Zen and the Art of General Practice

buy premarin Zen“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

I have recently had reason to think about Tom Marshall’s propositon that “General Practice is the best job in the world – you get paid for talking to your friends.”

Certainly it is the most rewarding of professions. However, there are many times when it does not feel like the best job in the building, let alone the best job in the world. Within the hustle of the working day we can often feel frustrated and overwhemed, and find ourselves looking forward to the last patient out the door, or just hanging in there until our next holidays.

Sustainability of workforce is one of the key issues for general practice.How can we make every day an ‘in-the-zone’ day’?How can we make our life as general practitioners easier, for the benefit of our practices and ourselves?

The Serenity Project. Fill your working day with Zen-like calm.

In the collaboratives, we have learnt that every system produces exactly the result it was designed to produce. If our days are often stressful and frustrating, we need to change the system that produces those circumstances. The corollary of this is that if we keep doing what we are doing, we keep getting what we get. If we don’t change the stuff that frustrates us each day we are doomed to relive it.

The improvement model tells us that we need to identify a problem, make a change, and measure to make sure that change is an improvement. We need to identify our itches, and then scratch them.

OK. I propose we collaborate and apply these priniciples to making general practice ‘easier’, for the benefit of our patients and ourselves.   

Know Your Enemy. Identify Zen-zappers.

The first step is to identify the circumstances and events that act to decrease our serenity.Keep a sheet of paper on your desk and jot them down as they happen.Interestingly, I have found that many of the things that non-GPs may suspect cause us stress  often do not appear on the list – and some simple things do.

For example, seeing an unwell person with acute chest pain is not usually too Zen-zapping. If the diagnosis is probable cardiac chest pain, our nurses have the oxygen on and ECG done and have cannulated the patient and are just waiting for the nod to call the ambulance to provide transport to the base hospital. No arguments from the ambulance or AEC.

Seeing a person who is not unwell with a vague chest pain that may be cardiac but probably isn’t can be much more time consuming, require far more decisions and persuasion,  and be far more Zen-zapping.

Discussing depression and anxiety with patients is something we are privileged to do every day – it becomes Zen-zapping when we know that  it is going to take hours to chase up a psychologist who is able to assist in their treatment in a timely and affordable way.

The opposition teams

In my own prelimnary list I can see the stressors sorting themselves into five major categories

1) Insufficent Time 

Jobs that may be simple become complex when there is inadequate time for their completion. Having a chat to the last patient about their condition can be pleasant – having a chat when there are six other people waiting to see us is less so.      

2) Inadequate Focus

It is a zen principle that whatever you are doing at any point in time should have your complete attention. We should have ‘mindful acceptance of the present moment’. It is hard to do this when the nursing home is on line one, there is a patient in the sister’s room requiring suturing, the patient in front of you is concerned about the behaviour of her child at school, the hospital is on line two, and the ambulance has just arrived to pick up your patient with chest pain and you haven’t done the letter – and the computer has just crashed.      

3) Inadequate Teams

This patient is going to need to see an Ear Nose and Throat surgeon to sort out their acute hoarse voice. Great. There is already a waiting list for the waiting list for the waiting list.      

4) Inadequate Tools

I had the doppler earlier this morning so who took it from my room! Really, you can’t turn your back for a minute. And not only has this ear-looker-inner run out of batteries but there aren’t any paediatric ear pieces left.      

5) Incomplete knowledge.

Bugger. I probably should have gone to that refresher course on heart rhythms.      

6) Attitude

Oh no. Second on the list is Mrs Kapphups. She was ungreatful enough to be allergic to my last treatment. I suppose she’s going to complain about pain again. What does she expect is she’s going to break her back.      

7) Rework

I’ve already filled in five worker’s comp forms and now they fax me a letter asking me the same questions I put on the form. And I wrote up all these charts at the nursing home and now they want me to write exactly the same thing on prescriptions. And the information required on this form could be automatically generated from my computer if they didn’t insist on it being completed on their own paper!      

