The SLS Board of Directors recently approved our new name. While the term “Laparoendoscopic” was intended to represent all MIS disciplines and technologies when SLS was formed in December of 1990, it no longer is consistent with current terminology and search terms. Our website and materials will be updated to reflect our new name and logo.

SLS is a unique multispecialty and multidisciplinary organization with a global reach. Our current and past officers and members reflect interest and leadership in Laparoscopic and Robotic Surgery and represent the knowledge and opinion leaders (KOLs) and pioneers in robotics and computer assisted surgery, surgical simulation, laparoscopy, endoscopy, and minimally invasive surgery.

Our updated logo is reminiscent of the Society’s original logo at the time of its founding in 1990 and reflects our new name. We will continue to be known as SLS.
We are witnessing an exciting and transformative period of unprecedented change in healthcare. The pace of change is virtually continuous with clear signs of a revolution on the horizon. Thank you for your ongoing support of SLS and its mission. Join with us as we create the future through collaboration and education.

 
 
 
Raymond J. Lanzafame, MD, MBA
Executive Director & Scientific Chair

By Raymond Lanzafame, M.D.

Besides the fact that almost every state requires that physicians complete CME credits for maintenance of your medical license (as well as board certification), actually showing up for a national medical conference is really critical for your career, whether you have many years of experience or only a few. Of course on line CME exists, but as you sit there, alone, staring at a screen, think about the fact that medical societies have gotten much better at putting on conferences in general.  Here is what you are missing by staying home:  

 1. You would have learned more.  Those who do attend conferences tend to have greater experience and social/educational skills, so it makes learning more interesting, more fun, and you can pick up more material because you are better engaged.  Also “catching up” with other professionals gives you added information that just doesn’t exist on a formal site.  It forces you to get out of your comfort zone and learn. 

Passive learning in front of a computer screen provides less-dynamic interaction with educational material—and you just wont remember much. Although we do have lecture formats – and for good reasons – we have many interactive classes, where you can engage in the discussion and gain a better understanding as a result.

2. You would have noticed that each conference is different—and those differences are enhanced in person.  At SLS, we can help you identify those specialists who benefit your patients; many that you hadn’t previously been aware of, or even find those within your own specialty, if necessary.  Each one opens up opportunities for sharing your medical knowledge and learning how other surgeons across the country tackle the challenges we all face.

3. You would have met new, powerful connections.  Knowledge and people build your career.  Use conferences to reconnect with colleagues and introduce yourself to new people, adding powerful connections.  Speaking with surgeons who have different patient populations and specialties allows you to expand outside the limits of your specialty.  MIS Week and other SLS conferences are especially good at this since we are a multi-specialty society.  General surgeons have lots of tricks in their bag, and knowing what they see regularly is of great value.

4. You’d know what’s true and what is false.  Fake News exists in medicine, too.  What’s true and false is best learned in discussion with leaders in medicine—and you find them at national medical conferences.  We all know the truth is often more complex than a headline.  These sessions may also provide more opportunities to get more involved in the issues that matter to you.  And live attendance gives you that context.

Staying up to date is also important.  It is tough to capture different perspectives on the newest trends in surgery if you aren’t live.

5. Last, you would have had fun.  I see the enjoyment in the eyes of those who take advantage of the (free) meals and entertainment, of those who are meeting new experts for the first time in a light atmosphere.

But nothing beats actually getting your hands dirty like live workshops.  You haven’t seen opportunities for developing these skills since residency, and it is rewarding to develop skills this way.   

While it may not always be convenient to come on by, there are so many opportunities at our conferences, you will miss a lot if you don’t get up from your desk and join us.

http://sls.org/mis2017/

by Linda Girgis, MD, FAAFP

Many consider private practice a way of the past. Truth bears this out when we see the large number of doctors selling their practices to hospitals and large healthcare systems. And the overall healthcare system suffers because of this.

In the current environment, the thought of starting a practice provokes fear in many, but it shouldn’t cause the demise of that practice type. In fact, patients receive the best care when their physicians maintain control of the way they practice.

Starting a successful medical practice is doable and offers many advantages, such as autonomy and ability to make business decisions affecting the practice. Despite all the changes happening in healthcare, I still think this is the best way to go.

Over the years, through successes, failures, trials, tribulations, gambles and experience, I devised the following tips to assist in starting a medical practice.

1. Location is key. You need to be in a highly visibly, heavily trafficked area. You will get patients just by being visible.

2. Rent, don’t buy until you are sure you’re staying. Commercial real estate is risky these days.

3. Credential with the insurance companies early. Some take 6 months to complete the process. If this paperwork is not something you can get done quickly, get help. There are many companies that you can contract to do it for you.

4. Prepare a marketing strategy. The best marketing is actually meeting people face to face. We went out and introduced ourselves to people in the community: pharmacists, the police department, the township. We gave talks at senior centers and the public library. In contrast, newspapers ads rarely bring in any patients.

