Physician communication using the tools of a trial attorney [PODCAST]

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“For twenty years, I defended doctors when they were sued, and now I coach female leaders from all industries on how to advocate for themselves and their potential with the tools of a trial lawyer. I know that when doctors are exhausted, distracted and powerless they’re more likely to be sued. They’re also more likely to burnout, less likely to enhance the patient experience, and more likely to have complications. And I know there is another way.”

Heather Hansen is a communications consultant and attorney.  She can be reached at Heather Hansen Presents.

She shares her story and discusses her KevinMD article, “When telemedicine leads to burnout.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Heather Hansen. She is a communications consultant and attorney, and she wrote the KevinMD article “When telemedicine leads to burnout.” Welcome to the show.

Heather Hansen: Thank you so much for having me, Kevin. I’m really excited to contribute to your enormous wealth of knowledge and to be here chatting with you today.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Heather Hansen: Sure. I am a trial attorney. For over 20 years, I’ve defended doctors, hospitals, and nurses in medical malpractice cases. My family makes fun of me because they say I think I’m a doctor, especially. The majority of my work just happens to have been obstetrics and orthopedics; we could talk about why that is. But I do think I could perform knee replacements and deliver babies, for sure. I’ve loved doing that. It has been my passion for many years.

Over the past five years, I’ve started a business where I help people, primarily doctors, learn how to advocate for themselves, their treatment plans, their teams, and their patients using the tools of a trial attorney. That means a lot of keynote speaking, a lot of consulting, and some coaching, and I’ve written two books, and I have a podcast of my own. So, a little bit of everything.

Kevin Pho: So, a lot of physicians, we have some communication courses in medical school, but we don’t necessarily have the training of a trial attorney. What do you find are the most common things doctors are missing when it comes to your communication skills?

Heather Hansen: I think it’s the curse of knowledge, and I’ll explain what that is in two different ways. First of all, I’ll describe the curse of knowledge. The curse of knowledge is when you know something so well that you forget what it’s like not to know that.

A good example is the word osteomyelitis. If, in their opening, the opposing side gets up and starts telling the jury about osteomyelitis, I know I’m already winning, because the jury doesn’t know what that is, and therefore their minds immediately. There are some studies that say that if you say one word the jury doesn’t understand, they don’t even hear the next 10 words you say. Their minds start running on “What is that word?” I told these lawyers, “I’m not smart enough for this. I don’t know anything about medicine.”

Doctors do the same thing. They know these terms so well that they forget what it’s like not to know them. Recently, the AOS tried to rewrite their website to make it more accessible to patients, and they found that it was still written at a ninth-grade level, whereas the best level to write something like that is the third- or fourth-grade level. So, for doctors to unlearn all of those words and to recognize that, especially for young doctors, they don’t have to use those words in order to appear intelligent to their patients, that’s number one.

The other part of the curse of knowledge is they forget what it’s like to be a patient, even though they are patients. They forget that even though you might perform a knee replacement five a day, every day, for this patient, it is their one and only. So, to talk to them and to describe it for them and to interact with them from their perspective, those two things can completely change your relationship with your patient.

Kevin Pho: So, tell us the story, or give us an example, of how you coach a physician on how to address this curse of knowledge and better communicate with the patient in the exam room.

Heather Hansen: Well, there’s a great exercise that I usually have them start with, and the listeners can do this themselves when they get home or when they’re talking to someone else. You want to snap five times with your dominant hand and draw a capital E on your forehead with your finger. When you do that, Kevin, you’ll notice that there are two ways you can draw that E. You could draw the E facing the other person, so that they can see the E, or you can draw it facing yourself, so that you can see the E. Studies show that the more powerful we get, the more likely we are to draw the E facing ourselves, the more likely we are to see the world from our own perspective. Just that exercise allows doctors to start to recognize that there’s more than one perspective.

Then a lot of it is catching it in the moment, so that when a doctor says something like osteomyelitis or necrotizing fasciitis, I’ll stop them and say, “What does that mean? How can we see this interaction from the patient’s perspective?” You know, I also do work with corporations like LVMH and Stryker, and we talk about the customer journey. Seeing the patient’s journey: Where are they going next? What might they be concerned about?

