Beyond the white coat: understanding what drives (and drains) physicians

I was with some physicians recently and one, a vascular surgeon, had to leave early. He’d been a big personality for the beginning of the meeting, a fun participant that all professional speakers love to have in their audience. He came up to me at the break and looked at me with deeply sad eyes and said, “I have to go to the hospital to amputate a leg.” And then after a short pause, he continued, “I hate this part of my job.”

I felt for him and wished him well. He then left quickly head down, no big personality now. Had we had the time to talk, I would likely have paraphrased, empathized, and perhaps been curious about this part of his work with some gentle questions allowing him room to process “This part of my job.”

An anesthesiologist at the same meeting loved his job because “I always win.” A family doc said, “I love seeing all the generations, I get to see them all.” Each physician responded to my question about their specialty and I always followed up with, “Do you still like it?” I get the inner part of their name and their noun (the specialty) with an extensional question meant to convey that I know there are some challenges associated with being a physician today. It tends to create a quick bond. One responded to me, “Oh you know it’s not like they told me it would be in medical school.”

How about your KOL? What do they really like about their work? Or really don’t like about their work? Sometimes after the “Hello” and the “How are you?” kinds of pleasantries, we may have a moment to say, “I don’t think I ever asked you this question and I thought of you last night. OK to ask you before we dive in?” I always get an affirmative response. And then some variation of:

·        Do you still like this work?
·        What’s the most satisfying part of this work for you?
·        What’s it like to have a patient who just doesn’t quite fit the pattern of your other patients?
·        Did med school prepare you for this?! (this can be a question or an exclamation!)

Of course you must pick the right time, right place, right KOL to extend this invitation to talk, but in my experience some of them want to talk to a receptive ear. Much of their day like ours is on automatic. This can be a reflective set of moments to create that human (and memorable) connection. This conversation will not be forgotten (by either of you).

And don’t worry if they disregard it, they won’t remember!

The power of doing things differently

There was a Seinfeld episode where George was belaboring his choices in life, and he said something like “every choice I have ever made in my life has been wrong…” The table discussion came up with a conclusion: Do the opposite! Of course, this leads to him ordering a different lunch, similar to one a woman ordered, and he winds up “doing the opposite.” He approaches her with the line “My name is George, I’m unemployed and I live with my parents!” She responds with a warm smile, “Hi, my name is Victoria!”

Watching this scene (way too many times) makes me reflect on my patterns, the ones that always work and the ones that seem to miss the mark by just that much… but I continue none the less! What about you? Is there a KOL, or an office receptionist, or a manager who you seem to “miss the mark” with no matter how earnestly you try? Or do you (and I) take some of our encounters way too casually when we could be more intentional?

That receptionist who seems a bit too busy, the flight attendant a bit too brusque, a KOL who seems to never pay enough attention, or the manager who seems to always have one more (discouraging/negative) thing to end our conversations with? What if you (and I) took an intentional look and decided perhaps not to do the opposite but certainly to do something different, perhaps vastly different, even if only within ourselves as we process what is happening.

Nido Qubein, president of High Point University in North Carolina, suggested to me once that my To-Do list could be radically altered if I also had a “Stop Doing List.” Then he continued that the shortest list is the most important list: the “To Be” list. George didn’t just do the opposite. He was fully present to Victoria even though he did not know her and was taking a risk.

In my coaching practice I notice so many of my clients struggle with that first step and often they too get a version of “Hi, my name is Victoria!”

How did you decide to do that?

One way to initiate change for yourself or others is to find a small bit of change in the process and then inquire about it. In the world of therapy this is called Solution Focused Counseling. You won’t need a therapist to benefit from its genius. Let’s say you have a very disappointing meeting with your KOL (or your family member!). Normally we would give it a good mental post-mortem in terms of what we did wrong, the failure it represents, the times when our self-confidence was hit pretty hard, etc. Using the Solution Focused Approach, our first question to ourselves (or to our discouraged MSL colleague) would be something akin to “What’s it like when it’s not like that?” A follow-up to that might be, “How did you decide to that?” and “What gave you the courage to make that move?”

Here is a short example: Let’s say your new KOL decided to evaluate you out and things didn’t go so well. You became more nervous as time went on. More and more like a final oral exam, all you could do was quietly count the minutes. It ended awkwardly. You walk out to the car and call a friend, and she says, “How were you able to stay there the whole time?” and/or “How were you able to keep your composure?” and/or “How did you decide to call me instead of just feeling bad by yourself?” Each of these questions will yield a positive response. But what if your friend said, “Oh my, that must have been terrible!” and/or “You don’t have to go back there do you?” and/or “That happened to me once and…”?

