Prescribe Respect

PUBLISHED ON  February 24, 2013

WRITTEN BY  Roni Zeiger

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I’ve been noticing recently that the most important thing I can do in clinic is listen respectfully and come up with a shared plan that feels like the patient owns it at least as much as I do.  When it goes well it almost feels like I’m handing out a prescription for respect.

Looking through this lens, I see respect as the critical currency in most of what we do, whether it’s doctoring, collaborating with colleagues, parenting, or teaching.

This year, our daughter’s 3rd grade teacher is probably the best elementary school teacher we’ve ever met.  One key to his success: every morning as the kids line up to enter the classroom, he individually looks every kid in the eye, shakes their hand, and genuinely asks them how they are doing, how was their weekend, or similar.  What does it mean for an 8 year old to have a respected grown man take them that seriously everyday?

When things aren’t going right with someone at work, or with my wife for that matter, it seems like it’s always a good idea to remember to ask myself: does the other person feel like they’re getting enough respect from me?  These relationships are obviously more complex than this, but I’m finding this simple framing helps me better understand others’ perspectives.

While I can’t prove it, I’m willing to bet that a prescription for metformin accompanied by an extra dose of respect results in better adherence and outcomes.  What does respect mean in this context?  This is definitely a work in progress, but I think it includes:

  • Introducing myself as “Roni Zeiger, one of the doctors here” instead of “Dr. Zeiger”, a tip I recently stole from Otis Brawley after reading his book, How We Do Harm
  • Asking the patient what he or she thinks is wrong; I explain that I find patients often know what’s wrong or their ideas provide useful clues
  • Explaining that the diagnosis and/or treatment we agree upon might be wrong and how we’ll learn that if that’s the case

In this context, respect means I’m interested in your perspective and it matters, we should collaborate, you are part of the solution.

Here’s to prescribing more respect and more sincere collaboration with patients.

The 5-95 Rule

PUBLISHED ON  January 28, 2013

WRITTEN BY  Roni Zeiger

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I’ve had a ridiculously fortunate life and career so far.  One of my “problems” is that there are too many interesting things to work on.  I’m developing an approach to this problem, which I call the 5-95 Rule.  It’s a work in progress, and I’d like to share it in case it’s helpful and selfishly to learn how it might be improved.

Assuming a long and healthy career, I expect there will be about 5 projects that will be THE things I work on.  These are the ones that have the highest potential impact and are most uniquely suited to my background in medicine, product development, and informatics.  My last such ‘project’ was my fabulous job at Google.  The current one is a startup company called Smart Patients (more on that another time).

I estimate that over the course of my career there will be another 95 projects where (a) the project could have important impact on the world and (b) I could significantly improve the project’s chance of success.  So, a career with 5 projects that I’ll work on full time, and 95 others — hence, the 5-95 rule.  I’ve developed a pretty good sense of how to choose the 5 and dedicate myself to them.  But how do I find the other 95 and what do I do about them?

I don’t think I’ll ever have a perfect answer, but I actively think about this now.  Why try to find them at all?  I’m an impact junkie and I love to learn.  I’ve also learned lessons about how critical focus is, so we’re talking about small, targeted commitments.  One might be a formal advisory role, another a lunch and a few emails.

Currently, I’m an advisor for three companies: Qpid.me, ShareTheVisit, and Hobnob, and I’m on the board of directors of a non-profit, Medic Mobile.  One not-very-humble principle guides me: if I’m a formal advisor for a company, I want to be their best advisor.  If I can’t be, that’s a signal that it might not be a good enough fit.

I love that I often get asked for informal advice.  If I don’t think I can help much, I’m not shy about saying so, sharing my quick thoughts, and wishing someone good luck.  Probably once a quarter, I have lunch with a  young entrepreneur.  I’m certain that much of the time, I learn much more than they do.  (Another discussion for later: I’m convinced that the only useful definition of expert, is that someone thinks you’re an expert. The rest is self-fulfilling.)

One of the many reasons for starting to blog again is to have an easy to find “contact me” page.  If you’re one of the 95, let me know!

Patient Friendly Orders

PUBLISHED ON  December 26, 2012

WRITTEN BY  Roni Zeiger

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Here’s another technically easy and culturally hard product: Patient Friendly Orders.  My version of this idea was born when I was admitted to the hospital for pneumonia about 5 years ago.  Even though I had previously worked in that hospital, the quality of communication about my care between the patient and the medical team was poor.  This got me thinking…

There should be a touchscreen by my bed that lists all the current doctors’ orders. They’re not hidden in the chart.  They’re not explained only in ephemeral conversations that occurred without me present.  Of course, if they’re in front of me, they’re going to have to get written in English.

Let’s organize the orders, too.  Imagine a loved one is hospitalized for a severe skin infection which also caused his diabetes to get way out of control.  He has difficulty sleeping in the hospital and also needs pain control.  All the orders — whether for diabetes, infection, sleep, or pain — are organized according to the problem they address.  (While doctors’ notes are generally organized by problem, their orders are not.  I bet if we implemented Patient Friendly Orders, they’d be useful for doctors if only just for this reason.)

When the doctor or nurse or physical therapist comes in, the patient and family can have a conversation about the current plan, with that plan laid out in front of them.  They make a shared decision, and the doctor can update the plan on the same touchscreen.  “Sounds like a plan,” the patient says while actually looking at it.  When you visit your loved one, he can show you the plan, too.  If a question comes up about a given order, or why something is missing from the plan, you can make a note on the touchscreen so the medical team knows to address it when they next come by.

What about all the loved ones who can’t be in the room, the patient’s broader community?  When I was in the hospital with pneumonia, for example, I wish I could have tweeted: “Switched from ceftriaxone plus doxycycline to zosyn. Does that make sense?”  This of course raises important questions.  Certainly, any such broadcast requires truly informed consent of the patient.  I don’t think such a tweet would violate my doctor’s privacy assuming I don’t mention him or her by name.  It would be fascinating to understand what a doctor might think: “Switching to zosyn — oh [bleep], what are they going to say on Twitter?”  Is that a bad thing?  I suspect the good would outweigh the bad.

But more important, it’s a conversation the patient and his or her loved ones must be allowed to have with their community.  Indeed, we’ve probably all been a part of conversations about whether someone we care about is getting the right care.  It’s just time the patient’s medical team and the patient’s community can be part of the same conversation.