Phew! I feel my serenity fading away just writing that out.

Regaining Calm

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We’ve begun to identify the enemy.Now we can improve our systems to successfully scratch our itch. Having written down the things that upset my day, solutions begin to be obvious.Together we can collaborate and ‘steal shamlessly’ to systematically and proactively decrease these triggers to stress.

The next few postings will share solutions to these issues. 

Please share your thoughts below. 
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6 Responses to “Zen and the Art of General Practice”

  1. Oliver Frank
    March 3rd, 2008 | 7:47 am

    Good stuff, Tony. I would like to respond to your first Zen zapper of Insufficent Time.

    The most powerful thing I have heard about this is that we all have the same amount of time.

    I got sick of always struggling to stay on time. My standard appointments are now half an hour. If a patient’s consultation takes less, I do some of the many other tasks that GPs always have in their in trays, or on their task lists on on their hipster PDAs, or I even occasionally sit and … think.

    I am much more Zen like now.

  2. Patrick Pong
    March 3rd, 2008 | 10:29 am

    Thanks Tony. I recognised the subject above. I will throw in this one I have problems with because it seems to be out of my control.

    Other people’s paperwork (Rework in your list)

    Centrelink and their forms create stress 90% of the time. Centrelink refuse or would not accept my sick note. Everybody else including our legal friends accept it as a legal piece of paper but Centrelink in it’s own world refuse to accept it and would send patients back for one of their sickness benefit note. How did this come about and why did we let it happened? I can carry on about Centrelink but I will not.

    “My new employer wants a note for fitness to start work” but they don’t have relevant forms, sends my Zen crashing down. (I had one which needed me to certified a security officer mentally fit to carry a gun! After 20 years I still trying to understand how my wife thinks!)

    This is the most difficult one for me in my daily work. I have tried Zen and it always comes back as FI “F@#&K it” instead of FTT.

    Thanks for listening. That felt good.

  3. Keren Witcombe
    March 3rd, 2008 | 12:05 pm

    1. Problem: Trying to get beds for acute psychiatric emergancies.
    Solution: according to GP liason psychiatric nurse one must send the patient to ED requesting an urgent assessment instead of making the assessment yourself. If you assess the patient as needing a bed, it is your problem to find a bed. If they make that assessment, then it is their problem to find a bed! Goes against the grain but saves hours of frustration.
    2. Problem: Having patients sent home from ED with no explanation as to why they were not admitted and no investigation results.
    Solution: GP Liason Doc to explain problem to ED and improve quality of discharge letters. Worked at our local.

  4. Alan McCleary
    March 3rd, 2008 | 1:45 pm

    Lists, Related to your “Time” When you are running behind because of the fracture, suture etc and the next patient sits themselves comfortably in the chair and says they have several things to talk about today. They then leave the most important one until last e.g. today’s central chest pain and just when you think you have got there they say ” And while I was here I thought you could have a look at (insert serious problem here). “

  5. maura harvey
    March 8th, 2008 | 1:11 pm

    1. shopping list patients..ask for their list up front in the consult, then ocnsider yourself what’s urgent/related etc & arrnage what can be done today, & what carried over
    2. those forms etc…..RNs are good at doing forms!!! delegate.
    3. attitude…remenber it’s always the pt’s problem
    4, focus….i mostly deal with interruptions at the time..so much easier than retracing/finding etc the person/message alter. my pt notes, or simply asking “where were we up to” regains my focus re the pt
    5. laughter , anthropomorphizing/other simple analogies etc help pt compliance, comprehension & wellbeing….mine too!
    6. quality coffee @ work
    7. delegate more to RNs…they save my time…basic history, basic examination etc..use them as clinical assistants, educators etc = happy rn’s, smoother thru-put with less dr time stress. ideal.

  6. March 24th, 2016 | 6:07 am

    […] Zen and the Art of General Practice Part Two […]

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