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When Being an Expert is a Disadvantage

12/4/2012

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Recently, I've been putting much thought into the impact of "expertise" in healthcare.  As a leadership and physician leadership coach, I very often work with my clients on their habit of problem solving, knowing "the" right answer, judgment, and intellect. 

In my personal journey in dealing with my husband's life-threatening brain disorder, I find myself torn between wanting to look to my physicians for "expertise" and "hope," while also being aware of the limitations of medicine and my need to define my own reality... my own story.

It is an interesting perspective to be a consumer of healthcare and practitioner within healthcare at the same time.  I've been reading, with avid interest, the differences between the medical model and patient-centered model, as defined within "Escape Fire's" movie and facebook page (that is where all the "expert information" is, right??). As the authors describe, the patient-centered model  requires a shift from "physician dominant," to "physician collaborates:"  From "care is disease-centered," to "care is quality of life centered;"  From "physician does most of the talking" to "physician listens more and talks less." 

As I read various related literature, like "The Four Habits" that was created by the great folks at Kaiser Permanente, I think about tools that help shift this paradigm.  As they describe,  The Four Habits are: Invest in the Beginning, Elicit the Patient's Perspective, Demonstrate Empathy, and Invest in the End. The goals of the Four Habits are to establish rapport and build trust rapidly, facilitate the effective exchange of information, demonstrate caring and concern, and increase the likelihood of adherence and positive health outcomes.  What I find fascinating about this model is that it parallels the framework of a coaching model perfectly! 

In coaching, the client is the expert, holding all the wisdom, strength and courage that a capable, wise, and powerful being possesses.  A table succinctly describes the four habits and associated skills:  "elicit patient concerns;" "ask for the patient's ideas;" "be open to patient's emotions;" and in "investing in the end," "deliver education and diagnostic information and then involve the patient in the decision making process."  It reminds me of a dance that is more of an interplay between leader and follower with those roles being flexible and dynamic, rather than fixed and unchanging.

All of this requires a perspective that is quite different from doctor, or nurse, or any other discipline as "expert."  It requires a vulnerability that allows us to say: "I don't know everything" and most importantly, I don't know what matters most to my patient.  Therefore, while my breath and depth of knowledge is vital, I'm also a learner along this journey of wellness with my patient/ client.  Now there's a thought!  What impact would it make if we were to start labeling the "patient" "client?"  Better yet, how about "health partner?"  Whatever term would convey the essence of each individual's wisdom and insight to direct their own health, and their own wellness, even if that includes dying.

There are two resources I use repeatedly in my work with clients: Marilee Adams' "Change Your Questions, Change Your Life," and David Emerald's "The Power of TED."  Ms. Adams describes her simple, yet powerful "Choice Map," which helps the reader consider a shift in perspective from judger to learner.  It requires us to recognize when we are making judgments about others (which she describes as landing us in the pits) and intentionally shifting that perspective to one of learning and desired outcomes.  It's less about blame and who's right or wrong, and more of "what do we want, what assumptions am I making, and what are the options open to us?"

Mr. Emerald describes the empowerment dynamic as moving from victim to creator.  As a creator, I have choices in how I deal with life's challenges, and I can seek the help of coaches who can appropriately challenge me to discover my wisdom and help me move toward health and success.

Can we make that shift in healthcare?  Can we use our great strength in problem solving and science/ medicine, while also making room for art in more fully engaging our health partner on their journey to wellness?  Can we notice and abandon our own egos and judgments, in service to the patient?  I, for one, would love to be part of that journey!

I welcome your perspective!





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Should Doctor's Use a Professional Coach to keep them at the top of their game?

2/19/2012

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I must thank Dr. John Bethell in Australia for posting this thought provoking comment on a recent American College of Physician Executive's Linked In group site.  There are, as of this posting, 25 comments in response to this question.  Of course, I couldn't help but add my two cents.  The respondents include physician leaders and physician coaches.  Questions asked pertain to the inevitable question of "ROI," the distinction between mentoring and coaching, the definition of "need" of a coach, versus desiring of a coach, "what is coaching," and who is capable of being a "coach?"

As I've worked on my own growth as a former nurse and "technician," and as I work with healthcare and physician leaders, I am impressed with the challenge we have of relinquishing our desire to be, and to be seen as "experts," in service to learning and collaboration.  As "experts," the idea of asking for help and admitting "not knowing," or vulnerability can be scary.  Yet, if we were to look at the research re: medical errors, isn't it the facade of "knowing it all," and complacency that is amongst the higher contributing factors to patient incidents?  At what point do we find that balance between knowing as much as we can in service to the patient, and recognizing that we will never "know it all," and our greatest service may be in gaining awareness of the questions and joining others in discovering the answers?  And how do we shift gears in being that "expert" for the patient, and a fellow learner with other healthcare colleagues on issues of systems' change to support long term patient health and wellness? 

So, back to Dr. Bethell's question......should doctor's use a professional coach to keep them at the top of their game? 

The question of "should" imposes some standard or judgment.  My preference is to remove judgment and to answer the question of "can you benefit from using a professional coach to stay at the top of your game?"  At the risk of your irritation, I'll answer with a question:  "How much is it worth to you to be at the top of your game?" 

Coaching operates from a philosophy that our clients have their answers... it is the coach's responsibility to ask questions and offer observations to help them discover those answers.  I am confident that in your answering the question above, you will arrive at YOUR right answer!
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    Author

    Joy Goldman is an avid photographer, and perpetual seeker of positive and inspiring views. She has spent much of her life, regardless of career expression, in finding what's positive, and using that to serve others.  As a lifelong learner, Joy lives the principles she teaches, and challenges herself to be a model for the courage, humility and authenticity she requests of others.

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