Wavering

Boy making ripples in water of pond with a stick

Last week a physician shadowed me to see if there is anything I or my staff can do differently with my work flow with this new EHR. I was looking forward to having a forum to vent my complaints with the system and hopefully to have a way to fix it but nervous at the same time, not knowing what to expect, worried that they would have suggestions that would make me look a fool.

The physician who happened to come was one that had a hand in writing some of the new EHR templates. I was so disappointed in those templates that between you and me I actually cried in frustration in the first few weeks of our changeover. How could we be expected to do what we needed to do when these were the tools we were given to do it with? I told him that I did not like the templates, that I thought they S-U-C-K-E-D. 

Yes, I used the word sucked and I cringe even now at the recollection. With that one word I dismissed all of the considerable time and effort he had poured into those templates. 

Have you ever been so frustrated and nervous that unreasonable things just flow out of your mouth? 

Of course you have. 

Ever been on the receiving end of someone else’s frustration, as they vented like that? 

Sure you have…

At times, when I feel passionately about something, my filter just ups and disappears. After listening to him tell me that I should hire a staff member to approve or reject all of my refills instead of doing it myself, after having him say that my desire to take and enter my own past medical and surgical histories was a waste of time, after being lectured that writing a narrative history of present illness was silly that I should be clicking buttons instead… I was no longer really hearing his words to me or my own responses back to him. 

But I LIKE doing those things! Interacting with my patients is what makes medicine fun and rewarding for me.

It was not until days later that a realization hit me. He believes this stuff just as passionately as I believe that he is wrong. My response was not just unprofessional, it was mean. I try to have compassion and respect for all of my patients, even the difficult ones, but where was my compassion for him?

You need to be flexible. Medicine isn’t what it used to be. You have to adapt.

I don’t want him to be right. 

I hate that he might be right. 

And so I have spent this past week after reading his write up of our interaction licking my wounds, pondering the next step. What do I do from here?

The first thing, I believe, is to apologize. I don’t know that it will matter to him, but I need to apologize for me. I don’t want to be *that* person, the one who believes their rude behavior is justified.

And then? What then?

There is the question. 

Advertisements

122 thoughts on “Wavering

  1. :::like I’m the one to offer insight into working with others::: If you need to apologize for you, then do it, but make it short and sweet, not a lengthy narrative, and don’t be attached to the outcome (his reaction). If your style of notes and office operations doesn’t fit neatly into the new EHR, and you *have* to use the EHR (as it sounds like you do), then there most likely isn’t a middle ground. However, that doesn’t make the system good. That doesn’t mean it doesn’t SUCK. I’ve used a lot of programs that SUCK. Part of that some people think one way, another another way, others some way else (as you know), so what could be a perfectly good program for some, like the idjits who developed it, could really SUCK for other people.

    I can’t tell you how many insurance portals I deal with on a daily basis are just set up so poorly that I routinely wonder aloud if the person who designed it ever tried to use it. Our main hospital program (which isn’t integrated with the main clinic-side program, talk about SUCK) is another one where you just tilt your head and wonder who thought that was a good way to do things.

    All to say, you can do a polite, soul saving “sorry for the outburst” AND the EHR can suck AND you may just be stuck with it (and delegation ain’t so bad, could give you more time to blog).

    Liked by 4 people

  2. He needs to hear the truth about how you feel his work is impacting on you. (You may not be the only one who’s upset about it). An apology would soften the blow and perhaps open him up to consider where you’re coming from. You can’t be his “yes man”. A narrative history of present illness would be crucial in my opinion too. Tell what is important to you and why.
    Leslie

    Liked by 2 people

      • It just takes a little practice. I would approach it in a way that explains what is important to you and why its important. Remember the assertive training? “The EHR is really great but the most important thing to is …… and this ………..would, in my opinion would satisfy those needs.”

        Liked by 2 people

  3. The balance between listening and being objective and going with what feels right is often a difficult path to tread isn’t it. I agree that it barely matters if he is interested in your apology; it helps you clear your head to listen to see if there is any merit in his ideas; better I’d say that you see if there is even a sliver of merit than those who dismiss all because some of it jars, and those who accept all because they don’t question what’s new.

    Liked by 3 people

  4. It is right to apologise but, as Oniker said, make it short and sweet.
    For me, your most compelling comment was ‘Interacting with my patients is what makes medicine fun and rewarding for me.’ I hope you never let medicine stop being fun and rewarding for you.

    Liked by 2 people

  5. Please let us know how he responds to your apology. You are good people. Hopefully, he can see it. What then? That is something you will determine with the info you have. Pros and cons will determine your choice. Best to you.

