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Episode: Gain confidence and control with new patients

Author: Michelle Chestovich MD
Duration: 00:14:41

Episode Shownotes

Physician coach Michelle Chestovich MD shares common thought errors that make your work harder and shares a simple strategy to gain confidence in your work, no matter who you're taking care of.Want to apply this work in your life so you feel better? Join today.

Click here to join Stress Rx Group coaching: https://www.mamadoclifecoach.com/stress-rx-group-coaching-programThe CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/rhZbuQ

Full Transcript

00:00:00 Speaker_00
You are listening to Episode 150 of the Remind Yourself Podcast. Welcome to the Remind Yourself Podcast, the podcast for physician moms just like you who want to ditch mom guilt, stop yelling, and start enjoying their lives today.

00:00:21 Speaker_00
I'm your host, Michelle Chestovich, certified life coach, family physician, and mom of four. If you want to overcome overwhelm for once and for all, this is the place for you. Hello, Mama Docs, and welcome back.

00:00:39 Speaker_00
I hope you're having a most wonderful day. It is a beautiful, sunshiny day, and kind of unseasonably warm here in Minnesota.

00:00:47 Speaker_00
We typically get a little midwinter thaw, and I have to tell you, it is delightful to go for a run when it is in the mid 40s to 50s.

00:00:55 Speaker_00
So for those of you who get that year round, lucky for you, we are enjoying our shot of sunshine and warmth here, and I'm sure more winter will come back.

00:01:05 Speaker_00
What I really wanted to talk to you about was something that I've been seeing more in my group coaching program.

00:01:12 Speaker_00
It's come up a couple of times in the last few weeks, and I just wanted to share it with you because particularly if you're a relatively new attending and you are having a bunch of new patients, that can cause a lot of consternation.

00:01:24 Speaker_00
And I am here to try to help you make life simpler. So I wanna share with you a few things that have come up and how I help shift the perspective for physicians to make new patients easier. Okay, so let's get started.

00:01:40 Speaker_00
Number one, you may be getting new patients in your practice, either that you're new to the clinic, that maybe you've just started out after residency or fellowship, and or perhaps you've transferred to a different office, a new organization.

00:01:54 Speaker_00
So you've got a whole bunch of new patients. And the third thing that I see on the regular is that perhaps colleagues have retired or they've left to go to another practice. And so there are patients that are new to you that are on your schedule.

00:02:06 Speaker_00
And I just want to go through some of the things that I hear that fill you with fear and dread and perhaps make the job even a little bit more difficult than it needs to be.

00:02:17 Speaker_00
So of course we can say like seeing new people can be filled with challenges.

00:02:21 Speaker_00
And yet when we just focus on that, right, you've heard me before, say the way we think creates the way we feel, which drives what we do, perhaps thinking on the regular, oh my God, this is so hard, could in fact make that come true, that it is actually harder.

00:02:37 Speaker_00
So things that I commonly hear, number one, oh my gosh, it takes so much time. Right? And you have evidence to prove that, right? You're spending a lot of time reviewing the chart.

00:02:48 Speaker_00
You're spending a lot of time with the patient and perhaps a lot of time after. So like you prove that thought true because you're filled with probably some dread and fear.

00:02:57 Speaker_00
And so you go into the office visit without really a clear plan about how to be in control. Right?

00:03:04 Speaker_00
And so you kind of let the patient just go on and on, and the patient runs the show, and then you're a bit confused about should we tackle all of the things, or should I focus on their current problems?

00:03:14 Speaker_00
I really want to figure out what's going on in the past, but they just keep bringing up this acute issue. And so it just feels a bit overwhelming. Right? And it takes a very long time.

00:03:23 Speaker_00
Another thing that I commonly hear is, I don't want to miss something. Right? And this fills us with fear. Now, again, I want to remind all of you listeners that having a little bit of doubt is really good for our patients.

00:03:35 Speaker_00
Having that idea of, I don't want to miss something, in some ways is very noble. Right? Of course we don't want to miss something with our patients.

00:03:42 Speaker_00
They're coming in and we want to make sure that we have a full idea of what could be going on, a full deferential, be able to understand and evaluate. Of course we want to do that.

00:03:52 Speaker_00
And yet, when we focus on, I don't want to miss something, this is how that plays out. It creates a feeling of fear. And so you don't, number one, acknowledge the expertise and the knowledge that you do possess, even before you walk into the room.

00:04:08 Speaker_00
You don't remind yourself of that. You're just kind of in this worried state, like, I hope I don't miss something.

00:04:12 Speaker_00
And so again, similar to the last situation, you don't have a clear plan when you go in and you ask some questions, but then the patients maybe take a little bit of sideways and you feel like You just can never figure it all out.

00:04:27 Speaker_00
You think you need to review all the past charts, and you don't feel like you're actually giving the patient the time and addressing their current needs, right? And you just feel scattered.

00:04:40 Speaker_00
And you come out of the visit, you're like, I don't even know if I addressed anything. I accomplished some of understanding the history, but I don't understand it all. And now the patient's mad, and they're still going to need to come back.