5. Having good staff is essential. Patients will “chose you or lose you” just based on who you hire. We started with just one employee to answer the phone and added more as we got busier.

6. Get a good accountant. We went through five accountants until we found a good one. Business taxes are very confusing and not all accountants know the nuances of medical practices. You can contact your state medical societies for recommendations.

7. Incorporate. There are tax benefits, with perhaps the largest being that you will be able to deduct benefits, such as medical insurance, travel expenses and daily business expenses. As an incorporated business, you can also deduct your business losses, which is much more difficult if you are a sole proprietor. You can also write off or deduct items you already pay for, such as your car if you use it to drive to work. Moreover, income earned as a corporation is not subject to Social Security taxes, only the portion you take home as salary. Lastly, corporations tend to be taxed at a lower rate than self-employed business owners.

8. Hire a good attorney as well. As a business owner, you will be entering into many contracts, from leases to sub-contracting. It is always wise to have an attorney review your contracts.

9. Shop for office supplies and equipment. We get many items from Amazon.com for a lot less than what we would pay medical supply companies. For big equipment, negotiate. If possible, try to purchase at the end of a quarter because you can get better deals — companies are trying to improve their numbers and want to make the sale.

10. Get A-rated malpractice insurance. This is not something to skimp on. Occurrence is better but more expensive. Also keep in mind that malpractice insurance is in effect only while you are paying for the premium. You should buy a “tail” when you change jobs or carriers because you will not be protected for prior past acts by your new carriers. A tail covers what you did in the past.

11. Don’t be afraid to say no. It can be tempting to grant favors when you have few patients and someone requests something that your policies prohibit. If you give in, you will find your practice filled with drug seekers or other patients looking for special treatment. Set the stage early.

12. Know the rules. Be an expert in coding and billing. You are responsible for any mistakes. And go through your accounts receivable on at least a monthly basis.

13. Never write off copays. Make adjustments for financial hardships. And this should happen rarely.

14. Build trust in the medical community. Know the doctors you are referring to and vice versa.

15. Take time for yourself. If you get consumed with practice management and don’t balance it with things you enjoy, you will burn out.

Private practice is not doomed as many predict. Many doctors remain independent and find success. Lack of business training in medical school should not be a roadblock, just a hurdle to overcome. It takes time and nerve, but starting a private practice is a great career path and there are many resources available to help along the way.

Linda Girgis MD, FAAFP, is a family physician in South River, N.J. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University and other institutions. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University and she was recognized as intern of the year. She has been a guest columnist and contributor to many media outlets. She authored the book “Inside Our Broken Healthcare System” and has been interviewed in US News and on NBC Nightly News. Dr. Girgis’ primary goal as a physician remains ensuring that each of her patients receives the highest available standard of medical care.

April 11, 2016

Pain is something every physician is familiar with. It comes in many varieties. There is the pain of late night calls, the pain of angry patients, the pain of poor outcomes and the pain of dealing with billing and reimbursement for your hard work. It is normal to be pain adverse, as most of us are. Who hasn’t found themselves wanting to sneak out the back door while staff is left to deal with a difficult patient at the reception desk? Who hasn’t dreaded that 3:00 a.m. call from the ER or a ward nurse trying to address a problem? If you ask physicians what drives them to leave the practice of medicine in general, or at least wish to change their practice circumstances dramatically, more often than not it comes down to a matter of pain and relief. Pain always has a cost whether it is measured in monetary, lifestyle or satisfaction terms.

Pain is the primary driver that leads patients to seek us out. In most specialties there is a pain component to everything we do. If we dismiss it, we do so at great peril.

Consider pain from the patient’s perspective. When someone is suffering from pain, it comes at great cost: financially; physically; emotionally; and spiritually.  There are the direct costs that come from missed days of work, or from complete disability. Even at minimum wage, that can add up to tens of thousands of dollars per year. There is the cost of comfort. The money spent on medications, therapy, surgeries and devices in an effort to gain relief. I have seen patients who spend thousands of dollars of their own money procuring elixirs, braces, machines, alternative care and spiritual healers in a continuous search for relief from pain.

Our obligation to patients is to make a correct diagnosis and render the best therapy our science and experience have to offer. Failure to do this will absolutely result in pain for us. Repeated failure will catch up with us. I have known surgeons who left town because the medical community and patient population lost faith in their ability to adequately address patients’ problems. This could be from lack of technical proficiency, poor patient selection, bad luck, or a host of other reasons. The Internet brings with it powerful tools for punishment such as Yelp or Angie’s List where patients are free to rate their care. These tools are only growing more powerful.