    Liked by 1 person

  6. If it’s any consolation, it sounds like he could have phrased things a little better so you wouldn’t feel so belittled and defensive.

    But I think it is important to apologize. Otherwise, all of that negativity will sit on your back and weigh you down.

    Liked by 1 person

  7. Don’t you hate that. I remember exactly the times I have said awful things and once apologising would have made it so much worse that I feel like I will carry those terrible words to my grave. It is nervousness but maybe part of your incident was that it sounds like it was true too and saying nothing may have been worse. Though sometimes ‘sucked’ is not a helpful word. (laughing) . Ah Well. there you go. much love c

    Liked by 1 person

  8. Apologies are so humbling, so human. But I recall a crappy teacher raise while the administration got double. That really SUCKED! I wrote so to the CEO. I felt better. Nothing changed. He wrote back that our raise wasn’t so bad. CRAP! You know? Don’t apologize. How about a simple lie? “I was out of sorts the other day. One of my kids….” That’s it. End.

    Liked by 2 people

  9. I don’t know that I buy it this time. Some program changes do suck, and someone has to step up and call it what it is. I will caveat this by saying, it’s partially how I make my living to be that voice. Many times, seeking input is merely an exercise to say they did, and the conclusion is already made. In other words the decision is made before the meeting, and the meeting is mis-advertised, because all they want is buy-in. Speak up anyway.

    Liked by 1 person

  10. Sounds as if the apology will do YOU good – he may be too insecure to hear or understand realistic criticism. After all you and others are on the sharp end of implementing new procedures – if he’s worth anything, he will at least consider your comments. If he can’t do that then you may need to work out your own adaptive procedures which conform on the outside but do not compromise your ideals in regard to your patients. Sadly, all too often we find our ourselves expressing frustration because something looks good on the computer screen but can be highly impractical in real life because the designers have no experience in implementation. Is there any opportunity to invite him to join you for more than a few hours shadowing and using the new formats in a real situation ?? Good luck anyway and keep putting your patients first!

    Liked by 2 people

    • I have my own workarounds already. πŸ˜‰ To be honest they are super fast compared to what he wants me to do. I can do all of my own history taking and refills and documentation my way. If I did it his way, there would be no way. I would have to turn over much of what I already do to someone else.

      Liked by 1 person

  11. Victo, such a dilemma. Remember well the hospital EMR change from narrative reporting. The system we had was quicker in the long run, however impersonal. There was a section for added notes that could include interactions with the patient. Sounds as if you are stuck with what you have. Hard to undo the meeting and what you went through. Consider a short apology only for peacemaking. Any way to band together with other physicians who feel the same, and put together a report on pros and cons of the system? Probably already thought of that! πŸ’› Christine

    Liked by 1 person

  12. Oh Victo you honestly told
    this guy exactly what you
    thought of his program.
    He should see your total
    frustration.
    I am one of those talk 1st
    think later. I cheered when
    I read your words.
    A badly written system
    does not work. I wrote
    systems way back when.
    Always with the input of
    all of the staff.
    You surely can politely
    apologize for the wording.
    My advise is always wrong
    here, I always feel I have the
    right to tell you how I feel.
    Frankness can offend people.
    So tread lightly but be honest.
    That is who you are.

    Liked by 3 people

  13. Interesting. I’ve kind of been in both positions. I’ve used to fly through Microsoft Excel and then ground to a halt when the new version of Office arrived – couldn’t find where they’d hidden things and my productivity plummeted while I had to figure it all out. But I’ve also had to push a project to get staff to enter data in a completely different way, by direct input into the PC rather than writing on a form with a pen which would then by typed up by a speed typist. There was much moaning and gnashing of teeth (mainly from Clair, the most ‘mature’ of our staff) but once they got used to it overall productivity soared. Clair used to hanker after her quill pen and parchment but a few years later, when we had gone to different jobs, she told me that because I had dragged her into the 21st century she had become quite adept at using computers and was now considered the ‘Alpha Geek’ in her office!
    So, on the one hand, perhaps this guy is trying to make life more slick and efficient and has developed a tool that will help. So you have to try and see the merit in what they’re trying to achieve and identify if there are any practices you have that are not necessarily conducive to this – let go of the metaphorical quill pen!
    But at the same time, if there are some major flaws in the system they need to fix them. Why is X hidden under menu Y? Why do I have to click this page seven times instead of once?
    I think an effort to clear the air and re-focus on getting the best out of the system is a good plan. And if you can suggest specific tweaks that would make it more effective and more efficient you’ll be more likely to see them taken on board.
    Good luck!

