Coaching for Healthcare Professionals

In 2006 surgeons and nurses who were perceived as having an aggressive interpersonal style were being referred for training.  A coaching curriculum that is relevant to the medical professional evolved with input from the participants.  The training is clinically oriented to the health care profession.

An initial assessment is done to help evaluate an individual’s interpersonal style. 

The patient population and work force that a clinician works with is increasingly socially and culturally diverse.  It is important that there is a culture of trust and mutual respect between the clinician and other health care professionals.  It is also important that a physician is able to develop a relationship with his patients.  The physician or medical professional is more likely to get the patient to change a behavior or comply with treatment if they have a good relationship. 

“Disruptive behavior causes stress, anxiety, and anger which can impede communication and collaboration, which can result in avoidable errors, adverse events, and other compromises in quality care."

Alan Rosenstein; American Journal of Medical Quality. 2008; 22:165-167.

It has been estimated that the average time a physician listens to a patient before interrupting is 7-9 seconds.  Participants enhance their communication skills.
The skills learned in the training helps strengthen the therapeutic alliance between the health care professional and the patient.  
Scarce resources and staff shortages make the work of helping others difficult and at times frustrating. 
It can be difficult to use new behavioral skills in a stressful environment.  Participants practice the skills they are learning before using them in real situations.  
The use of critical incidents in the training keeps the training material relevant to the medical profession. 

This is a case study in which the insurance company settled with the plaintiff: A sixty year-old woman whose physician was a member of a large internal medicine group phoned on a Friday night complaining of several hours of chest pain.  The insured internist who was on call told the patient to immediately go to the emergency room  for evaluation.  A cardiologist was consulted. When EKG changes were suspicious for myocardial infarction, Nitroglycerine therapy was effective in relieving the pain, and arrangements were made for cardiac catheterization.  The patient was admitted to the ICU under the care of the internist.  A cardiologist who was to perform the angiography discovered that the patient's INR was elevated due to chronic Coumadin treatment for her prosthetic heart valve.  The cardiologist determined that the risk of bleeding was too high.  Since the patient was stable he decided to wait for the clotting studies to normalize before beginning the procedure.  The patient was upset that she would have to wait for the catheterization.  The patient accused the internist of postponing the procedure because it was a weekend.  The internist spent an hour with the patient and her husband trying to explain why it was medically necessary to wait until the lab results showed that her blood clotting was at a level that the procedure could be performed without her bleeding to death.  The internist ended the conversation by saying:  There is nothing more she can do now.  The insured internist was off duty Saturday. The cardiologist came to see the patient in the evening noting in the medical chart that the INR was still too high for an invasive procedure.  The patient apparently slept through the visit.

Sunday morning the patient was demanding to know why no one had come to see her and they had not begun the procedure.  The ICU nurse called the insured internist who immediately came to the hospital.  There was a note in the medical chart written by the cardiologist that morning noting that if the INR Result was near normal the patient should be given heparin to prevent her valve from clotting while awaiting the cardiac catheterization that was scheduled for Monday.  The insured internist tried to explain that they had been monitoring the lab results and now there was a need for heparin.  The patient's husband became angry said that the doctors on the case are idiots and that he was not going to allow his wife to take the heparin because they had been repeatedly told that she was already over anti-coagulated.  The patient insisted she would not take the drug. The insured internist raised her voice to be heard. After a heated exchange, the insured internist pointed her finger at the patient and said, "If you refuse this drug your heart valve could clot and you would die. It is suicide but I can't do anything to stop it.”  The patient refused medical treatment.