Society also has a great and growing stake in our work and the quality of our results. The pressure to do good, or at least do no harm, grows every day. Along with the expansion of government subsidized insurance comes more onerous policy. Because the government is the payer, it has direct incentive to encourage improved outcomes, or at least to limit costs. Take for example policy surrounding the prescribing of opiates and the advertised opiate epidemic that our country now faces. I spend a good deal of time working with government agencies as an expert as they work to enforce current policy. I see physicians and midlevel practitioners lose their licenses every month for what the government considers poorly managing patient pain.

Now more than ever, we need to render the best care possible and avoid merely trying to mask pain in the long term with powerful opiate drugs. We are all being watched and you can be sure that if your results drop below what is considered acceptable, there will be consequences. Just as transplant services and infertility clinics depend on outcomes to remain in business, so too will all of us in the near future. The option of putting the patient on pain medications and referring them back to the primary care physician or to a pain clinic is quickly being eliminated. It won’t be enough to merely do the work as advertised. One will need to get the promoted result as well. I can imagine no greater pain in medicine than being told I can no longer do that for which I trained for the first 30 years of my life.

The obvious response to all this dire warning is to think, “Good riddance. I can quit and go do something more to my liking.” I’ve tried that. It’s fun for a while, but eventually I missed the intellectual stimulation. I found my professional friends begin to drift away as we had less and less in common. Even attending medical society meetings became painful. I found that as other attendees realized I was not in active practice, and therefore not a potential source of referrals, they moved on to talk to someone else. Even my 7 year old daughter questioned the notion that I was a doctor when she observed that real doctors have patients to see and I did not. As frequently painful being a physician is, not being a physician was worse for me.

Throughout all of this, I have not mentioned the financial costs of unrelieved pain in this country. In 2012, The Journal of Pain estimated that the cost of chronic pain is as high as $635 billion a year. More than the yearly cost of cancer, heart disease and diabetes. These were felt to be conservative estimates. More people seek care for arthritis pain and back pain than for any other cause in this country. Worldwide, pain is estimated to affect 37% of the population. It is impossible to ignore these numbers. If you aren’t in the business of relieving your patient’s pain, you probably won’t be in business for long.

Dr. Bradley Carpentier is a board certified anesthesiologist and pain physician in central Texas.  He is the author of  Unraveling the Mystery of Chronic Pain: What You Need to Know to Get Relief.  He completed his training at Stanford University Medical Center and The University of Texas Southwestern Medical Center at Dallas.

 January 23, 2017

While we know you don’t always have full control over who is on your team, here are some basics to think about in selection and hiring. It used to be that you were the master of your domain as a surgeon. You got to make all of the decisions about who worked or did not work on your team or in your business. And the process of both hiring and losing team members was quick and within your control. Now, there are lots of interferences between you and the decision as to who works around you.

Here is a basic concept to consider in the new order:

• Customer Service is a key to the success of every business – Are you hiring schedulers who make every patient feel like they are the only person he/she speaks to today?
• Customer Service extends to everyone on the patient’s team, whether spouses, parents, children, significant others, or friends who accompany them on their visits. Staff members need to understand that and practice to meet that expectation daily.
• Customer Service is not just concerned with who is on the phone – it must be demonstrated in each interaction, whether on email, in direct contact, or on the phone.

In other words, developing new skills to work effectively and efficiently within the new model, or what’s expected from patients in the new millennium. In this and further posts, I’ll emphasize lessons from my experience working with professionals in the in the healthcare industry.

Lesson #2: Hiring Schedulers and Front Desk Personnel

Your front office staff is you to the 3^rd power – they have to be the best ever in today’s competitive environment. Purchasing decisions by the patient are often made on the basis of interaction with these various staff members. Some basics of hiring that you need to know now:

• Start with a well-defined job description that details a clearly defined job title and the experience and skills one needs to have to perform the work on Day 1 on the job. Have one of your team members interview you to get your input.
• Have a candidate pool to select from – never hire the 1^st person you interview immediately. Ensure that you and your team always consider more than one candidate.
• Use the same process with each person – if it is an in person interview process, use the same process with each candidate. Not only does this broaden the acceptance of the new hire by the team, it gives multiple inputs to the decision. This is really empowering to the whole team, and ultimately takes the pressure off of you.
• Ensure that your process doesn’t violate any of the larger organization’s rules on timing, posting, or advertising. Those rules are in place to protect the whole organization, and while they may cause you a delay the rules are there for the longer/larger scope protection of the organization. Keeping you out of court on employment issues is a prime priority in every business today.
• Ensure that references and/or background checks are performed on selected candidates before they are hired. While this seems like “motherhood and apple pie,” it is a prime requirement in hiring today – one cannot trust only superficial judgment about an individual and their reported background.

In further posts, we’ll discuss other Management 101 issues for your consideration.

Deb McClanahan, Principal of BroadBand HR Consulting, helps companies with Executive Search and HR Consulting.  She can be reached at (650) 520-7589 or through email, Deb@broadbandhr.com.

