Are you a good noticer?

PUBLISHED ON  August 18, 2013

WRITTEN BY  Roni Zeiger

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We’re reading The Voyage of Dr. Dolittle with our son and among the countless lessons is this clinical pearl, when the Doctor’s apprentice asks the wise parrot: “Do you think I would ever be able to learn the language of the animals?” Polynesia, the parrot, answers:

“… are you a good noticer? Do you notice things well? I mean, for instance, supposing you saw two cock starlings on an apple tree, and you only took one good look at them, would you be able to tell one from the other if you saw them again on the next day?… that is what you call powers of observation — noticing the small things about birds and animals: the way they walk and move their heads and flip their wings; the way they sniff the air and twitch their whiskers and wiggle their tails … lots of the animals hardly talk at all with their tongues; they use their breath or their tails or their feet instead.”

This is the best description I’ve seen about really paying attention to your patients (and children and friends…).

Which wolf are you feeding?

PUBLISHED ON  June 11, 2013

WRITTEN BY  Roni Zeiger

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Life has been wonderfully busy, especially building a startup company, so I haven’t written recently. It seems fitting to share a a Cherokee legend that a friend just taught me about:

One day an old Cherokee is teaching his grandson about life. “A fight is going on inside me,” he said to the boy. “The same fight is going on inside you. It is a terrible fight and it is between two wolves inside us all.

One is Evil – it is fear, anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.”

“The other is Good – it is joy, peace, love, faith, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, and compassion.

The grandson thought about it for a minute and then asked his grandfather, “Which wolf will win?”

The old Cherokee simply replied, “The one you feed.”

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.