00:04:48 Speaker_00
Like it just feels very, unresolved for many people and you continue to have this feeling of, I worry that I'm going to miss something.

00:04:56 Speaker_00
I have clients who are seeing patients and they continue to think about them because that thought runs so strongly in their brain. Now again, of course that that's going to come, but when we let that thought take over, it makes our day so much harder.

00:05:09 Speaker_00
The final thing that I will say that I see on the regular is that patients say, like, excuse me, clients say, ugh, Dr. X retired and now I'm getting all of their patients. They are so difficult.

00:05:23 Speaker_00
Whether it's due to the complexity of all their medical issues or the fact that perhaps that physician had a different practice style and perhaps they're on medications that you don't typically prescribe, that sort of thing.

00:05:35 Speaker_00
So you're filled with dread and anticipatory worry before you even see the patient. Raise your hand right now if this is true.

00:05:43 Speaker_00
It certainly was true for me, because in my practice, I had a couple of older docs retire, and I inherited their patients, and they had a different sense of things. They were great physicians.

00:05:52 Speaker_00
This is not to disparage the colleagues who've left, but it's just that we all have different practice styles. And perhaps the doctors from days of old had a different knowledge about things than we do, right? Like, of course.

00:06:03 Speaker_00
And I'm not saying that's good or bad. It's just that it's okay to have your own practice style.

00:06:06 Speaker_00
But when you are dreading seeing these patients, and you're worried about what the patients are going to think, again, you have this feeling of dread, you walk into the room, feeling nervous, kind of like walking on eggshells, you're afraid to tell them your plan, because you don't want to upset the patient, you don't want them not to like you.

00:06:22 Speaker_00
And so you don't have a clear game plan. and confidence to back it up. And so it's sort of like a free for all and you're worried every single time and you forget that you've done it before and that you do have a plan.

00:06:34 Speaker_00
So what do all of these three scenarios have in common? It's that you're letting your default thoughts run the show. Right? We have 70,000 to 80,000 thoughts a day. Of course we're going to have thoughts.

00:06:45 Speaker_00
We've thought many of these on repeat, so of course they come again. The brain likes to be efficient and offer up these same thoughts. And yet, what I like to ask you is, are these thoughts serving you? And what does that mean?

00:06:56 Speaker_00
When I ask that question, it means, does it help you get your job done more easily when these are the thoughts that are front of mind? Most of you would say, absolutely not.

00:07:07 Speaker_00
And in fact, this is why it comes up in coaching, because this is an area of struggle. And so what do we do about it? We acknowledge, oh, it makes sense that my brain has thought this way. And I've got a lot of evidence to prove that it's true.

00:07:18 Speaker_00
Because again, when you think on the regular, I hope I don't miss something, you end that whole day still worrying if you miss something, because you're not teaching your brain that you do know what you're doing, right?

00:07:29 Speaker_00
So this is what we brought up in group. And this is what we dig into on the regular, whether you're doing group coaching with me and or one-on-one coaching, we come up with simple solutions. So I help physicians create

00:07:42 Speaker_00
plan, your own personalized plan, because I don't have the wisdom to know what's going to be best for you.

00:07:47 Speaker_00
But in this scenario, I hope you realize I do indeed have a plan, whether it's with a complex patient with multiple medical issues, whether it's a retired physician who left and their patients who are on medications that I'd prefer them not be on, you need to have a plan in place.

00:08:05 Speaker_00
Number one, first and foremost, This is how I simply deal with X, Y, or Z. Number two, you are going to remind yourself on the regular that you do have expertise. I brought this up to a client the other night.

00:08:20 Speaker_00
I said, if you couldn't review the charts and you just had to walk in and knock on the door and go in and say, how may I help you today? Do you feel confident that you could help them with something? And indeed they said, yes.

00:08:32 Speaker_00
And I reminded them that our ED physician colleagues, this is what they do every day. They stumble into, they don't stumble in, they walk into a scenario where they don't know all the background typically, and yet they can very,

00:08:45 Speaker_00
accurately start moving forward, figuring out this is what's going on. These are some tests we need to do, and this is going to be our current plan until I figure something else out, right? They are able to use that expertise.

00:08:56 Speaker_00
So I remind us all of us to tap into that. You do know what to do. And the other thing that I'll remind you is even if you could only glance at their medications, that tells you a lot about the patient. You are really smart.

00:09:08 Speaker_00
You know that if they're on lisinopril and metformin, that tells you a lot about the patient, right?

00:09:16 Speaker_00
Like sure, you wanna know their past medical history, you wanna know their past surgical history, all of those things, but remind yourself that you are really smart and walking into the room, eyeing the patient and seeing how they look, looking at their vitals, huge right there.

00:09:29 Speaker_00
Asking them a question, how are you here today? You gain a lot of information, people. Yes, it's great to know the history and you don't need to know it all right this second in order to take good care of the patients.

00:09:40 Speaker_00
You can get a great snapshot from the medications alone. And when you remind yourself of that, perhaps you can chill the F out a little bit and realize, ah, I do have a plan. I walk in, I ask them, you know, why they're here today.