Innovation seems to be the “buzz word” in boardrooms across the U.S., Europe, and Asia. So what are the important elements of innovation and why is it critical for company growth?

For W.O.M., with headquarters based in Berlin, Germany and subsidiaries in the U.S. and Asia, it is vital to have an innovation process that is clearly defined. As a global full service OEM provider of medical devices for minimally invasive medicine, innovation involves every employee in all countries. This can be challenging, although very possible, due to technology, communication and set processes.  Here are some questions and answers that help us understand this better:

Why should you have an innovation process?

Anyone within a company can have that “Ah ha!” moment. However, if there is not a process in place, ideas often do not get shared or documented. A platform needs to be in place with clearly defined goals and steps.

Use your Innovation Manager: WOM’s Innovation Manager is responsible for the process, including moderating online idea sharing and analyzing the feedback. The manager also works to integrate innovation into the company culture. Innovation is part of the company strategy.

Where do ideas come from?

In the ever-changing field of minimally invasive medicine, ideas often stem from identified trends. For example, trends might be based on technologies, indications, or changing healthcare legislations. Ideas may also be about improving an existing process, internal and/or external or a service activity. Each company must define its own goals, methods and priorities for future growth through innovation.

Create an Innovation Scout: WOM also has an Innovation Scout. This person searches and analyzes new technology trends and ideas inside and outside of medical technology. Industries such as automotive or consumer electronics may provide insight into general trends that will affect medical technology in the future. The scout will also support and challenge the internal idea generation and idea campaign from the technical point of view.

WOM has defined innovation as a new idea that may help to accomplish the following:

• Creates or increases value
• Solves an end-user problem
• Solves a customer problem
• Solves an internal problem
• Fits in with corporate strategy

There are good versus bad ideas.

It is important to consider all ideas as being viable in the early stage. Criticism of an idea is unavoidable, as this is what helps to decipher between one that is unviable and one that should move forward. Innovation also involves some risk. The motto “time is money” rings true to any business in all parts of the world. Therefore, gathering feedback quickly and efficiently, and testing critical assumptions early in the process will save both time and money.

How do you inspire participation by all employees?

Once an innovation plan is in place, it is important to brand the process internally for all employees – include a logo, tagline, brochure, etc. Schedule an official kick-off event for all locations and be prepared to outline and explain the process fully. Include an exercise to encourage creativity and teamwork. Encouraging innovation should be an enjoyable process.

WOM’s innovation process is known as WOM InnoHub. Our brand and processes are well defined and all tools are in place. When an InnoHub campaign is initiated with an idea, the process begins and someone’s “Ah Ha!” moment is realized by all company employees.

How does innovation equal company growth?

As with all company goals, there needs to be a process. The innovation process will make ideas flow, yet it will also streamline the best ideas so they are not lost or forgotten. Most importantly, innovation is the exploitation of these ideas. This is a creative process that results in company growth through improved productivity, cost reductions, new products or services and anything that results in being more competitive in the marketplace. If you do not have an innovation process, it may be time to move from a random innovation method to a true innovation process to call your own.

Melissa Cleveland is the Strategic Marketing Manager for W.O.M. World of Medicine USA, Inc.  For more information on the company, visit http://www.world-of-medicine.com/en.html

It used to be that you were the master of your domain as a surgeon. You got to make all of the decisions about how, why, what, and where surgery was practiced. Now, there are lots of new rules implemented that impact the how and why – and nobody asked you. Welcome to the new age of health care in 2016 and beyond.

You became a minimally invasive surgeon to help patients. That’s still Goal Number 1. The process of how you get there is what has changed.:
• Are you feeling like everyone gets a vote but you on how services are delivered today?
• Do you have a non-surgeon telling you how to do your job?
• Are you impacted by the Healthcare Accountable Organization regulations?

What all these changes mean is that you need to develop new skills to work effectively and efficiently within the new model. In this and further blogs, we’ll emphasize lessons from corporate organizational change professionals that will help you adapt to this new world.

Yes, this is not why you went to medical school, and why you continue to develop your skills through additional training and certification. But this stuff is important today …

Lesson #1: Influencing Skills

Your vote used to count more than everyone else when it came to purchasing and using the newest and best equipment available. Now it is incumbent on you to develop influencing skills regarding new equipment or facilities.

There will be a lot of information available from the equipment vendor or manufacturer about the features and benefits of the latest and greatest advances for your specialty. You can talk to those specialists about whether the product or service reduces the time involved in a procedure or if it improves surgical outcomes or reduces side effects or improves recovery time. This is important information to share with that person who is now the decision maker. Rather than argue that it should still be your decision, bring that person the detail on why the new thing is critical to improving the practice.

Align your values with the decision maker, even if it is a CFO or administrator. This is corporate management 101 – manage up, down, and across. Share information that will help with an informed decision.

