Month: January 2013

This is it. The last day of this 31 day challenge to better doctoring. If you have traveled with me this far, I sincerely thank you. I hope you have had as much fun as I had in going through these little daily challenges. Let me recall, that these exercises were written just for me, so I can push myself to be a better doctor. Not in terms of knowledge, but as a person, a colleague, a worker, a public servant. I hope you had enjoyed the thoughts behind these challenges as well.

This day is yours. Fill in the blanks. Choose your own little challenge to better doctoring today. You can pick from the last 30 challenges and repeat one of them, or you can come up with a good one on your own. Whatever it is, challenge yourself. Today, you can be a better doctor than yesterday.

Thanks again for traveling with me this far. To my dear friends on Twitter and blogosphere who had conversed with me along the way, a sincere thanks. It is really encouraging to see that there are many people out there wanting to make a difference wherever they are. I salute you for your hard work.

Love,

Otorhinolarydoc

Someone said that the secret to happiness is not in doing what you love, but in loving what you do. As doctors, we are in such privileged positions. We get to practice our art and help others along the way. As medical students, we fell in love with medicine. But as we grew up in medicine, we get lost in the busyness, stresses and demands which are inevitable parts of a career. We get hypnotised by the temptation of money and fame. Along the way, we lost our love of medicine. We lost the reasons why we entered medicine in the first place. We lost the child-like awe and excitement that used to greet our days at the hospitals. We lost the inquisitive curiosity that used to fill our minds. We lost the love of medicine. No wonder many of us become quite sad, grumpy, cynical old doctors.

If there is one challenge in this whole 31 Days to Better Doctoring Challenge that I hope every doctor would do, it would be this: The challenge to love your work. The challenge to fall in love with medicine and surgery all over again. The challenge to infuse more enthusiasm and love into everything we do. The challenge to love what we do. I could almost guarantee that the more you love your work, the happier you would be and the better your work would be.

So today, I challenge you to fall in love all over again with your work.

‘Doctor’ comes from the Latin word ‘docere’, meaning ‘teacher’. ‘Surgery’ comes from the Latin ‘chirurgia’, or Greek ‘kheirourgia’, meaning ‘working with hands’.

I believe as a surgeon I am called to be a teacher who works with my hands.

The primary duty of a doctor/surgeon is to teach. To teach patients how to live better. To teach students the causes and treatments of diseases. To teach nurses how to care for patients. To teach families how to support a patient in need. To teach, teach and teach. You’ve heard it said before, “Give a man a fish, and you’ll feed him for a day. Teach a man to fish, and you’ll feed him for a life time.” And that is true. Caring for one person for a day limits my impact. Teaching how to care for a person will teach the patient, their families, their carers, their nurses, my students, colleagues, and many others the art and science of better living. Teaching is foundational to the legacy of health I will leave with my patients and the doctors after me. Long after I’ve laid down the scalpel, it is my legacy of education that will continue to bear fruits of healthy outcomes. By teaching, I do not mean a transfer of information. No, the photocopier does that. Teaching, to me, is primarily measured by a change of action or behaviour resulting from an educated mind. A life change, like stopping smoking, caring for ear health, vocal hygiene, etc, are the outcomes of my teaching as a doctor. Antibiotics and surgery are just some of my tools. And when I see a non-ENT doctor being good at managing BPPV, otitis externa, chronic rhinosinusitis, salivary stone, etc. then only have I done my duty as an ENT surgeon. Teaching is not focused on the teacher, but the student. Teaching a patient to stop smoking requires a different technique to teaching a medical student the biochemical carcinogenic effects of smoking.

Every moment is a teachable moment. Not a lecture session, but a teachable moment. Be proactive in teaching today. Fulfill your ancient Latin calling as a doctor/teacher.

Throughout my training I’ve found that even the hardest bosses are really softies at heart. Some of the nastiest surgeons I’ve met turn out to be very reasonable and friendly mentors once you get to spend time with them. It’s just that they don’t let too many people come close to them and they demand perfection from everyone working with them. That gives them an air of unapporachability, though they’re really human beings wanting to do their best for their patients. I’ve actually fallen in love with some of these hard to break surgical bosses. In fact whenever I start with a new unit I still make it a point to identify the ‘hardest’ boss in that unit and aim to ‘turn him/her around’. I make it my goal to soften the hardest boss. And surprisingly, it always starts with appreciation. So today, do something to appreciate your bosses. A word, a card, a gift, etc. Surgeons and bosses are people who also need to know that they’re doing well in their work. They too need feedback and appreciation.