    Liked by 3 people

    • I had six pages of tweaks scribbled down for him. It’s a symptom of my OCD. I did try the templates for a few weeks, hoping when I had learned how to use the whole system better I could get them to work for me. There are supposedly some improvements coming and I am not averse to try them out when they become available.

      Liked by 1 person

  14. I think you took a step by being honest on here with all your readers. Will be thinking of you as you make an apology to him and sure hope it goes well! I can understand your frustration with the system and with being told all the things he was telling you. But even with that I love how you said how you don’t want to use that as an excuse for what you said. That is the maturity that so many MORE people need to show! So easy to make excuses anymore for everything!

    Liked by 1 person

  15. Been there…Humble Pie ain’t so bad if you’ve had it a couple times before. Apologize and wait. You can’t redo the conversation. All you can do is apologize and move on. Whether he accepts or not isn’t your problem. Best wishes!

    Liked by 2 people

  16. I’m not sure it I would apologize ….you are feeling guilty and he probably never gave it a second thought once he walked out the door. If it sucked…it sucked. He probably knows it sucks…

    Liked by 1 person

  17. It’s a dilemma…why do women always feel the need to apologize? Men never do, in my experience. But I feel your agony, I go through it often enough myself.
    Change is hard, but not all change is good. From a patient’s point of view, I hate seeing my doctor on the computer all the time. Where was I just reading about the stupidity of always being more efficient?…oh, Gary Snyder. A wise man. (K)

    Liked by 1 person

    • You are right! We do always apologize. In this case, I don’t think it is a bad thing because I am not taking back the fact that the templates are awful, just how I said it. πŸ™‚ I hate being on the computer in front of patients which is why I do narrative history taking. I can type and maintain eye contact. If I point and click, I have to look at the where my cursor is on the screen. I hate that family history has been reduced to a bunch of clicks. It takes forever to document a good thorough history now, whereas before I could free text it in a matter of seconds. We have the federal government to thank for that mandate.

      Liked by 2 people

  18. Thank you for sharing this story. We all need excellent examples of self-reflection, humility, and reconciliation these days. May you continue to practice these virtues out loud and in front of people, and may you be well-supported in doing so. You lead by example. Thank you. ❀️

    Liked by 2 people

  19. Medicine isn’t what it used to be. You have to adapt. I know that you said that. But I don’t know if you agree with it. Medicine might be different but an old man who is worrying about prostate cancer is the same as his father was and his brother.

    Liked by 1 person

    • I don’t believe it. They throw that at me every time I tell them the EHR can be better. “We are years, many years, away from a good EHR that minimizes clicks. You are just going to have to adapt. Change how you practice.” I adapt, but not how they want me to adapt… πŸ˜‰ I just don’t understand how we can in ten years goes from flip phones to smart phones and we cannot manage to make an EHR with fewer clicks. THAT is bogus if you ask me.

      Liked by 1 person

  20. I can understand how you may want to apologize for telling him his work sucked. But it does NOT change the fact that YOUR work is being dismissed and disregarded, and the value and importance of your doctoring is being micromanaged. You are a doctor. It doesn’t sound like anything they (he and the ‘system’) were doing by shadowing you had anything to do with making you a better doctor. It had more to do with making them more money.

    Thank you. For being a doctor.

    Liked by 3 people

  21. Just tell him you’re sorry his templates suck.

    On another note, I’m posting that recipe you wanted, in just a few hours. If it sucks, please let me know so that I can come up with all kinds of excuses to defend it.

    Liked by 1 person

  22. The apology is important. Even if he does not care one way or the other, it will show that you are accountable for you words and actions, and that makes a difference in the long run. But the answer to your question, is compromise. You will have to sit and look at his report objectively, and reconcile what you can relinquish and what you can hold on to. You can continue to do your narrative histories(which I think is awesome), but hire someone else to help with refills(which can be time consuming). He may be a little right, especially with our growing assembly line healthcare system, but you are right, too. Compromise akin to the one I mentioned may make all the difference.

    Liked by 1 person

    • We have been trying to hire a float medical assistant to help with refills for over a year now. As soon as we find someone, someone else quits and we are left short staffed again. We never can get out head above water.

      Like

  23. Oh, we’re listening. I’m not a doctor but I am a patient – couldn’t agree more about trying to talk about something, perhaps sensitive or embarrassing, only to see a doctor gazing at a computer screen instead of at me! It seems to me that it’s the personal interaction that has disappeared from medicine today, from the nurse more interested in the machines clicking around you than whether you have cramp or need a drink … It’s obvious from all these reactions that you have lots of support from across the spectrum. Hope you can tell him you’re apologising for your delivery not the content and walk away with the guilt relieved. and, yes, why do we feel guilty in these situations????