Follow up: let the person know that you’ll be calling or emailing to check back, and include when that will happen. Talk to others who may get a vote – lobby for support of your idea with other department heads or those who can influence. This is a standard process in most organizations – build support for your idea.

If it isn’t approved on the 1st submission, ask how soon you can have another review . Again, standard management practice on issues like this are often reviewed every 6 months or in some alignment before the annual budget is set. Items that are not within the budget cycle often require some other process- ask the decision maker if that is possible and who else needs to be involved.

In further episodes, we’ll discuss other Management 101 issues for your consideration.

Deb McClanahan, Principal of BroadBand HR Consulting, helps companies with Executive Search and HR Consulting. She can be reached at (650) 520-7589 or through email, Deb@broadbandhr.com.

SS: Thanks for agreeing to this interview, Dr. Jason. To begin, are there some generalities you want to share with us? What aspects of communication are important for having a clinical practice that achieves high standards?

HJ: Thanks, Sarah. Please call me Hill.  Since contemporary clinical practices depend on the efforts of many people, creating and maintaining a high-quality practice begins with the task of establishing a harmonious, effective, collegial working environment. The senior leaders of the clinical practice need the understandings and skills required for creating and sustaining a team in which everyone strives toward the same high standards. We need highly motivated people who support the “culture” of the practice.

SS: Thanks, Hill. Can you say a few words about the culture of a practice?

HJ: Sure. The culture of a clinical practice includes the aspirations, values, standards and specific kinds of relationship patterns that dominate that practice.  Successful practices have a coherent, consistent set of expectations that everyone understands and supports. Both management and staff should consistently represent the leaders’ guiding principles, and they should have clear ways of managing any questions or disagreements that may arise.

Most of us conduct our lives based on our beliefs and assumptions, which we may or may not recognize. Without effective orientation and communication, some members of an office’s team may behave in ways that are inconsistent with the leaders’ principles, goals and intentions. Inconsistencies, especially in key areas, can breed conflict and dysfunction in an office. As in health care, prevention is a critical part of ensuring that staff performance is as close to optimal as possible. Coherent, consistent, open communication, built on a foundation of trust among all members of the office’s team, are basic to preventing dysfunction and achieving high quality.

SS: Interesting points. Do you have some advice on how to have trust-based communication?

HJ: A foundational tradition in healthcare, shaping the actions of all good doctors, is being an effective diagnostician.  We understand the importance of gathering relevant information before making decisions and acting. As clinicians, we begin by asking questions and making observations. The same principle applies to selecting and managing staff. Just as we have optimal health in mind as our goal when we diagnose and intervene clinically, we need an image of an optimally functioning office as our goal when we take actions as leaders of a clinical practice.

SS: Can you summarize these important ideas in the form of explicit steps you advise our readers to take?

HJ: This is an overview of some steps toward communicating effectively in a clinical practice.

1. Being clear about our expectations: We can’t have others helping create and maintain an environment with consistent, high standards, including mutual respect and trust, until we have identified those standards for ourselves. How should patients be greeted? How do we want patients to be treated by everyone? How should we respond to questions and complaints? What are the procedures for expressing our own dissatisfactions? And more.
2. Selecting and preparing an office manager: The office manager is your representative. Having a well-functioning office requires us to be clear about what sort of person we want to represent us when they recruit, hire, orient and supervise the staff.
3. Recruiting and interviewing effectively: The process of selecting team members is the most influential time we have available for shaping our work environment. Any steps we take to try and change people who we’ve already selected aren’t likely to be as effective as selecting the right people in the first place. Our capacities for changing people in significant ways is quite limited. If an employee’s fundamental values or relationship styles are contrary to ours, we need to know that prior to making a hiring decision. Otherwise, we are virtually assured that there will be a continuous string of events we regard as problems. Making effective hiring decisions requires a specific set of “diagnostic” skills. When reviewing letters of reference, and during hiring interviews, we or our representative need to be perceptive observers. We need to look for clues that will answer such questions as: How needy is this person likely to be? Does she seem able to be collaborative? How much effort will it take to work with him? How is she likely to relate to colleagues and patients? Might he tend to lift other people up or drag them down? (Also, see Sidebar One)
4. Optimizing everyone’s performance: People tend to do their best when they feel a sense of “ownership” of their work. Ideally, everyone on the staff will, or will come to, care deeply about the job that needs to be done. To be highly motivated and dedicated to achieving high quality, most of us need to be recognized and valued as individuals. Part of the task of senior leaders of a clinical team is taking the small amount of time needed for thanking people for contributions they make, and for getting to know enough about them and those close to them, to ask about their health and accomplishments. To do our best, most of us need to feel appreciated.
5. Facilitating successful change: To remain effective, organizations need to evolve in response to changing circumstances and new opportunities. When we and our senior colleagues decide that some basic changes are needed in our policies or operations, we need to use our understandings of the change process to ensure that we achieve the improvements we’re seeking, without inadvertently causing damage. Everyone who will be involved in helping implement the desired changes, or who will feel the impact of those changes, needs to understand what is to be done and why. For significant changes to go well, we also need to be patient. Achieving lasting, worthy change takes time. We need to be patient with those who feel disrupted or excessively challenged by new expectations. As with so much else in achieving a high-functioning clinical practice, effective communication and trust-based relationships help make everything else easier and happen more smoothly.
6. Preparing for emotionally-charged issues and events: Whenever two or more people work together for extended periods of time, under some pressure, events and issues can arise that cause disagreements, hurt feelings, or other forms of distress. Not all of us are equally adept at managing emotionally-charged situations. Part of being prepared for such events is reflecting on our own level of comfort and skill in managing such events effectively. If appropriate, a constructive step can be acknowledging our own limitations. Whether it is us or someone on our behalf, emotionally-charged issues must be recognized and dealt with as promptly as possible. An important step in ensuring high performance in a clinical practice is identifying, in advance, the person or people who are equipped and ready to take constructive steps when signs of conflict or other relationship difficulties first appear. As with most potential disruptions, emotionally-based difficulties are best managed by being prevented or by intervening as early as possible. Any office team that doesn’t have someone who is focused on, and well equipped to recognize and sensitively manage emotional difficulties and interpersonal conflicts can be a time-bomb waiting to go off.

