Deciding to be a physician when I was in fourth grade was a natural choice. I loved science and animals. The natural world was my playground. I remember getting my acceptance letter from Baylor College of Medicine and thinking, I can realize my dream of being a small town doctor.
I entered medicine school with a sense of mission, a sense of humor, and a sense of optimism.
Four years later I graduated wondering if I would be a Good Doctor, apprehensive and saddened by the suicides of two medical student friends.
I completed a residency in family medicine, well trained to be a country doctor – but also scarred by all the experiences: being pimped (a term of art for a specific kind of bullying)[1] by attending physicians, seeing death up close, and being trained to have The Answer.
In a random sample of recent college graduates, those headed to medical school are happier than the average. Four years later many of them have moved into depression. In one meta-analysis, published in the Journal of the American Medical Association, “the overall prevalence of depression or depressive symptoms among medical students was 27.2%, and the overall prevalence of suicidal ideation was 11.1%. Among medical students who screened positive for depression, (only) 15.7% sought psychiatric treatment.”
I believe those percentages are low.
Throughout my career, I became involved in nearly every aspect of medical care – office family medicine; emergency medicine at a ski resort; turnaround implementer in a failing occupational medicine clinic; a medical device startup; the Federal government as both political appointee and career Fed in two different Departments; a medical communications company; and a medical insurance quality organization. Everywhere, I saw the consequences (we physicians might call them sequelae) of the missing parts and overwhelming pressures of the standard education of physicians.
While at the US Department of Health and Human Services I began looking at telemedicine, a way to leverage technology to bring medical care outside the traditional locations to see clinicians – hospitals and offices. I realized the technology was easy. Implementing its use was hard. Hard because of personalities, hard because becoming an effective leader or manager takes time and hard because we physicians aren’t trained to manage people. We’re trained to give orders (I even wrote an book that included the challenges: Telemedicine and Telehealth: Principles, Policies, Performance and Pitfalls.)
During my tenure at the Veterans Health Administration I observed over and over the results of not listening to all involved, of not acknowledging others’ suggestions (whether or not you followed them), and of trying to implement change from the top down. VA shut down BearingPoint’s Core Financial and Logistics System (Core FLS) after taxpayers paid $278 million. It’s easy to point fingers. It’s harder to sort through systems issues that guarantee failure. And you need folks in charge who are seasoned, expert leaders—but that’s not one of the subjects of medical school.
My journey from clinician to manager and leader was fraught with missteps, anger and confusion, as shared in “The Essential Difference between Managing in Medicine and Management in Business.” According to Google’s research, the most important skills are not generally taught in medical school: the most important characteristic of their best teams is emotional safety. That’s right – no pimping and no bullying. Both actions are embedded in medical student education, residency training, and the Republic of Medicine. STEM (Science, Technology, Engineering and Math) knowledge is the least important individual characteristic for those in the best teams.
From the selection process through success in medical school and residency, test scores in science and performance on rounds (the herd of physicians, fellows, residents, interns and medical students that go from patient to patient on hospital wards) are rewarded. We teach what we learn, and systems tend to reinforce themselves – unless you add something to help them find a new equilibrium. So Jack Penner, a Georgetown University School of Medicine student and I began coaching as a method of teaching and supporting the personal and leadership learning which has been missing for medical students. We created and implemented A Whole New Doctor, a program to provide pro bono coaches for medical students.
Jack and I created A Whole New Doctor as an experiment with the strong hypothesis that providing coaches to medical students would make a difference in their lives (like providing coping skills and reducing pressures that lead to depression or learning how to engage in team leadership and mindset shifts). I moved from coaching physicians to including medical students because I believe the effects of skills in reflection, polarity thinking, and creating common experiences will not only make their medical education more effective (and more bearable) but will also multiply as the students move through their medical careers.
This issue and the next issue of The Future of Coaching are all about that experiment and experience: what happens when you introduce coaching to physicians and to the field of medicine. Atul Gawande wrote an excellent piece advocating coaching in The New Yorker. Harvey Finkelstein, COO of Shopify, wrote a guest piece in Forbes, “My Dirty Little Secret: I Have an Executive Coach.” Eric Schmidt wrote “Best Advice I Ever Got: Hire a Coach” in Fortune. Bill Gates spoke on “Everyone Needs a Coach.”
The Republic of Medicine has been slow in joining other industries to implement coaching. Our culture tends toward Blame and Shame, as in pimping, mentioned above. During my residency there were three rules:
- Keep your mouth shut,
- Don’t make excuses, and
- Never, NEVER argue with an attending.
More recently, here’s a paragraph from an email from a Surgical resident with “Greetings med students” in the subject line.
Rounds: if any attending is talking, shut up. Don’t contradict them or a senior resident. Offer info outside of the room to the resident and speak to the attending only if directly addressed. Our program is more casual than others in terms of hierarchy, but it’s still there. When in doubt, keep your mouth shut.
In this and the following issue, we’ve asked physicians who coach, coaches who coach physicians and physicians who have been coached to share their experience. We’ve also included brief essays from some of our Fellows – the medical students our coaches are coaching – to show you, with Fellows’ and coaches’ permission, the effects coaches are having on medical students.
As you will read, the early returns on A Whole New Doctor are strongly positive. In spring 2018 we will hold our kickoff workshop for Cohort 4.
And I have found my passion, my purpose, and my mission, rolled up into coaching and teaching. I am bringing more of the country doctor to my profession.
What is to Be Found in this Issue of Future of Coaching:
Read Sally Ourieff’s “Coaching in the Upside Down World of Health Care” for the backstory and tutorial on coaching physicians.
Read Joy Goldman and Petra Platzer’s “Meeting Clients Where They Are – the Adult Development Coaching GPS” for practical tips on coaching anyone.
Read Lubna Maruf’s “Impact of Medical Student Coaching in A Whole New Doctor” for a coach’s view on our medical student coaching program, A Whole New Doctor.”
Cliff Keyser and I wrote a how-to article on using Polarity Management to help your clients. And yourself. [Link our polarity article to Polarity Management.
One of the co-editors of this magazine (Bill Carrier) wrote about a phenomenon we see all too often in health care (and many other types of institutions): good judgment hardening into judgmental thinking. There are terrible sequelae for teams and personal relationships, — not to mention patient care.
I wrote “Develop a Coaching Culture” with four easy steps.
Learn Jack Penner’s (2018 Georgetown University School of Medicine graduate) experience with coaching, “The Power of ‘What Else?’”
Emory Buck is a medical student who offers her own experience as A Whole New Doctor Fellow in her essay “On Coaching and Self Care.”
For a compilation of articles by Nilesh, Cooper, Elizabeth, David and Greg, five of our A Whole New Doctor (medical student) Fellows, read “The Importance of Coaching in Creating A Whole New Doctor.” Tip: bring smiles.
Margaret Cary, MD, MBA, MPH, PCC
Guest Editor
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[1] “On the surface, the aim of pimping appears to be Socratic instruction. The deeper motivation, however, is political. Proper pimping inculcates the intern with a profound and abiding respect for his attending physician while ridding the intern of needless self-esteem. Furthermore, after being pimped, he is drained of the desire to ask new questions – questions that his attending may be unable to answer.” From Grammarphobia