an all-time high. Providers are often in separate silos that limit collegial interaction and support. Physicians connecting with physicians has been shown to significantly reduce burnout and improve fulfillment.
My observation is that silent barriers to communication between physicians are the norm in academic centers and in community hospitals. Teaching each other must be construed as something that is helpful, collegial, and as an effort to improve and to foster growth and excellence in patient care. However, many docs have no time or desire for this, seeing teaching as something they put on the shelf after residency. To improve our own well-being and reduce burnout we need more teachable moments with colleagues. Here are a few things you can try for making teaching and collegial interaction a priority:
Coffee rounds or huddles for 15 minutes every Friday morning in the office or physician’s lounge (ideal if interdisciplinary).
Causal history of medicine or literature in medicine can bring colleagues together.
Recognizing the accomplishments of older physicians who have blazed trails in your hospital or community is a good way to include or bring up teaching points (e.g. “What we have learned from old Dr Smith”)
Simple tools like videotaping or working with standardized patients are a great opportunity to do more teaching with seasoned physicians who can leverage these opportunities to foster learning.
PE: It sounds like the skills you’re brushing up on in the Physician Effectiveness Project have had a positive impact on patients and your own experience as a clinician. How so?
Dr. Paul: The Physician Effectiveness Project speaks to my soul as a physician who still greatly enjoys the privilege and challenge of taking care of people every day, even 32 years out of residency. The physician faculty here creates concise and meaningful messages that define our profession and what we should strive to achieve for our patients. For me, it’s universal, important and fulfilling. We all have our strengths and weaknesses and I like the attitude of “hey remember this from medical school and residency training — this is very important stuff to allow you to connect with people and to be more effective and happy in what you do.”
Personally I am not a walking example of a model physician who excels at communication and clinical skills, and runs around pontificating to students and residents every day. I am as challenged as any physician — getting my charts and tasks done in a timely way, and being focused as I enter the next exam room. I struggle as much as anyone communicating effectively and setting emotional boundaries with difficult patients and scenarios. I continue to work hard at finding an acceptable balance with my personal and professional life.
We have a unique contract with society in personal service to others that no other profession has. I have always felt obligated to push myself in continuing professional development in constant improvement of my knowledge and skills, and to go the extra mile for patients. I am fully committed to lifelong learning, which is a key part of the definition of our profession. Practicing Excellence and The Project, specifically, brings all of this together allowing me to reflect on my role and grow as a medical professional.