September 2003

Leave your problems at the front door

by Timothy Feuling

Have you ever noticed that you tend to make more mistakes when you are tired, stressed out, physically ill, or distracted by personal or professional problems? You misplace items, grab the wrong patient record file, hit the wrong keys on the computer, forget people's names, give the wrong instructions to your C.A. ‑ and just plain mess up more. Worst of all, you are more apt to snap at everyone around you and fail to focus on their needs.

Making mistakes and damaging relationships not only can turn a happy practice into a stress‑filled one, it can lead to malpractice lawsuits.

In a Medical Economics article, Edward E. Bartlett, a risk‑management consultant who conducts stress‑reduction seminars for medical‑malpractice carriers, says, "Stress affects patient care in subtle and insidious ways. You can't always separate and quantify the stress to show a cause‑and‑effect relationship to a patient's injury. But we know it plays a big role... Stressed‑out doctors are emotionally exhausted and may just be going through the motions, not completely attuned to their patients' physical or emotional needs." ("Why burned‑out doctors get sued more often by Dennis Murray, Medical Economics, May 26, 1998)

The article also quotes Theodore L. Passineau, senior health care adviser for PICOM Insurance Co., who states, "There's a link between stress and liability. Calmer, rested doctors are more careful, and therefore get sued less."

Although running a chiropractic office today is a complex task filled with challenges that can raise the blood pressure of even the most placid personality, doctors tend to bring stress with them from home as well.

Arguments with family members, personal financial difficulties, and physical ailments are common "stressors," but boredom with one's off‑hours activities, a lack of time for hobbies or personal relationships, normal physical changes associated with aging, or even such transitory problems as filing tax returns can each add stress.

Each factor, taken alone, might not be significant, but the combined effect of several can throw you off your balance enough to make you careless, short‑tempered, or forgetful ‑ and ripe for a mistake that ends in a malpractice claim or a board complaint.

The first thing you need to do is to become aware of your own stress levels. Go so far as to appoint one staff member (or family member) to be your "stress monitor." Instruct him or her to let you know (without fear of retribution!) when your mood or your activities indicate you may be feeling above‑average stress.

If you feel your practice is suffering from stress‑induced problems, consider taking a stress‑management course or read a book on the topic and practice some of the proven stress‑reduction techniques (deep breathing, meditation, etc.).

Try dealing with the problems before seeing patients. Just as couples counselors always advise people not to go to bed angry with each other, doctors should never go into their office until they can do so with a happy and focused outlook.

Of course, that's easier said than done. When it just isn't possible, try using visualization techniques to leave your problems outside the office. Before entering your front door, visualize yourself stuffing all your personal problems -- the fight with your kids, the fact that your hot water heater is on the fritz again, the bill you just received from your credit card company -- into a large plastic garbage bag, and depositing it on the doorstep. It'll be there for you to deal with later, but while you're seeing patients, you can focus on them.

No matter what you do, however, there will be days when you just can't avoid stress during practice hours. In that case, being aware of your stress will help you avoid its negative affect on your performance. Compensate by using checklists and cue cards to make sure you don't miss important tasks such as updating patient notes or having new patients read and sign a "Terms of Acceptance" form.

Post a large sign in your private office that reads: "Put the Patient First." This will help keep you focused on the real reason that you're going in to work each day, and help, at least temporarily, to block out the distractions of personal problems.

By eliminating or managing stress in your practice, you'll not only be able to better serve your patients, you'll be reducing your risk of malpractice lawsuits.