    Liked by 1 person

  24. I have very often said exactly what I think and felt I had to apologize afterwards. It is a horrible feeling. Chatter Master is correct but you will probably feel better if you say sorry for saying his system sucked but you can mention that you hate all this ridiculous bureaucracy. I booked an appointment on Friday for a UTI. The receptionist told me I can ONLY talk about the UTI…WTF!

    Liked by 1 person

    • WTF? Screw that. I had a patient come in for arm pain this afternoon. She also let me know that she was having a vaginal discharge, recurrent boils, and abdominal pain. It isn’t like you can ignore any of those. It’s just the way the cookie crumbles. You get through it. One problem? I scoff at one problem! πŸ˜‰ But…. Friday for a UTI? You could die from urosepsis by then.

      Liked by 2 people

      • I have a medical record full of interesting UTIs, most of which are antibiotic resistant. In the end up we had to have a long conversation to explain about vaginal atrophy, I had Thermi Va on Wednesday, blah, blah and now I have just taken a Diflucan. Geez Louise!

        Liked by 1 person

  25. I once had words with a former boss, to the point that I felt utterly righteous and satisfied, and quite frankly, had I been fired, it would have been worth it. Then there was avoidance, an utter breakdown in communication, and finally, he made the bold comment that it was water under the bridge and things changed for the better after that. Something has to be done to break the tension and calm the waters. If you’re up to it, I think it will help you. No matter how clever the interface, there’s still user frustration to consider. Your point is valid, even if he’s right. Regret — now, regret really, really SUCKS. πŸ˜‰

    Liked by 1 person

  26. i often misplace my filters when i am reacting to something.
    and sometimes i react before i have completely comprehended what is being said to me–reacting to what i suspect is being said.
    which makes communicating by text nice–i can wait and decide before responding with my gut response.
    i also then spend hours or day (sometimes years) analyzing my own words & behavior, trying to figure it all out. was i right? was i wrong?

    i think, overall, both these are good things (speaking frankly & checking myself) but they can also be exhausting.

    Liked by 1 person

    • It is terrible how the bad things always surface in our memory at the most inopportune, most vulnerable times. I agree that speaking frankly and checking myself is exhausting. How do people do it? You know. The ones who never seem to say anything out of line, whose words are always full of wisdom.

      Liked by 1 person

  27. I didn’t read all your comments (there are always so many!), but I know from many years of experience and studying Buddhist teachings that you can’t control anything but your reactions, feelings, thoughts. In that one thing, you have a choice, and therein lies all the power in the world.

    I can’t control the weather, but I can control how I react to the weather. I can choose to accept it or embrace it or be miserable about it. Other people’s behavior is just as out of my control as the weather, but my reactions are still very much my choice. All of this is quite easy to conceptualize and say; it’s quite another thing to put into practice!

    I’ve been a student of Buddhism for many years and still struggle with its deceptively simple teachings. The best I can say about my practice is I how notice when I flub up! That’s progress of a sort. In realizing that you may have been too harsh and should apologize, you illustrate my point. Awareness after the fact is better than not being aware at all. πŸ™‚ ❀

    Liked by 1 person

  28. Apologize or not? Maybe for the words and/or manner. Given his response, I’m not sure I would personally apologize. Your call. The bottom of the issue remains: you have been obsessed and frustrated with this new system (and the previous one) for a long time. There surely are objective reasons for that. Write them down if only for you. Then I suggest a few things:
    1) Go back to the system with a cold eye. What is it that is bothering you? It could be the format. (I can’t stand Android for instance. I’m an I-Phone man. I have to use Android every summer in France and it’s wearing me down every time) or it could be the philosophy of the “Thang”.
    2) Ask yourself whether the EHR is a medical or administrative tool. If it is – only – the latter, hire a clerk to fill it up for you, based on your instructions. (And you will avoid much frustration) If it IS the medical tool of the future, sign up for a training seminar. And learn to beat that system.
    3) Whatever it is, format or philosophy, administrative or medical, you DO need to get it out of your system. Why pile up more frustration? (But then you have control issues right?) πŸ˜‰ Another way to look at it, if you cannot beat the sytem, nor join it, then “ignore” it. Hire someone to “run” it, fill the forms, so you can concentrate on being a doctor which is your calling.
    (I sometimes wonder whether I might be spreading myself too thin. Are my points useful to you?)
    Ye be good naw.
    (PS. I still overall think you are too hard on yourself. Give yourself some slack. Hiring a clerk to do that job could well be a solution) πŸ˜‰

    Liked by 2 people

    • I’m not sure patients like having a scribe in the room. It takes some of the intimacy away. Actually, I think I should ask that question on the blog. I may be just assuming something that isn’t true. I like your analytical approach to problem solving, though. πŸ™‚

      Liked by 2 people

      • I made a living being analytical. (And solving problems for clients) πŸ™‚ I understand the scribe thing. Not too good, though you could ask your patients. Do a “kitchen” sample. Another question: Do you have to feed the system while you’re attending the patient, or can that be done later? (By someone else) πŸ™‚
        (I really want to get this machine off your back) There is no point in being miserable while doing the job you love.

