Surviving Storms

Posted on Sep 28, 2010 in Heal Thyself | 0 comments

7 Keys to Surviving the Perfect Storm

 

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We’re in trouble. A nationwide survey found that 49% of physicians plan to either decrease the numbers of patients that they see or quit altogether within 3 years. That was 2008. We are facing a national healthcare disaster with extreme consequences. Those of us that choose to stay and practice undoubtedly will face increasing demands at the very time when resources are becoming scarce.

• Have you lost your passion for medicine?
• Do you feel like you’re becoming burned out?
• Have you discovered success at the cost of significance?

As the director of the Katrina medical triage unit at the New Orleans Convention Center, I was confronted with a variety of situations that produced some significant insights. These concepts matured over the next couple of years and they were reinforced during my recent experience as the medical director for Medical Team International’s “First-In Team” responding to the Haitian earthquake. Haiti was a very raw and emotionally challenging experience. I am convinced that these concepts not only apply to the disasters we see on television but they also apply to the very real disasters and challenges that we all face in our own personal lives. Disasters of all types contain opportunity within the crisis. Naturally, many of us feel like running in the opposite direction and giving up. On the other hand, there is another way to approach these literal and internal storms that will enable us to make a profound difference and leave a lasting positive impact. What strategies will help us succeed in difficult times and circumstances? What can we do to be successful in our life’s work when the presenting circumstances look like there is looming defeat? How can we move from assuming the role of the victim and choose, rather, to become a Thriver?

#1 – Locus of Control

Discovering the power to make a difference

Before our team was deployed to New Orleans I saw a woman interviewed on CNN, yelling at the camera, “When is George Bush going to bring me my food!” I remember thinking at the time that she was behaving like a victim. But, there was something else that was bothering me. Months later I discovered what it was.

The renowned psychologist Julian Rotter was raised in Brooklyn, New York, and experienced firsthand the impact of difficult times. His father operated a profitable business that ran into trouble during the Great Depression. The economic downturn had a significant impact on his family and he saw how external forces can impact people. In 1954 Julian Rotter first described his observations regarding what he termed “the locus of control.” Victims, according to Rotter, have an external locus of control. They believe that power exists outside and that power impacts them. They are at the mercy of an external force. In contrast, people that excel during difficult times have an internal locus of control. They believe that no matter what happens to them, they always retain the power to choose how they are going to respond.

Perhaps the best example of this is the famous psychiatrist, Viktor Frankel. He was captured by the Germans during World War II and spent over 7 years suffering in a concentration camp. He endured unspeakable torture and yet he was able to say, “We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man or a woman but one thing: the last of human freedoms–to choose one’s attitude in any given set of circumstances; to choose one’s own way.”[1]

Clearly, the woman on CNN, that I mentioned earlier, had an external locus of control. She believed that the solution to her problem rested with President George Bush. She was behaving as one who was powerless. Perhaps that may seem like an obvious insight. However, what really bothered me about her went beyond her powerlessness. She had a second trait that also defines victims. She was a “taker.” What strikes me most about her, in retrospect, is that she was only concerned about herself. She wasn’t asking the question, “When is George Bush going to bring some food for my daughter?” She truly could not see beyond her own self. She was a Victim: a “Powerless Taker.”

#2 – The Golden Paradigm

To find life, you have to give away

 I started bringing together the concepts of Givers VS Takers and Empowered VS Powerless as a framework to analyze behavior following disasters. This 4-quadrant diagram has profound implications. The 4 quadrants are Victims, Exploiters, Bystanders, and Thrivers. The first quadrant, Victims or “Powerless Takers” has already been illustrated above.

The next quadrant, “Empowered Takers” is the Exploiters. Exploiters have the attitude of “ME first!” Exploiters believe that they will get ahead by putting their own needs first. Following Hurricane Katrina, the looting was extensive. There were a number of people that took advantage of the situation. It was the break they had been waiting for! Finally, they would go and take the big-screen television that they believed they deserved. However, Exploiters really never win in the long run. I wonder at what point those people with their big-screen televisions realized that they no longer had a place to even plug them in.

