Adrenaline-Fear or Fuel? The Choice is Yours

Have you ever anguished over a phone call to a disgruntled patient, or experienced sweaty palms when you had to make a presentation in front of your colleagues?  Have you ever been intimidated by hospital administrator who calls you to his\her office for a discussion about your admitting practices? If you answered 'yes' to one or all of these questions, then you will want to read the rest of this article that will help you deal with those feelings and will provide suggestions for turning fear into fuel.*

 Every doctor knows the experience of the adrenaline rush or high that comes from a successful phone call to media when they agree to run your story on the 10:00 news. That same chemical, adrenaline, is also responsible for the anxiety, apprehension, tension, and self-doubt that results in procrastination, avoidance, and possibly even depression. Successful physicians are able to harness the power of adrenaline and change the fear response and its associated paralysis into a positive action response and adaptation.

 Nearly every doctor, if he\she is honest, will admit that they experience anxiety before getting up in front of a group of strangers and making a presentation. This sensation or feeling is a natural response to being out of your comfort zone. You have the choice of remaining powerless to the discomfort and fear or you can anticipate potential objections, visualize outcomes, and ultimately to expect a favorable response from your program. You can use the adrenaline to creatively find solutions in this heightened state of awareness instead of allowing the adrenaline to keep you immobilized.

The reality is that doctors are more knowledgeable about their subject(s) than the members of the audience. Consequently, you know most of the answers to any questions posed by your audience. You have mentally rehearsed the objections such as insurance coverage, risks and complications, and alternative treatment options. It is unlikely that an audience member will ask a question that you are unable to answer. But even if they do ask a difficult or curve ball question, you are in heightened state of awareness thanks to the adrenaline, and you will be absolutely astounded at how quickly you can adapt to the new situation. The adrenaline that had you frightened moments just before is now producing appropriate and creative responses.

 There are many situations on a daily basis that you and your office TEAM are confronted with difficult situations that may leave you in that paralyzed anxious state. Whether it is a patient angry for waiting too long or an insurance company not authorizing a needed test to diagnosis a patient, your TEAM member will have to deal with the situation at hand, seeking the best possible result. As the leader in your office, you should develop and reinforce on a regular basis a culture of always delivering a positive action response. An important part of your office culture should be to always accept responsibility when one makes a mistake. Most people see through insincere and fake apologies, which just add fuel to the heightened fire with them already being angry. Statements such as these will surely irritate a patient: “I’m sorry you are so sensitive”, “I just started and do not know”, “Sorry we are so behind with our schedule, this is always a problem here,” and “I am having a bad day today in the office.”

It is well worth the investment in time and effort to write a protocol manual making it clear and simple how your TEAM members respond to the most common questions especially those from an angry patient. Discuss the importance of what is said to patients at an office meeting emphasizing that a patient’s perception is their reality. Come up with best ways to respond to patients contrasted with bad responses. For example, instead of saying, “I do not know, sorry” say, “Good question, let me find out for you.” Replace the phrase “You should have” with “Will be better for you next time to do…” We cannot emphasize enough the importance of taking action when reading articles like this one to discuss this topic with your TEAM, create written protocols, train, practice and revisit this topic on regular intervals to be sure systems remain. And let’s not forget to recognize, reinforce, and reward a job well done.

 Conflict resolution with a disgruntled patient is a great example of how to harness the creative power of adrenaline. There are three questions to ask to help you deal with conflict with patients. As you use them, you will begin to see the dynamics of conflict unfold. With practice, you can begin to understand how conflict resolution works, what to look at and ignore, as well as where resolution possibilities may be hiding. 

Question #1:  “What has happened that has caused you to be upset or frustrated with this situation or me?”  The goal of this question is to capture what is wrong, why the patient is upset, and what happened. Your tone is important. It must be inquisitive. You may think you know what is going on, but until you hear it from them, out of their mouth, you can’t be sure. 

This question gives them a chance to vent. They could get very angry and yell, “You only want me to come in so you can collect addition co-payment. Give me my test results over the phone, so I don’t have to come in.”  You could immediately respond with, “OK,” and the irate patient would, in all likelihood, tell you off anyway, letting you know how unreasonable it was to even ask them to come in. 

Question #2: “What are you asking me to do?”  This is the critical turning point of every conflict. While it seems innocent enough, what you are doing here is huge. Here is why. 

Conflict has a temporal orientation. It has a past, a present, and a future. Only the past and the future can be negotiated. In conflict, everyone drops into negotiating the past. Negotiating the past always creates defensiveness. Then, people get stuck in the past without progress. 