        Liked by 1 person

      • Much of what was in the old record did not cross over into this new one so I am having to manually reconstruct every chart as they come in. That is the real time sucker right now. That will get better.

        Like

      • I don’t think I would mind having a scribe in the room. I look at it this way-my physician is spending more time with me instead of writing down her notes/thoughts. Thinking back, I had several radiology visits last year and there was a scribe present and it did not even register until just now…but what I do remember is how attentive the doc was in those particular moments. I say consider this option if it is an option especially if it will reduce your stress.

        Liked by 1 person

  29. Good on you for apologizing, but I do hope he can view your side somewhat!

    Btw, my spam filter caught something directed to *you* today letting you know not to trust me to keep paying for my website, that it could go down anytime. So weird but funny πŸ˜€

    Liked by 1 person

  30. If you apologize, you don’t have to say, “I’m sorry….” You can say something like, I regret my tone when I said the program sucked, or there might have been better way to give my feedback on the program. My main concerns are….. If you were to prioritize one specific thing you’d like them to change the most, what would it be? I know you might not get it, but if enough people want the same thing, they might change it. They’re asking you to make changes, maybe they can make some, too.

    Liked by 1 person

  31. I’m betting that he respects you for talking up. On important professional matters, and where time us money, matters of language and politeness are not needed as much as accuracy and clarity. He got the message. The ball is in his court.

    Liked by 1 person

  32. What do you mean you don’t know if your apology will be appreciated?! Of course it will! Apologies open doors. I believe it’s part of the basic human condition. And imagine how much better you’ll feel. It’s tough but realizing and following-through will make it better for everyone.

    Liked by 1 person

  33. When I read why you dislike the new system and what the other doctor sees as the way the system should be, I read that you are more interested in continuity of care and really knowing your patients than parting out the system like an automobile factory, in an effort to save money. Instead of bending yourself into a pretzel trying to fit into a system that is driving the humanity out of the practice of medicine, could you craft a response demonstrating the inherent dangers of dividing up health care into discreet bits and pieces? I really feel your frustration. And the way the system is moving, it has me worried for patient care and for doctors’ job satisfaction.

    Liked by 1 person

  34. I’ve been thinking upon your post. My response may be a little different from most. Diplomacy is a great asset to employ as we learn to keep our emotions under control. Not easy! I also don’t think you should necessarily apologize for how you really feel but approach the future conversation with calmness saying you could have worded your opinion differently but that being said … apologize IF you have hurt his feelings. Secondly state matter of factly WHY you think the program sucks and what improvements you believe would benefit all physicians. I’d also state that your way of doing things is right for you and since we are all different you would like it if he could respect your way of doing
    things which for you is effective and efficient. I hope this helps. If this person’s ego is big enough to not hear you, YOU will have known you put your best effort forward.

    Liked by 1 person

  35. I think an apology will free you up to get past your reaction and communicate your difficulties with his ideas/solutions.
    I hate when an apology needed eats away at my day. You are not alone!

    Liked by 1 person

  36. Hummmm using some of his suggestions may give you more time with your patient>?? using the buttons to do your summary would shorten the time you spend writing up what it does in a few brief moments…time given to your patients, I am sure the program has a spot you can add any special notes that you feel are worthy in your own words….just a thought…and yes apologizing is important for you…you are not one of those people who do this on purpose….being overwhelmed with change can be just that….overwhelming….I would give it a try….at least you can say you gave it a change…kat

    Liked by 1 person

    • The buttons only work for simple things like a head cold. That would be fine except no one ever comes in with just a head cold anymore. It is also depression and right lower pelvic pain for about six months and blood pressure medication side effects. There is no other way around that as they are jumping back and forth than to just type it out and power through it! πŸ™‚

      Like

  37. I don’t think we should have to censor ourselves when we are explaining our frustration with colleagues… that being said:

    I am usually in trouble because I am a little too candid. Totally get it.

    (Still we are all adults- can’t we just be honest?)

    Liked by 1 person

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s