Which is harder? Writing down the bad stuff you’ve done, or the good ones? Yesterday you wrote about the things that you could have done to improve your game. The wrongs that could have been made better. Today, write down the events in the past week where you have done well. Think about your interactions with your patients, the procedures you’ve done, the jokes you shared with the nurses, the plans you’ve set for your patients, the drugs you chose, the presentations you’ve made, even the clothes you wore. The ability to fairly assess your performance as a doctor is important. In the current context of cynicism and negativity at workplaces, it is always important to be able to assess your own performance and determine how well you are doing. Celebrate the good you’ve done.

To err is human. Doctoring is human. If we are honest with ourselves, there will always be mistakes we can admit to and things we can do better. We are trained in this. As a trainee surgeon, in particular, I am trained to continually audit my performance. I measure my outcomes, record my complications, scrutinise my results. My logbook is updated daily with surgical numbers, techniques, outcomes and complications. But what about the non-operative aspect of my doctoring. Have I ever measured how many times I’ve been stressed out, rude to nurses, chose the wrong analgesic, arrived late in theatre, not clarified my plans enough to patients, failed to communicate with the GP, wrote illegibly, etc. Take time today to think about the past week, and every moment of the days. Write down the things that could have been done better and how it could have been done better. It may involve technical matters of doctoring, or the non-technical ones.

Hospitals are pressure cookers. Working in hospitals involve dealing with pressures at all times: time pressures, clinical demands, urgent matters, sick patients, excessive workload, mounting paperwork, challenging procedures, etc. In the midst of high tension and pressure situations, egos get rubbed, tempers flare, and sharp, hurtful words get thrown about. Even on days with less pressures, sometimes our communication often involve cynical and sarcastic remarks about colleagues, patients, other specialties and allied health staff. Let me challenge you this Friday to hold your tongue. Hold back on any sarcastic comments or negative words you are about to say. Just hold it and let the comments pass. Don’t even justify anything. Just smile and keep quiet. See how that will change your mood. Hold no grudges. Live lightly and live well.

You are always running, probably. I know I used to. I used to always run between theatre, emergency, the ward, clinic, preoperative holding bay, recovery, etc. I need to run so I can pack more things into my day and spread myself thinly over many things. In the midst of running, I often realise that I am less effective and less helpful to others. I project this air of busy-ness and keep others at a distance so they won’t bother me. But I’m learning now to slow down and purposely hold my thoughts longer. I’m learning to slow down during rounds so I can spend a bit more time with patients, and allow students and nurses to stop me and ask me questions. I slow down enough to make me interruptible and approachable. I slow down enough to allow my mind to think clearly. I sit on the patient’s bed. I sit on the nurses desk. I slow my footsteps. Interestingly, I still get the same amount of stuff done (or not done) during the day whether I am at 110mph or just on slower speed. I am realising that slowing down is good for me, my colleagues and my patients. Try that.

Doctors never work alone. Patients are best served when doctors work well with allied health. I can easily list the allied health workers that ENTs work with very closely: nurses, pharmacists, audiologists, speech and language pathologists, physiotherapists, nutritionists, social workers. What about your specialty? Who do you work with? Take time today to thank them and appreciate them. It will build a stronger working relationship that will benefit your patients.

It takes an army of workers to make a hospital run. There are many, many unseen employees in every hospital working for the good of the patients. As doctors, we are often seen as the face of the hospital, but we know that we would not be able to work effectively without the help of so many others. Today, make a special effort to see those unseen workers. See them, smile at them and thank them. See the janitors, cleaners, porters, security guards, engineering, kitchen services, receptionists, switchboard operators, operating theatre sterilisers, lab technicians, etc. There are hundreds of unseen quiet workers in the hospital. A tap on their shoulders with the words, “Thank you. My patients and I appreciate your good work” may just make their day.