00:09:54 Speaker_00
I tell them I can't wait to get to know them, and it's going to take some time. If I want to make sure that I go over their chronic issues, I can do that. But maybe we don't need to go into the weeds. Maybe you just stay up into the organ systems.

00:10:06 Speaker_00
Again, you don't need me to tell you these things. You are brilliant physicians. Perhaps you start with the cardiovascular system. What's going on there? Neurologic. You keep it really high level.

00:10:15 Speaker_00
And over time, you're going to dig in, you're going to learn all the things about them. But you can decide for yourself, what are the most important things that I want to know about this patient today?

00:10:23 Speaker_00
And I'm going to let them know that, yes, they've been with this other doc for 30 years, and they knew them inside and out, and I too will get to know them over time. We're not going to learn all the things immediately.

00:10:34 Speaker_00
We're not going to be able to tackle all the problems immediately. And those two things right there spin a lot of docs out. Because when you focus on, like, I need to know it all, I need to help them with all their issues here, it's no wonder

00:10:45 Speaker_00
these new patients to you are overwhelming. So I want you to gain back control and remind yourself, I do have a plan. And you're going to create your own personalized plan.

00:10:54 Speaker_00
And you're going to remind yourself that, wow, my wisdom, I could just walk in there and help with something, no matter what, whether I have a chart to look at or not. Remind yourself, I can help them today with something.

00:11:06 Speaker_00
Your brain is going to tell you, I didn't do all the things. Yeah, that's right. You're helping them with one thing or two things, and you're going to invite them back and get to know them over time.

00:11:14 Speaker_00
So the final thing I want to say is that, for instance, with medications that you don't typically prescribe and perhaps they're on, you know, meds that you are like, hey, wait a minute, this is on the beers list and this is a 74-year-old patient.

00:11:26 Speaker_00
I would like to get them off. Have a plan instead of kind of tiptoeing around and feeling uncomfortable. Stand in your confidence. Empower yourself to say, I know what's best for the patient.

00:11:36 Speaker_00
And even though they might not love the plan, you can let them know, these are the things that I think would be right for you, and this is how we're going to work on it together. Right?

00:11:45 Speaker_00
It doesn't have to be like a punitive thing, and you maybe don't even want to bring it up then.

00:11:49 Speaker_00
Say, you know, I'm going to work with you to make sure that this medical list over the next few weeks and months is going to be safer for you and most optimized, and we're going to simplify things for you. however you want to say it.

00:11:59 Speaker_00
So that is how you start to build your confidence in new patients if this is something that you struggle with. And I know many of you listeners are like, I've been doing this for years. I've kind of figured it out. That's great.

00:12:10 Speaker_00
And I want to give a jumpstart and a little bit of a boost for those who are new attendings because this is something that I see time and again. Another thing that can help build your confidence is to join a like-minded group of physician women.

00:12:24 Speaker_00
This is exactly the work we do week after week in StressRx group coaching. We talk about building our confidence. We talk about validating ourselves because, again, we're used to getting all the A's and now we're not getting that anymore.

00:12:35 Speaker_00
But how can we build our own validation that we are doing a good job? as in attending, taking great care of our patients.

00:12:43 Speaker_00
We learn to set boundaries with our staff, with our patients, so that we can have a life outside of medicine, so we can learn to get our notes done more efficiently, so we can enjoy our evenings with friends and family or just take time for ourself.

00:12:58 Speaker_00
You also learn your own personalized chill the F out strategy so you can learn how to get your cortisol level down on the regular, simply. These are just a few of the things that we do in the group.

00:13:09 Speaker_00
If you're struggling, I just want to tell you that it doesn't need to be so hard. And we just started this week, Monday the 29th, a new group kicked off. It's not too late. If you want to join and jump in with us next week, it's not too late to join.

00:13:21 Speaker_00
We still have a few seats available. So click on the link in the show notes, come join us. The next group's going to be starting in the spring, but why wait until later in the spring to start feeling better? You can feel better today.

00:13:33 Speaker_00
Click on the link in the show notes, find out more about the group. Okay, whether you join the group or not, I know this knowledge and a little bit of a plan is going to be so helpful for you. Because now you've got a strategy.

00:13:47 Speaker_00
You are brilliant, and many times we're not taught this. And we, of course, as high achievers, want to do all of the things. Of course, you want to take great care of your patients.

00:13:54 Speaker_00
But I want to remind you that you don't have to do all of the things, that you don't need to know all of the things about your patient in order to take excellent care of them today.

00:14:04 Speaker_00
Okay, my friends, I hope it is beautiful and sunshiny wherever you are. Get out, go for a walk or just bask in the sunshine for a few minutes and take care of you. Until next week, peace and love to all of you.

00:14:18 Speaker_00
Are you ready to take control of your life and put these tools into action? I'm here to help. I offer free consultations for physician moms to see if my one-on-one coaching package is right for you.

00:14:30 Speaker_00
You can sign up for a free consult at www.MamaDocLifeCoach.com