SS: Thanks for that helpful set of recommendations. Is there anything else that you consider particularly important?

HJ: There are two large categories that I’d like to emphasize: 1) the importance of being an effective Role Model, and 2) let’s return to the process of Earning Trust, since it is so fundamental to almost everything else.

Role Modelling. Among our many ways of communicating, the most influential messages we convey to colleagues and staff can come from our own consistent behaviors. Our role modelling, the examples we provide, can have a powerful impact on the atmosphere, standards, priorities, and quality of everyone else’s work. Intentionally or not, we tend to be living illustrations of what we consider acceptable and desirable. As a leader of the office team, we need to be aware of our own communication and relationship style. Our ways of relating to others are likely to be reflected in what others do.

Earning Trust. To make good decisions about our organization, as in making good decisions about the patients we care for, we need access to good information. That information needs to be as accurate and as complete as possible. Staff members may have access to far more information than they convey to their supervisors, which leaves those supervisors handicapped. If we and other senior staff are to make the best decisions, everyone in the office needs to feel fully comfortable sharing their observation without hesitation.

Optimal leaders work consciously at creating an atmosphere in which everyone feels safe communicating their relevant perceptions and concerns, even if some of that information seems negative or worrisome. We can’t solve problems that we don’t know exist.

Some steps toward having an open, supportive, trust-based environment     

Being non-judgmental gives you access to the best information from your staff.  How do you show that you are a non-judgmental, employee-supportive leader?

1. Consider being called by your first name: Senior leaders who are comfortable being on a first-name basis with their staff (at least when away from patients) tend to find that they are told more about important events, developments and problems in their office than they were when their hierarchical status was being emphasized with the use of titles. I must emphasize that this step is only likely to be of help if it is accompanied by other considerations, as follows.
2. Being non-judgmental: Deemphasizing status and hierarchy, as the use of first names can help accomplish, tends to work best in teams where everyone feels valued, respected and supported. Such an atmosphere doesn’t imply lowering or eliminating standards. We don’t need formality, titles, or harsh judgments, to achieve high standards. In fact, the relationship between standards and judgmental relationships tends to operate in reverse. Standards are usually highest when everyone feels “ownership” (responsibility for) those high standards; when they are pursuing those standards as much for themselves as to please a “boss” or supervisor, or to get a good rating. Non-judgmental supervisors are not those who have low standards. Rather, they convey their expectations of high standards without causing others to feel judged, put down, or at risk.
3. Being diagnostic, with “open” questions: Bringing the open mindset of the good clinician to our work with colleagues can take practice and explicit effort to form new habits. Those of us who are inclined to relate harshly to others, to be controlling, can need help and patience to change our relationship style. Anyone who is inclined to express dissatisfaction quite quickly when hearing about or witnessing something unwanted, is at risk of preventing growth opportunities and closing off potential sources of important information. Many of us need reminders from others and repeated practice to replace hasty judgments with neutral inquiries. What were you thinking? can be conveyed harshly or supportively. The question: Why are you doing that?, delivered with a harsh voice, needs to be replaced by the same question being conveyed as a simple question, with a neutral voice. The more we begin explorations by asking questions that are “open” not “judgmental”, the more we contribute to having an atmosphere of trust and comfort, which can help everyone grow and the practice thrive.
4. Empathic Communication: Learning to be an empathic means perceiving the world from other people’s point of view. As doctors or administrators, it means adjusting our speech to those with whom we are communicating; to a pace and vocabulary they will find easy to understand, while not being patronizing. Empathic communication involves being diagnostic: observing and listening carefully, and being reflective about those perceptions. With staff, as with patients, we need to ask ourselves such questions as: What is this person able to understand? Am I helping her feel sufficiently comfortable to tell me private information that is important to my being helpful? Have I double-checked to be sure he understood what I’ve suggested?
5. Some negatives to avoid: Gossip, Complaining, Dogmatism: Having a productive staff involves both what we do and what we avoid. Good morale, a sense of safety, and optimal performance can all be undermined by behaviors that are hurtful or counter-productive. Gossip involves the sharing of opinions or (possibly inaccurate or hurtful) information about a group member behind their back. It can lead to the formation of an in-group and an out-group in an office, destroying morale, collaboration, and trust. Complaining tends to involve repetitive assertions that there are problems, without constructive efforts to solve those problems. Like gossiping, it can be destructive. Dogmatism reflects rigidity and an insensitivity to alternative points of view. All 3 of these signs of negativity are symptoms that require quick action. They are danger signs, requiring information gathering and appropriate interventions. Sometimes, it is traceable to one person whose behavior may be changeable with supportive guidance, or it may indicate some personal difficulties that are beyond our capacity to resolve. The only solution may require that she/he be terminated as an employee.

