David M. Tang
Ask An Attorney - Managing Complications
Updated: Mar 24, 2020
I have been practicing medicine for 15 years. Lately, I’ve hit a streak of difficult challenges – more than before. I am constantly buried in paperwork and I caught myself making a mistake probably due to overwhelm. I am also navigating various issues in the office after an unexpected death of a patient and loss of a key staff member. Do you have any suggestions for riding this out?
Murphy tells us that things go wrong in life. Likewise, errors are inherent in the practice of law and in medicine simply due to humans being imperfect by nature. In my practice, there are times when I’m challenged to deliver ‘bad news’ to a client -- sometimes the facts of the case mean our client will face exposure or liability; in other cases, a recovery due to injury is just not possible due to circumstances beyond our client’s control. With time, I’ve adapted a few methods for dealing with complications or difficult situations. This article considers a few ideas for how to respond for dealing with overwhelm and things that go wrong -- at work or at home.
We Can Only Control What We Can Control
The Greek Stoic philosopher, Epictetus, taught that some things are in our control and others are not. Things in our control are opinion, pursuit, desire, aversion and, in short, whatever are our own actions. On the other hand, things not in our control are body, property, reputation, command, that is, whatever are not our own actions. In dealing with a difficult situation, assess that which is capable of being influenced or effected by your own actions. It may relate to communicating information, making a recommendation, or pausing and reflecting on making a measured response in lieu of reacting to an insult. In the context of helping staff members or a friend through a difficult moment, you can control your own actions and the timing of the actions, which may take the form of listening, counseling, or offering a shoulder to lean on.
Some years ago, I read an article by surgeon and writer Atul Gawande in The New Yorker on the question of what should medicine do when it can’t save your life. In that, he reflected on an observation from the paleontologist and writer Stephen Jay Gould. Gould was diagnosed with abdominal mesothelioma in the 1980s; he went to the medical library to review the latest literature and confirmed that science had concluded that the disease is incurable, with the median survival being only 8 months from discovery. Gould, however, studied patient survival curves and he noticed that patients were not clustered near the median survival but fanned in both directions and, notably, the curve was skewed to the right. It was in this long, though slender tail, in which Gould found solace. An experimental therapy that he received allowed Gould to live another twenty years. Also mentioned in The New Yorker article was a Harvard Medical study that asked doctors for 500 terminally ill patients how long they thought their patients would survive and then followed the patients. Only 17 percent of the doctors underestimated. A fascinating data point from that research was that the better a doctor knew their patient, the more likely they were to err. The suggested takeaway was that in addition to having a natural tendency to avoid difficult conversations, our own views may be unrealistic regarding likely outcomes versus desired outcomes. If you are struggling with issues in the office, try to be open about the practice’s needs and any new expectations from clinical staff, so everyone can see that the goals are realistic and achievable.
Make Time for Communication
In my work, communication goes a long way to help me understand a client’s objective and based on that understanding, my colleagues and I will work to craft a solution that best fits the stated goals. Gawande wrote a powerful anecdote of the transformative of a policy to systematize an end of life discussion for residents of a township in Wisconsin. Anyone admitted to a hospital, nursing home or assisted living facility completed a 4-question survey. The community increased advance directives from 15% to 85% in 5 years. Having the conversation resulted in end of life cost in that township that are half the national average. Good listening is a critical part of effective communication. When we deal with difficult patients or people, can we identify their objective? Are they coming from a place of fear or anxiety? If so, can we move them to a place a safety to mitigate or lessen the anxiety so that space can be made for information sharing and/or a productive discussion of goals?
Ask for Help
If the situation calls for it, give yourself permission to seek help and find a trusted confidante or friend or a grief counselor or another professional with whom you can discuss your situation and identify options to better handle emotions or the emotionally-laden information that you are processing. In his article, Gawande shared details of his experience when shadowing a hospice care colleague to get a frontline view of her approach to help patients “have the fullest possible lives” in their final weeks or months. He shared his mindset shift from believing hospice care hastened death, because patients forgo treatment and are permitted high dose narcotics. Rather, he found and cited research showing no difference in survival time between hospice and non-hospice patients with breast, colon and prostate cancer. In some cases, hospice care seemed to extend survival (those with pancreatic or lung cancer gained 3 to 6 weeks, those with congestive heart failure gained 3 months).
Maintain Good Health
When dealing with a challenging situation in the office or at home, take time to do a mini audit on your self-care regimen. Whether it is yoga, laps in the pool, walking the dog or taking a mindful moment every morning, create time for preserving and enhancing your physical, mental and spiritual well-being. Steven Covey, author of Seven Habits of Highly Effective People wrote, “We must never become too busy sawing to take time to sharpen the saw.” A few years ago, my friend, Ron Friedman, wrote a great article for Harvard Business Review called, Regular Exercise is Part of Your Job. The article explains that social scientists who researched the impacts of exercise determined that the benefits go beyond a healthier heart, better physique and lower blood pressure. What caught my attention was that the evidence suggests exercise improves how one thinks: sharper memory, prolonged mental stamina, and enhanced creativity. Ron wrote about a study of 200 employees which found that on the days when employees exercised, their work experience changed: the employees reported being more productive, having smoother interactions with colleagues and enhanced mood. To the extent that dealing with a difficult situation with a colleague or a friend or a difficult patient is challenging on its face, increase the odds that you will face the challenge in a focused, mentally clear manner by keeping up good health habits.
More Empathy, Less Sympathy
Empathy is feeling with people. Sympathy, in contrast, is feeling sorry for someone (a patient, colleague or friend) by keeping a distance from the other person’s feeling. According to Brené Brown, the research professor who gave a viral TED talk, empathy fuels connection; sympathy drives disconnection. Brown writes and has spoken eloquently about the challenge of empathy: she points out that empathy is a choice -- a vulnerable choice, because it calls for us to connect with something within ourselves that connects with the emotion that the other person is feeling. Brown notes that in the face of a difficult situation, it is a natural instinct to want to try to make something better. However, she challenges us to recognize the truth that rarely can a ‘response’ alone make something better. What makes something better is connection.
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