The little secret about conflict you need to know is that all resolution is future oriented. To get to resolution you have to return to the future. The second question does just that, moving the discussion out of the past and into the future. If you understand how conflict works, you know this is where the conversation needs to be. So, let patient vent a little, then ask question #2. “What is it you are asking me to do?”  “I want you to….” Remember what he said?  “…to give me my test results over the phone.”  Don’t do it! 

Most people believe the solution would be to give the patient what he is asking for. Remember, this was the proposal coming out of his single solution mindset. Typically his single solution ends up hurting you and helping him – right?  So what do you do? 

Instead, ask the third question: “How will getting your test results over the phone help (benefit) you?”  The answer to this question launches you into the world of resolution. There are many possibilities in this situation, and more than just the obvious two: give in or lose the patient.

Question #3 is the benefit question, and it reveals two parts: a benefit to them and a benefit to you. Now, you never have to use the word benefit. There are many ways to word and explore this realm of resolution. You will need to practice asking it. The answer to question #3 is the beginning of what is called “need exploration” and negotiation.  

A final step can make your office TEAM shine bright as you reveal what you and your TEAM’s needs are in this situation. For example we say to the patient, “Mr. Irate Patient, is there anything I can do to improve your trust of me?” The person may respond, “Yes, you can give me my test results over the phone and save me some money!” You close with, “Well, that is definitely a possibility. I’m wondering, however, how does saving you a co-pay increase your trust in me?  Is this more about trust or about money?”

The key to the resolution lies in benefit to both to you, the doctor, or there is no real reason to consider doing what Mr. Irate Patient is asking for, especially if his proposal is coming out of a single solution mindset. In fact, a single solution mindset is the very reason not to do it. Try something like: “Having your trust in me, Mr. Irate Patient, is important to me and would help me do my job as your doctor. It is not clear to me, how saving your money helps me as your doctor.”   By doing need exploration, on yourself and on the patient, you have a clearer idea what will work and why. The number one benefit of need exploration is that it gets you beyond the single solution mindset, beyond the limited two option lose list, and into untold possibilities of creativity for solutions. With multiple options (more than the two) you increase the chance of finding a resolution (not just the only solution) that will satisfy both your needs and the needs of your irate patient.

“My daughter, who picks me up and takes me to my appointments, is having car trouble and money trouble and she is not going to be able to get me to your office until the end of the month. I cannot wait that long to get my test results and the treatment you are prescribing.”  You may hear, “My funds have run out and I have a cash flow problem until next month. I cannot afford to come into your office because of the co-pay issue.”  Or “I don’t trust you and think you are being greedy.”  Note the answer to the benefit question raises new questions and gives tangible examples—all that gives open dialogue for resolution.

You have a choice how to use the adrenaline. You can make it into flight response or convert it into fuel for positive action. Adrenaline is the ultra-mental lubricant that greases your gears, sharpens your senses, and makes you more effective. The next time that you are in a state of anxiety and out of your comfort zone, think of how you can use fear as fodder for heightened awareness. The choice is up to you. As President Truman said, your office TEAM can shine when they work to "Turn lemons into lemonade." We have learned and always reinforce for the office TEAM that like in baseball and being to hit on best pitcher, if you can make the toughest patient happy the rest will be easy.

Finally, you need to always to ask yourself what's the worst that could possibly happen if you are turned down or don’t know the answer to a question?  It's almost always not as terrible as what you envisioned while you were in your adrenalized state of fear and anxiety. The rejection is usually not personal or related to you. The rejection usually means that you have not provided with the other person(s) enough reasons to follow your lead or your recommendations.

Avis rental car company had a campaign many years ago with the message that the customer was number one. To have your TEAM be most loyal to your office, patients, your mission and convert fear into adrenaline, it is time to make your TEAM number one. Research consistently shows that staff satisfaction extends far beyond how much you pay them. There are many opportunities to do little things that mean so much. On your TEAM member’s birthday, mail a birthday card with personal note to their home with 1 one dollar scratch off lottery ticket for each year they have worked in your office. For no particular reason, hand out a small gift certificate to each TEAM member or a movie ticket. Do this in front of patients and it gives you an extra bang for your dollar. Find a book that is a simple read with a powerful message and buy one for each TEAM member

Bottom Line:  It’s okay to feel anxious as you approach a situation that may be stressful. But if you can harness that anxiety and use it to enhance and escalate your dialog, discussion, or presentation, you can be sure that you will boost your connection with that colleague, administrator, or audience.

*P.S. If you answered no to all of the above questions, please contact us because we want to be more like you!

Hal Ornstein, DPM and Neil Baum, MD