Look for small moves. “I stayed because he kept talking and I shifted to listening mode, I thought of myself as a student with a teacher” and/or “I kept my composure by remembering pharmacy school exams, I have to barrel through” and/or “I knew that if I didn’t call you, I’d be a mess all afternoon and I have more appointments today.” All positives. You don’t need to call a friend, simply ask yourself!

Now what

Singer Paul Simon, Chef Grant Achetz, Diva Celine Dion (and maybe you) have faced the loss of hearing, tasting, bodily control, and hundreds of other challenges beyond our prediction. We all know someone who woke up one morning fully alive and by evening was a different person. Some resign themselves to their fate while others take a different approach. There is a Japanese therapist who has a three-sided small pyramid in his office. On one side it is written “Poor Me” on a second side is written “Those Bad People” and on the third side it is written “So what am I going to do now?” When you come for therapy, he hands you the pyramid and says, “So what do you want to talk about today?” You can certainly talk about any side of the pyramid you want but ultimately that third side is staring you in the face.

“Could I be wrong in my thinking about this?”

“Could I be wrong in my thinking about this?” -Mohsen Shabahang, Wellspan Health

I wondered as I heard him present about the nature of change, what this question could do for me. It does go counter to my usual question when I am stumped, “Something is wrong here." His question forces me to own the issue, my question externalizes actually making the issue even bigger. When I own the problem, I can decide what to do regardless of what the other person (or issue) is doing.

"Dare to have the courage to be imperfect"

The operative word here is “dare.” We all know that we are imperfect beings, and we often fight that realization struggling for one more grade, bonus, sign of approval, or award. But realizing our imperfection and then being able to operate within it are two vastly different things. Often, we compare ourselves to others or we compete, or we criticize. All these activities are on the vertical plane where one is up, and one is down. It is based on a model of being with others based on who is superior and who is inferior. But if we realize our humanity, our common humanity, we realize that we can live in a horizontal world where each person can contribute to the whole without having to be better than, more important than, or even…perfect. Of course, games and sports have winners and losers. Our science needs to be as accurate and perfect as possible, but when you visit your KOLs or your team or those who report to you think “How can I be useful here?” rather than “I must be perfect!” Let your PowerPoint be perfect if you must, but for you and me… We are at our best when we are seen as useful.

"Make the change easy for me"

We have more control than we think when it comes to helping someone change. To change their prescribing patterns, to change the way they think about something, even to change how they feel about the last sales rep from your company. Make it easy for them to talk about it without judgment, make it easy for them to try a new behavior, make it easy on them in all the many ways… Just make it easy.

"The issue in all human conflict is never about things, but always about respect"

We can so easily lose sight of things when we find ourselves in conflict over who did what to whom. Dr. Rudolf Dreikurs the famous Chicago psychiatrist said that ongoing conflict is never really about money or sex or how we load the dishwasher. Rather it often takes the form of:

-         “My right to decide is being weakened here.”
-         “My right to control is being jeopardized.”
-         “My judgment and my ideas are not being considered here.”
-         “My prestige and my status are being questioned by this person.”
-         “My feelings just don’t seem to count here.”
-         “I feel unfairly treated.”
-         “I feel defeated.”
-         “I feel powerless.”
-         “I feel inferior.”

Ever feel those ways regardless of the content? These feelings of respect or rather feeling disrespected linger long after the event that initiated them. Attend to the real issue and you may find resolution around the corner.

Creating a community through connection and care

“Building a Community.
Physicians go where they are Welcomed…
Remain where they are Respected…
And grow where they are Nurtured.”
- Bill Leaver, CEO, Iowa Health System

Substitute the word physician with these words: nurses, security guard, housekeeping, receptionist, etc. Maybe even replace the word physician with MSL! This is the key to community regardless of working out of your car or on the phone. You and I can add to a community feeling (The German word is “gemeinschaftsgefuhl,” indicating a connectedness of well-being with others). On your KOL visits, you can bring that shining light of welcoming, respect, and nurturance to every practice and university you visit. When you do, they want you back and will remember you. And you will remember them as well.

It's showtime folks!