The patient has the right to refuse medical therapy.  The insured physician fulfilled her obligation to warn the patient of the risks associated with refusing medical therapy. 
Shortly afterwards the patient had gone into a ventricular fibrillation.  A code was run according to an ACLS protocol by a cardiologist who was in the ICU but it was unsuccessful.  The patient was pronounced dead 45 minutes later. The patient's husband began yelling at the insured internist and blaming her for the death of his wife.
An autopsy found a rupture in the patient’s right ventricle. The heart was significantly enlarged and had 70 to 80% blockage in three cornering arteries. The defense expert cardiologist said that the rupture was inevitable was not caused by the heated argument between the patient and the internist and that it would have been difficult to predict or prevent even if the coronary catheterization had not been delayed. The plaintiff’s expert said the delay in our catheterization was below the standard of care.
While they could have argued from a medical standpoint that it would not have altered the ultimate outcome of the case, there was concern that because of how the insured internist would be perceived, a jury may be sympathetic for the plaintiff.

The ICU nurse who was in the Room at the time of the discussion between the insured internist and patient said that she thought at the internist behavior had not been appropriate. She recalled the insured as being arrogant and failing to explain the function of Hepburn to the patient or husband "she didn't show them any respect". The nursing supervisor who arrived in the ICU after the code said that she had been irritated by the insured's demeanor. She stated that when she asked the insured internist why she was upset with the patient and her husband the internist reportedly said that she was having a bad day. The nursing supervisor responded by saying that she was not nearly having a bad day as the patient and thought the internist should have apologized. 
The insurance company decided it would be best to settle with the plaintiff because of the testimony of the internist peers, although from a medical perspective, a coronary catheterization would probably not have changed the outcome for the patient. 

The perception that the internist was not empathetic with the patient and her husband became a legal liability and cause the insurance company to settle with the plaintiffs.
A poor relationship between the internist and the patient contributed to the patient refusing to comply with treatment.  Better communication between the patient, husband and the insured internist would have helped. It would also have been helpful if the insured internist had the skills to de-escalate the husband’s anger.  The internist became angry when the husband raised his voice .The internist would have been able to handle the situation better if she had anger management skills. The situation probably would not have occurred if the insured internist had developed a therapeutic alliance with the patient and her family at the beginning of treatment.

Physicians have valuable skills 

They have been trained to perform specialized tasks and are usually good task leaders.  Traditionally in our culture Physicians have been held in high regard and are in charge at their work environment. Some have compared the role of a surgeon in a surgical unit as the captain of the ship.  Their judgment and behavior was rarely questioned as long as the task (Surgical Procedure) is completed successfully. No one would question a physician who lost his temper or who yelled at other medical staff because of frustration.  I have been told by surgeons that it is their patient.  "I brought the patient to this hospital." “I am ultimately responsible for this patient." Other medical personnel are perceived as support staff rather than vital components of the medical unit. 

Medical treatment has become more complex with the advancement of medicine. The volume of complex technical equipment in the ICU and in modern operating rooms makes it a necessity that the surgeon is able to rely on other members of their surgical team to successfully complete a medical procedure (Task). The more complex the task the more interpersonal interaction is required. In the most complex cases the surgical team must function as a symbiotic organ.  Sending and receiving information and working in concert like a well orchestrated symphony. 

The education and training a physician receives is focused on the technical skills they will need to complete a medical procedure or task.  The more specialized an area of medicine the physician practices the more education and training is required to learn and implement that specific set of skills.  The educational process produces a skilled task leader. However as a task gets more complex, the relationships with other group members becomes more important. The modern physician must not only be a good task leader but also a good relationship leader.


Training Objective:

Develop Relationship Oriented Behavior and Emotional Intelligence.

Training Curriculum:

The curriculum composed of 10 individual 60 minute Executive Coaching sessions 3 skill modules, and the use of critical incidents.

Each module takes approximately 3 to 4 hours to complete.

Skill Modules:

  • Communication
  • Stress Management
  • Emotional Intelligence

Participants Benefit by:

  • Having communication skills that get you what you want
  • Facilitating the flow of information
  • Enhanced interviewing skills
  • Regulating Emotion
  • Managing stress and conflict
  • Strengthening the therapeutic alliance with patient and coworkers
  • Improving patient compliance and treatment outcome

Training Time 10 Hours. Training Materials Included.  Cost: $980.00

A common trigger for frustration among medical professionals is the pager.  An effective intervention is reviewing and clarifying the on call policy.

For more information call 415-875-9560
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