The third group, “Powerless Givers,” is described as the Bystanders. These are the people that wish that they could help. They have the attitude of a giver but they lack the power to take action. They don’t make any significant impact and they certainly do not leave a legacy. Often times, these people incorrectly assume that they will be safe if they do not get involved. However, it is well known that bystanders are in fact impacted when they stand by as witnesses and just do nothing. Playing it safe is not safe at all. Bystanders are affected by their failure to act. Unfortunately, there are all together too many bystanders in the workforce and even in medicine. They show up at work day after day and never make much of a contribution. They are living life on the sidelines.

The fourth group, the “Empowered Givers,” is the Thrivers. They have the attitude of “YOU first!” They understand that by investing in other people they will discover significance. Not only will these people leave a legacy but they are also more likely to be successful in the long run. This goes beyond the concept of the Golden Rule (do unto others as you would have them do unto you).[2] The Golden Paradigm is that if you want to discover significance, if you want to find life, you need to give it away. Imagine the powerful experience you would have if you were on a team where everyone had the same goal: “I will do anything within my power to make the other people on my team successful.” In some ways, I really don’t even care what a team like that is doing; I just want to be a part of it.

#3 – Solid Support Structure

“A cord of 3 strands is not quickly torn apart”[3]

It has been said, “Two are better than one because they have a good return for their labor.” (Ecclesiastics 4:9) When responding to disasters we never send anyone in alone; we always go in as a team. Many physicians practice in isolation. Very few people, if any, are even aware of the internal struggle that’s going on within the physician.

One of the tools frequently used within the National Speakers Association is the concept of Mastermind Groups. These groups are made up of people that are in similar situations in life. They may be scattered across the country but they meet on a regular basis either by phone or in person. Although the rules for these types of groups vary, usually the format is highly structured.

• The total length of the meeting is predefined and divided up by the number of people in the group.
• Someone is assigned the role of timekeeper and then the meeting begins.
• The first person to lead off states a specific question that he would like to have the group address.
• The person then has 2 minutes to give any background information.
• The other members of the group are then allowed to ask clarification questions.
• Once the question has been clarified, the other members in the group then take turns giving advice to the person who asked the original question.
• At the end of the time, the person who asked the question then summarizes his take away points and any action points that he plans to do.
• It then shifts to the next member of the group.

I have participated in a Mastermind Group for nearly 2 years. It has been invaluable. The challenges that we face are not unique. This format offers a helpful structure to be able to address a variety of different questions without one person dominating the group. Not only did I learn from my questions, I also learned at least as much by taking notes on the answers to other people’s questions. Not everyone in the group needs to be a physician. In fact, there may be advantages to having people in the group that are not physicians.

Building a great support structure does not happen by accident. No one will show up at your door and say that she is from “Friends Anonymous” and ask you to join her group. If you would like to re-energize your practice and improve your current situation, you will have to take the initiative yourself.

#4 – Problem Solving

There is no such thing as failure

One of the characteristics of people that do well in disasters is that they are outstanding problem solvers. They tend to believe that there is no such thing as failure, only feedback. In the midst of a disaster, resources can be scarce. This requires improvisational thinking. Typical resources may not be available. It then becomes important to adapt and think creatively. Children are very good at doing this. If you give a child a prop she will oftentimes turn it upside down or try to use it in the opposite manner and thus discover a completely new use. As adults we often become limited because we have been taught how things “ought” to be. One of the tools that we use during disasters for problem solving is called the ETA strategy. This is a simple, 3-step strategy:

1. Evaluate the gap and formulate a plan
2. Take action
3. Assess learning

The bedrock of this tool is that there is no such thing as failure, only feedback. Thinking differently means that we practice differently…and more effectively.