"The average person looks without seeing,
listens without hearing, touches without noticing,
eats without tasting, and smells without awareness." - Leonardo da Vinci

I was struck by this quote when I was playing with the DaVinci robot attempting to get a rubber band off some pretend tissues. Not easy! What I noticed was that my whole self was in a state of awareness, not the ordinariness referred to in the master’s quote. When we are in awareness, something happens not only to you but to us. I have a new awareness of when I am talking and when I should go quieter, when to ask a question and how to answer one and being especially aware of how I look not in the mirror kind but in the engagement kind. Performers remind themselves: “It’s showtime folks!”

"Find out who you are and then do it on purpose"

A quote from the famous philosopher Dolly Parton urges us to be our distinctive self. In a world of managers who may want you to look alike or speak alike, make sure that you don’t extinguish your personality, your energy, your values, your distinctive self. Feedback is fine but be careful if you are being asked to be someone other than who you are. And frankly, when you are on the road with your KOLs, nobody is monitoring your every word. Be yourself. (Well… Maybe not all the time! Ride-alongs with your manager might not be the best time to be fully you!!)

Your job is to engage the audience

“Your job is not to please the audience; your job is to engage the audience. And it is in the engagement that then they will be pleased.”

Nora Dunn from Saturday Night Live said this in one of my classes and it has stuck with me ever since. So often in this business, we sit down and think we have to talk. Or our physician might open with something to the effect of, “What have you got for me today?” Make sure you switch it around to get them talking, to engage them: “Any interesting patients this past month?” or “First let me ask what would make our time together successful for you?” (This is a standard coaching question so that you can get right to the need and set up a goal for the meeting.)

At the end of the meeting, you can then say, “What was most useful about our talk for you today?” This too is a coaching question to put a cap on the session and mark progress. Just ask the question and go quiet to give them time to both think and feel it is their turn to talk. The mistake many make – even professional interviewers – is out of nervousness, anxiety, or a desire to show what we know; we add possible answers to our questions, “Was it good?” or “You know I mean this past 20 minutes.” Doing so doesn’t allow the person to find their own answers because they are busy listening to yours.

“The first time I meet them I know nothing."

“The first time I meet them I know nothing.” A sales friend of mine said this was the key to his success! And he was affectionately known as the guy you go to for help. I probed, of course, and he said that although many of his clients old and new have the same issues, “I always treat them with curiosity and openness as if they were the only one or the first one. I alert my whole self to them, to their pain, to their need to say it all to me. And I do alert myself he said or otherwise I’d be a generic visitor to their pain.” How do you approach that “first visit” (and perhaps subsequent ones as well)? When we put ourselves first as the receiver of what is top of mind for the KOL (or anyone), we are in a better position to provide what they really want from us.

Choosing a presentation for your next MSL interview

I am often asked my perspective on what topic a candidate should choose for their interview presentation, whether that is a student interviewing for a fellowship or an aspiring MSL looking for their first industry role. My advice is to pick a scientific topic on which they are familiar and confident.

Most of the time I suggest they stray away from a company publication (unless the company provides it) and instead focus on one from a competitor that is relevant to the audience.

Interestingly, a student pursuing a fellowship told me that they were told to pick any topic that reflects their interests, and it didn’t need to be about science. While this might be a clever way to get to know a candidate, I’m not sure a presentation on the optimal kayak stroke or brewing an IPA is the best reflection on the candidacy for a fellowship.

The ideal situation is for the company to provide a publication as that offers room for comparison across candidates, saves the interviewee time searching for a topic, and has the candidate learning a topic relevant to the job for which they are interviewing. A win-win-win in my perspective. Since the audience are experts on the study, they need to be cautious about expecting too much from the candidate but no doubt they are aware.

What advice do you provide to students/candidates on the topic to choose for an interview presentation?

Your S-curve journey

Would you agree that you’re a little slower as you learn something new? That can be frustrating for a highly functioning person. Imagine getting permission and space to be a little slower as you grow a new area of expertise. Would that relieve the stress associated with learning, especially when working in a high-pressure environment in which that new skill will provide long-term value?

Welcome to the concept of the “S-curve”! Charles Handy first introduced this concept as the “sigmoid” curve in the 90’s as an organizational and individual growth module for life cycle thinking. Whitney Johnson described the application of the S-curve in her 2012 Harvard Business Review article “Throw Your Life a Curve” in the learning and development space as a powerful tool used to support the development of new competencies.