Clinical groups do important work, usually under pressure. Creating an environment in which all team members are performing at their best, and the total contribution of the team is as close to optimal as possible, rarely happens spontaneously. Helping make sure that happens takes awareness, perceptive observations, and persistence over time. Ensuring a culture of excellence is a most worthy and achievable goal, but that task is never done.

I hope that you and your colleagues have already established the trust-based, collegial, supportive working and personal setting that enables everyone involved to be at their best, especially those for whom you make this special effort: your patients. I wish you well in achieving the standards of quality you want.

Sidebar 1: Additional Interview Questions

By asking these and similar questions you can get indications of how collaborative a candidate is likely to be.

Have you worked in a patient-care setting? (If so) Please describe that experience.

Have you worked with a difficult patient or colleague? What was that like? How did you respond?

At your last position, what kind of decisions did you make?  What was it like to make those decisions? Please describe anything you would do differently if you needed to make those decisions again today.

In a prior job, have you worked with outside vendors?  Please describe that experience.

Sidebar 2:  Earning Trust with “HAIL” (See this link)

Honesty: Being straight and trustworthy

Authenticity: Being truly ourselves

Integrity: Being consistently dependable; Following through

Love: Wanting and doing our best for our staff and patients

Social media can be a powerful tool for surgeons: it can provide medical information to patients and help you connect. It can also deliver the kind of visibility that helps with career advancement, third party relationships or as a resource when we want to be heard about a particularly important issue. But certain social media tactics and tools can also be a waste of time when you have such little time to begin with. Here, I’ll discuss how to navigate this still fairly new, vast tool.

How I Would Dedicate 15 Minutes Each Day to Social Media

For Twitter:
The Twitter audience can work well for surgeons. It is designed to be quick and higher level. I highly recommend using Twitter for colleagues, not patients. You do not want certain patients to have public access to you, so please restrict who you follow and who follows you by choosing content only your target audience is interested in. Choosing this particular network will also save you time. The goal should be communication and relationship building with colleagues.

One method of limiting your audience to colleagues and peers is to use your first name only. Twitter CEO Jack Dorcey uses just @jack for a reason: to show that access to him is limited to those who either know him or would impress him. Using your first name with numbers or symbols with it can help secure the approved use of your name.

I also recommend defining your use of Twitter topics ahead of time so that there is a discipline to the process and you can gain comfort in knowing you do have boundries. For example, your priority content for Twitter may be something like this: news of my research; interesting news with my comment; my opinions on [this] topic; colleague praise. You will also want to tweet out any interviews you do or any on line coverage of your good work. Trust me, this saves time.

Further, I counsel my clients to tweet their impressions at conferences. It gives you a record of the event and stimulates appreciation from those who could not go.

You can quickly keep up with what colleagues and friends are doing.

For LinkedIn:
It was once thought that people only use LinkedIn when they are job hunting, but that isn’t always true. LinkedIn can work well to remind your colleagues that you are practicing and that referrals are welcome. Simply fill in updates and let your connections know when there is something news worthy about your life or career. Connect with anyone who can be a referral partner.

Use updates to post your papers, any media coverage or events you are involved in. There is a place to post your presentations, and I recommend you do so to increase your audience. Make sure you announce that it is available.

I don’t recommend their message center—stick with good old-fashioned email to make sure they received your message.

For Facebook:
I use Facebook to keep up with my adult kids, who are at the age where they use it regularly. But I also have a professional page—and that is my priority on Facebook. Here you can post updates on your activities and provide information on the same topics I mentioned above.