The more that we can work on seeing things from other perspectives, the better we get, and much of that is practice. When you work with a coach, a coach helps you to see things that you don’t see. When I do my trainings, they’re often a continuation, whether it’s by podcast or something, because some of this is repetition. But overcoming the curse of knowledge, seeing things from another’s perspective, is really, for me, the foundation of compassion, which is one of the five core competencies of an advocate.

Kevin Pho: All right, let’s transition into the KevinMD article that you wrote. It’s titled “When telemedicine leads to burnout.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Heather Hansen: Yeah. I coach with a woman who’s a female physician, and I know that she has been, like many of the people I coach with, experiencing increased levels of stress, anxiety, and burnout, especially now in this pandemic era that we are in. I read an article that’s cited in my article that said that women and new employees are struggling the most with Zoom fatigue. The articles seem to think that it might be a situation where women are constantly judging their appearances and by constantly seeing yourself on screen.

But when I said to my client, as she was telling me that she’s on Zoom not just for her interactions with her patients, but also administrative meetings, educational meetings, she’s on Zoom much of the day, I asked her whether she ever asked whether they could do it by phone, not so much telemedicine, but some of the others, and she said it hadn’t occurred to her. So, I wrote that piece to talk about the fact that choice is another one of the core competencies of an advocate, and you do have choices.

Now, I recognize that some insurance will compensate for Zoom visits or televisits and they won’t compensate for phone visits, so I know that the choices may not be as broad as we would like. But I think that once we recognize that we do have a choice in almost every moment, it gives us so much power and freedom. So, that article was a little bit about telemedicine and the impact it is having and continuing to have on our mental health, but also a lot about the power of choice and recognizing that we have a choice in every moment.

Kevin Pho: I think what you said was very powerful. I think a lot of physicians don’t realize that they have choices, and that is one of the reasons that leads them to burnout, especially not only with telemedicine, but being told what to do, being told that they have to adhere to these certain regulations, being told that they have to do this stuff by administrators who don’t necessarily have a clinical background. How do you coach physicians in terms of asserting themselves that they do have choices? Because a lot of physicians don’t feel that way.

Heather Hansen: As I mentioned, I keep talking about the five core competencies of an advocate. They are choice, compassion, creativity, curiosity, and credibility. With each of these five C’s, I talk to my clients about their jury, and I’m putting air quotes around this, because in the courtroom, I have my jury of 12 people who decide whether or not I win. But you have your juries, too. They’re your patients, they’re your administrators, they’re your nurses, they’re your partners at home. They might be your kids, if you’re trying to get them to eat their vegetables.

I also talk about an inner jury, which is the part of you that chooses. If all that you feed that inner jury is a voice that says, “You don’t have any options. You’ve got to do as you’re told. This is just the way it’s done. You don’t have a choice,” your inner jury has no choice but to believe that. So, part of what we do in our work together is to give voice to another attorney in your head, arguing for “You do have a choice. Let’s be creative about this. Let’s see things from the administrator’s perspective, so we can use some compassion and then come at it that way, create some evidence, and really start to advocate for ourselves.”

I recently interviewed Dr. Alexander Vaccaro, who’s the president of Rothman Orthopaedics, for one of the podcasts I do for one of my private clients. He talked a lot about the need for autonomy in medicine. It’s exactly as you just said, Kevin. Doctors feel like they don’t have autonomy; they don’t have choices. The first part of being an advocate is always advocating to your inner jury, so that you can start making the choices that will serve you and therefore your patients.

Kevin Pho: So, walk us through that. How do we advocate to our inner jury? Can you tell us a story or an example where a physician successfully did that?

Heather Hansen: The reason that I recognized that I had a superpower in teaching people how to advocate was because I did it in the courtroom, right? So many of my doctors that I took through trials would often think, “This is going to be terrible. This is the worst thing ever. I’m never going to make it through this trial.” So, again, I bring it back to: They had that negative attorney in their head telling them this was the worst thing that they’ve ever experienced, and there’s nothing to be done with this.

I’m in Philadelphia. Philadelphia juries have a reputation for being difficult for doctors. It’s one of the worst places for doctors, according to some studies. The doctors know that, so the negative attorney in their head was telling them that as well. So, part of the process is me explaining to them that this is actually also an opportunity. It’s an opportunity to tell their story in a way that the jury is going to understand. It’s an opportunity to have the patient who’s in the courtroom hear that story as well. It’s an opportunity to become a better advocate, a better communicator. One of the things we found is that when doctors were represented by me, they went back to their practices and got better HCAHPS scores, better outcomes, even less burnout, all of these things, because they became better advocates.

