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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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Cadence and Transitions...

7/8/2012

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In less than 7 weeks, I'll be "running" this race!  It's been a journey for me since signing on the dotted line in January of this year!  I, along with two great friends and current Irongirls, have decided to do what we didn't think was possible (at least that goes for ME!) complete this sprint triathlon.  I've seen the race completed a couple of times; at times wondered: "what is it that makes someone want to put themselves through this?," and have walked away unchanged except for the admiration for those "winners!"

So, how did I push the "send" button?  As a coach, I often challenge my clients to do what they didn't originally think was possible, and watch their courage in executing their success.  We use their belief system and "habits" that were cultivated to apply to other challenges in life.  I believed that in completing this race, I would execute a cascade of possibilities I never even imagined.

So, when my bicycle coach today talked about "cadence" and "transition," it somehow resonated with  me.  In cycling, it's about the "RPM... revolutions per minute" and trying to hold them constant to get the most efficiency out of your body. It's a rhythm of sorts.  Now, in the comfort of my air conditioned home, I think "isn't that what life is?  Finding that rhythm... not overreacting to one thing or obsessing about one idea, but to find that natural flow of what we want our life to be?"  Pedaling through the hills and valleys and shifting up or down in anticipation of what might come next.

Today, I learned to shift up my back ring (to higher gears) so that I could shift down my front ring (lower gear) while still keeping the same effort.  If I try to shift down with my rear gears low, then I start spinning like there's no resistance, and I also risk my chain coming off my bike.   What a great metaphor...  life is not about not having resistance.... it's about feeling the road; knowing that your muscles will be working hard; that your breathing is important, and that sometimes, pressing through the pain can help you keep going.  With no resistance, we can fall or spin our wheels and go nowhere.  It reminds me of the saying that "Kites fly against the wind.... not with it."

So, I will be working on flow, rhythm, and cadence over the next several weeks, to help  my ongoing transitions in life and in health.  I will remember to shift up or down to allow me to press on and be successful!

How are you using cadence and transitions in your life?  I'd love to hear from you!....  and perhaps I'll see you out on the road!

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Perspective and Visibility

5/21/2010

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Spectators...... Preakness Hot Air Balloon
"Make visible what, without you, might perhaps never have been seen." 
Robert Bresson

I dragged my husband out of bed last Saturday to see the hot air balloons take off for the annual running of the Preakness.  This would seem like nothing out of the ordinary if you didn't know that we had traveled to Albuquerque last fall and did the same thing for the Hot Air Balloon Festival, last day, and the weather prohibited the balloons from taking off.

So, this was going to be it!  This was our due!  We arrived at Turf Valley around 6:05am and it was a gorgeous, sunny day, with many folks gathering for the same reason.  We saw some balloons inflating and joined the hundred other photographers hoping to get the perfect shot!  We later learned that, once again, the weather was going to be our enemy and that the winds were too much up high, and they were blowing in the direction of the airport..... I guess I have to concede that that might have resulted in some difficulties... planes and hot air balloons......

Still, due to the graciousness of the pilots, a handful did inflate their balloons so folks would not be totally defeated.  I managed to shoot 58 pictures, regardless... and later came home to see what I got.

What you see here, was my favorite.... while I was thinking that I'd get the beauty of the inside of the balloon...and it was a very colorful balloon, what I loved far more was the shadow of other photographers on the outside of the balloon..... what might never have been seen is the "balloon's perspective."

How many times in life do you think you know for sure what someone else is thinking or judging, when, after some exploration and dialogue, find to be something different!  Practice seeing another perspective.....  you never know what shadows may be revealed and what miracles may appear!

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Change Your View and Create a World of Possibilities!

3/22/2010

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Ahh, can't wait!
I went away recently to a beautiful timeshare resort in Hilton Head, SC.  To my amazement, there were not just one, but two, huge jacuzzi tubs in the villa!  I love to take jacuzzi baths, with the jets particularly focused on my lower back and shoulders.  And, I really love taking them in hotels where I don't have to clean the tub after I use it!  So, here I am, filling the tub, with excited anticipation for the experience I'm about to have.  Click on picture for larger view.

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What's wrong with this?
Here's the tub without water in it, in case you couldn't see clearly....  You'll notice the jet placements.  Well, again, I was just so excited that I jumped in the tub and planted myself smack in the middle of this luxurious bath.  Soft music was playing, it was going to be heavenly....  until, I really began to sweat (and I hate sweating), and I noticed that I wasn't really getting the spray on my lower back as I had hoped.  I began to think:  "what's wrong with this tub?"  Here I had all these high expectations of how I was going to luxuriate in the warmth, and vibrating comfort of the jets against my sore shoulders and back, and it wasn't working!!  Notice..........  "IT wasn't working........"

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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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