I recommend limiting your time and your content. Make sure it is restricted to ensure there is no drama or errors. There is new survey data that people who spend a lot of time on Facebook experience anxiety. While we don’t know for certain yet if this is true, it may be a good idea to stick with it as a business tool, because it is no substitute for good relationships.

Sermo:
If you want an on line platform for free-flowing information that is for physicians only, Sermo might work for you. It is popular with physicians in general. Keep in mind that you are still public and your words can be repeated, but having another place to share information among peers, much like this one, can be satisfying and stress-relieving.

Sarah Sherwood has been a publicist for 26 years, working with great clients like SLS. www.sherwoodcommunications.com

Legal Issues: Managing Your Money Effectively
By Harry Rein, M.D. J.D.
Doctor – Lawyer – Judge

Legal Issues: Managing Your Money Effectively
By Harry Rein, M.D. J.D.
Doctor – Lawyer – Judge
Physicians live in a world of financial uncertainty dependent on the actions of the stock market, government, the hospitals in our community, the uncertainty of future medical insurance, taxation of our hard earned income, and even the whim of our legislators. Planning, prediction, understanding and control are essential.

I have seen the metamorphosis of the medical enterprise system of practice go from cash only for services rendered and occasional bartering service for products, to negotiating with insurance companies for your employees, contracting with large corporations for their employees, Blue Cross and Blue Shield, to the further development of Medicaid, Medicare, and finally to the new controversial Obamacare. Amendment, alteration, and replacement of all of these events are certain to follow. They have and will continue affect your personal pocketbook, just as hospitals engulfing private practices has done. You know how these affect your emotional response better than anyone does, but the reach and understanding of such financial encroachments requires more.

I am Harry Rein, a doctor, lawyer and judge, who has lived through and participated in these events and in the development of a detailed money management technique that I will discuss here. I make this information available to private practices through my lectures and private consultations because these issues are so important.

The secret is an open method known to many but implemented by relatively few physicians and high earning professionals, because it seems much easier to accept the status quo than to invest in learning how you will be affected by legislation, your competition, and what hospitals have planned for your community. These plans are sometimes surprising; even, financially shocking.

One example that very few physicians know about, or think about, or plan for is what is known in Florida legislation as the ” balance billing” issue. This particular Florida statute was aimed at emergency room physicians, who, under its terms would not be permitted to bill the patient for a balance not covered by insurance, nor for any part of the fee if there was insurance company refusal to pay for the particular service. This law is one of many that negatively affect physicians. Others can be sure to follow. There are dozens of traps, but for every one of them, if you are in private practice, there are beneficial plans of action.

Business planning, professional expenses, financial prudence, and the old Benjamin Franklin teaching, “ A penny earned is a penny saved” is meaningful every day and must be expanded to include office overhead, negotiated insurance fees, the use of car purchases and leasing, your children’s education, golf weekends, and what physicians do worse of all other professions: investing and financial planning. I continue to be amazed by how poorly balance sheets are prepared and not understood by us, a large group of highly trained
professionals. I have concluded it is because of continuous substantial cash flow. This is particularly true in reference to investing – in the industry known as money management.

There are many kinds of business ventures: conservative, aggressive, balanced, speculative, domestic, international, bond portfolios, common stock, penny stocks, real estate, and more. Speculative portfolio salespeople know and frequently joke privately that the easiest high-income professionals to sell are physicians. This has serious implications and impact on your family financial planning; because we as physicians work under significant stress. At the same time we are subject to frequent and continuing financial opportunities. But these opportunities can be evaluated very poorly. The preparation process for determining a roadmap must not be done without the right knowledge, understanding and interpretation of family status and all financial resources and expenditures, present and projected.

At the core of financial planning is resource preservation. You may lose many of your good investments. And, you may even lose some of your great investments. But when you win, how great it feels.

If you are a laparoscopic surgeon, think of why you do not operate on acoustic neuromas. All of our individual skills require specialized training, understanding, experience, individualization, and successful repetitive performance. Ask yourself, “Is the right thing being done at the right time, in the right way for the right reason, and getting the desired result? And if not, why not?” That is the definition of my risk management method, applicable to all professional fields. This definition and method have been under continuous development for the past 40 years.

Dr. Harry Rein has taught SLS programs for over a decade and has consulted in 30 states and five countries. He is the only active physician, trial lawyer and retired judge in the U.S. and is known for his teaching and lectures. He is the author of From Stethoscope to Gavel: Of Becoming A Doctor, Lawyer and Judge (on Amazon). Currently a trial lawyer whose practice includes teaching doctors his money management program that “Money Can Buy Happiness”. You can reach him at: DrRein@uscourt.com; or see www.uscourt.com; or the best way is call: 407-333-4444