From the slow beginnings of learning, we gradually accelerate our learning trajectory and then plateau as we are comfortable with this new skill and execute it with confidence. See the “S” shape forming?

When you’ve identified a new skill that you need to develop, talk with leadership about the space and time you need to journey from the tail of the S-curve, through the middle, to the plateau where you have achieved mastery (and need to start a new S-curve).

Having a growth mindset

A growth mindset allows you to add the word “yet” after acknowledging that you don’t know how to do something or if you are still developing skills in an area.

In her book “Mindset: The New Psychology of Success,” Carol Dweck, PhD outlines the concept of growth and fixed mindsets. If you have a fixed mindset about something, you may avoid new challenges, focus on failures, and believe that you cannot broaden your talent. Doesn’t that feel stifling Having a growth mindset allows you to look at challenges as opportunities, failures as a learning experience from which you can grow, and understand you can develop new skills.

Perhaps you want to play the piano but have not done so as you feel it is daunting and that you had tried in the past without success. Approaching this now, you might say “I can’t play the piano yet,” acknowledging that you can and will develop that skill.

She provides examples of celebrities that demonstrate these mindsets (Oprah Winfrey, Michael Jordan, John McEnroe to name a few) and I’ll let you guess which category these individuals personify. She describes herself as a person who evolved from a fixed mindset to a growth mindset!

It’s such a liberating feeling to know that you don’t need to be great at everything and that it’s OK to be in the development phase of a new skill. What is it that want to develop and can’t do YET?

Your favorite book on networking

We all recognize that networking is important, and it may be daunting, especially if you are out of practice. The pandemic has an impact on our networking skills and has offered us an opportunity to develop our skills in diverse ways. How did you develop your skills? What ideas can you offer individuals who are less comfortable networking?

What networking book do you recommend and is there a tip in that book you found to be of particular value? How does networking differ depending on where you’re at in your career? How may it be different if you change direction in your career?

Let’s use our experience to develop a list of books to expand our skills and foster our growth in this key area.

Your secret sauce is...

A final idea for the year, and it's a quick one...so yes you do have time to do it! Send an email to each of your KOLs telling them their ‘secret sauce' - their unique talent that you noticed this year. It might be their engaging ways, their devotion to their patients, what they have taught you, their courage, their amazing human relations skills, etc. Put it in the subject line so it won’t be passed over as a typical holiday greeting. Perhaps in the Subject Line: “Dr. Canady your ‘secret sauce’ is….” And then tell them what you have noticed in the body of the email. Do not fear doing this! Everyone, even your most reticent, inward KOL will be most pleased with this friendly feedback. (Trust us on this…we are trained professionals!)

Setting a goal and moving it forwards, one step at a time

With New Years around the corner, you may be thinking about your goals for 2025. When you set goals, do you achieve them? Perhaps you accomplish your work goals but let your personal goals sit on the back burner. Does this sound familiar?

You are more likely to accomplish your goals if they are heartfelt and if you can visualize what success looks like. Are you passionate about your goal? If so, it is easier to put the necessary time and effort into succeeding. Eat the elephant one bite at a time… Break the goal into manageable pieces and timeframes. What can you do today to begin moving forward? What can you do tomorrow? This week? Imagine how good it will feel to take one, two, three steps toward your goal, no matter how small they are. This is how you gain momentum to reach your goal.

What personal goal do you want to accomplish? What step forward will you take today?

Filling our plates

As we approach the holidays, we will have the opportunity to indulge. We will see our favorite foods, new foods, foods we haven’t had since childhood, and food we swore we’d never eat again. In some situations, we will have the opportunity to fill our plates and go back for more. For me, this reflects life. We have so many opportunities in front of us, and all outcomes depend on which ones will we add to our plate.

I was speaking with a student the other day that has a full plate with all the things you’d expect: school, work, extracurricular activities, family, and a personal life. He was struggling to deliver on his responsibilities and felt bad that he hadn’t met the goals he had committed to. No one feels good about overpromising and underdelivering. Why do we over commit ourselves? Is it related to beefing up our resume? Is it a feeling that we’re the only person that can do the job? Are we shopping for new experiences to add to our collection? Are we unaware of how time consuming these commitments will be?

When you have an opportunity to fill your plate, do you leave room or fill it to the brim? Does your method work? Is so, what is your secret? My secret for this holiday season and new year is to leave room around the edges for that opportunity (or dessert) I wasn’t anticipating.