So, we had to give the positive attorney a voice, and we would do that for the littlest things. If the doctor was having a negative voice in their head that was saying, “You’re going to be a terrible witness,” then we would start to collect evidence and tell the story of all the ways in which that doctor could be a phenomenal witness. First, you’ve got to recognize that those voices are happening, and that’s where a coach or a trainer helps, because someone from outside your brain tends to see, you know, you’re only thinking one particular way. Then it’s just a matter of collecting evidence to support the other side.

One last thing that I ask my doctors to do is to create an evidence journal. If they’re having a negative, repetitive thought that the administrators at their practice are never going to put systems into place that they want them to put into place, I will ask them to start creating evidence and writing it down of the opposite, so that the administrators might put this thing into place. We collect things like: They’ve done it before, they’ve been creative before, they’ve been receptive to the doctor’s arguments before, other doctors want this thing as well. Sometimes it takes time, but these changes do happen, so that at the very least, your inner jury, the part of you that chooses, has a choice. Because otherwise, you just go through your days like a cog in a wheel, thinking that medicine has completely given up on you as an autonomous physician, and that just isn’t true. But it becomes more true if we think it’s true.

Kevin Pho: We’re talking to Heather Hansen. She’s a communications consultant and an attorney, and she wrote the KevinMD article “When telemedicine leads to burnout.” Heather, I’m going to take us back into the exam room. I’m a primary care physician. What would you say is the single biggest piece of advice you give to doctors in the exam room to better connect with their patients?

Heather Hansen: I can’t overstate the power of tone of voice. It sounds crazy, but if you want to look at the work of Wendy Levinson, she has done a ton of work on this, and I first learned of Wendy Levinson in reading Malcolm Gladwell’s book Blink. There, he talks about one of her studies where they recorded conversations between doctors and patients, took out the words, Kevin, and played just the tone and the tenor of that conversation to the researchers. The researchers could predict with something like 90 percent certainty which of those doctors had been sued most often. Tone of voice.

There’s a Yale study that tells us that you can tell more about a person’s emotional state from their tone of voice than from their facial expressions and their body language combined. So many doctors that I work with will say, “Well, how do I? I can’t control my tone of voice, right? It’s high, it’s low, it’s bad.” But you can, with your energy and your breathing, make a huge impact on your tone of voice.

So, if before you step into that room, Kevin, you take a deep breath, maybe count down from five to one, sort of ground yourself in your body, and think of something that makes you smile, because a smile is proven to change your tone of voice, and you walk into the room with that. I hate the phrase “fake it till you make it,” but I like “show it till you grow it.” You show that little bit of happiness to your patient as you walk into the room, in your tone, in your energy. The patient will feed off of that and show you some back, and now all of a sudden, you are both starting to bubble up with more and more of that. So, tone of voice, being aware of yours, reading the patient’s, that in and of itself can change everything.

Kevin Pho: And my final question: What are some of your take-home messages you want to leave with the KevinMD audience?

Heather Hansen: I think that the message for everyone, but especially doctors, is that you are your own best advocate. You know, in the courtroom, my doctors, nine times out of 10, would say, “I wish you could testify for me.” Sometimes I did, too, because I knew that I could answer these questions more easily, because it wasn’t me. But the jury doesn’t want to hear from me. The jury wants to hear from the doctor who laid hands on the patient.

In your lives, your juries, the people that you want to persuade, they have to hear from you. No one has your experience, your talents, your passions. No one knows what you want and need the same way. So, my best piece of advice is to know that you are your own best advocate, and then just get better at it. It’s a skill, just like all the skills you learned in law school. I have created a three-year residency program with a health care provider for residents to learn these skills, because they are skills that you learn.

Kevin Pho: How can people reach you?

Heather Hansen: Oh, sure. The name of my website, my company, is Advocate to Win, so you can find me there with all of my things. My podcast is called The Elegant Warrior, and I have a book called The Elegant Warrior and a book called Advocate to Win. So, those are all the ways.

Kevin Pho: Heather, thank you so much for sharing your time and insight, and thanks again for being on the show.

Heather Hansen: Thank you for having me.

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