#5 – Ask Great Questions

Without great questions, there will be no great answers

As I was reading a CME program recently, I came across a quote that was a bit startling: “The best predictor of physician prescribing behavior regarding antihypertensive medications is the year of graduation from medical school.”[3] It is difficult to improve without asking if there is a better way to do something. I’m not referring to the type of questions that are just another form of complaining; I’m encouraging curiosity and creative questioning that seeks better answers. Great questions lead to great answers — answers that are buried within and would not have been uncovered without the questions being asked. It may be helpful to actually write your answers down. Here are a few questions to get you going:

• What is happening?
• What information do I need to make a good decision?
• What are the short-term (long-term) consequences?
• What are my options?
• What are my goals?
• How can I specifically reach my goals? What is my specific plan?
• What can I specifically do today for someone else?
• What do I feel?
• What do we believe?
• Who is on my team?
• What are the outcomes that I want?
• If the strategy I am using does not work, why?
• What have I learned so far?
• Were there early clues that I missed?
• What is amusing about this?
• What would happen if I did the opposite of what people think I would do?
• Do I present myself as a person who takes orders rather than as a person who makes things happen?
• What are my personal limitations/weaknesses that need to be addressed in order to achieve my goal?

#6 – Take Good Care of Yourself

You can’t give what you don’t have

Cutting the head off of the goose that laid the golden eggs to get more eggs out is not a great long-term solution. Most of us are familiar with information on self-care but chose to ignore it. In a disaster setting we frequently see providers that have pushed themselves beyond their limits. At that point errors increase, interpersonal skills decrease, and people become ineffective. Following Katrina I met a physician that had not slept for 4 days. He was wandering around a parking lot, semi coherent, and drinking an open bottle of wine that he found in an abandoned shopping cart. Somewhere in the midst of that catastrophic mess, he forgot to take care of himself and, as such, he became ineffective when he was still needed.

Sleep deprivation has been shown to significantly increase both errors of commission as well as errors of omission and, accordingly, we now have limits on the numbers of hours that resident physicians can work. However, those of us in the “real world” are left to supervise ourselves. Regular sleep is important and so is exercise.

The Mayo Clinic lists the following 7 benefits of regular exercise:

1. Exercise improves your mood.   
2. Exercise combats chronic disease.
3. Exercise helps you manage your weight.
4. Exercise boosts your energy level.
5. Exercise promotes better sleep.
6. Exercise can put the spark back in your sex life.
7. Exercise can be – gasp – fun!

Making change, however, can be difficult. Start simple. Just add a 15-minute walk in your day. Ask yourself what the next step is. Don’t forget to have someone hold you accountable. You are worth it. As a healthcare provider, it is hard to give what you don’t have.

#7 – The Power of Humor

Laughter is the best medicine and it doesn’t taste all that bad

Our medical team’s mascot is a rubber chicken. Are we taken seriously? Absolutely. We are hard working, first-in, boots-on-the ground people of action. Strategically, however, the people that I have recruited to be on our team all have humor as one of their core traits. I have found that people with a sense of humor are much easier to work with in a disaster setting. Those folks that need to have everything outlined, scheduled, and in a box don’t do very well when everything is scattered and in disarray. Not only are people with a sense of humor more flexible and dynamic, they are more fun to work with as well. Besides, the rubber chicken has made many a sad person laugh because it caught them off guard. Sensitive humor can bring hope, perspective, and resilience.

Putting the 7 Keys to Work

We all are going to face challenges during this time of transition in healthcare. Remembering these things will increase the likelihood that you will thrive in the midst of these extraordinary times:

1. Keep an internal locus of control. You have the power to make an impact.
2. To life, you need to give it away.
3. Much like a 3-cord rope, you are stronger when you are intertwined with others. Find or start a group.
4. There is no such thing as failure, only feedback. Be tenacious in your problem solving and keep your eye on the goal.
5. Be curious. If you want to find great answers, you have to ask great questions.
6. Take good care of yourself; you are in this for the long haul.
7. Find humor. It will free up your creativity and you will be more likely to discover a better solution.

Dan Diamond, MD
Published on September 28, 2010

About the Author
Dan Diamond, MD, directed the Katrina medical triage unit at the New Orleans Convention Center and led one of the first teams to respond to the Haitian earthquake. In 2010 he received the Washington State Governor’s Award of Excellence and the Red Cross Real Hero Award. Passionate for bringing people back to life, Dr. Diamond is well known for his work with organizations that want to reengage their employees to deliver outstanding service. Book him to speak to your organization by going to www.powerdyme.com.

References

1. Frankl VE. Man’s Search for Meaning. Boston MA: Beacon Press, 2006.
2. Ecclesiastes 4:12.
3. Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995;274:700-705.