Lessons Learned from a Seasoned Novice

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…Lessons learned from a “seasoned novice.”

Background: I have practiced clinical gastroenterology since 1990. In 2001, I accepted a part time position at a community non teaching hospital as “Physician Informaticist.” A committee was formed to pilot CPOE. It was a slow process as acceptance and adoption were low. In 2005, CPOE was deemed “mandatory,” but usage data were still below 50%. By 2007, the percent of orders entered by CPOE increased to 70%. In 2009, we migrated to the vendor’s new platform and underwent a “Big Bang” conversion- specifically 11/3/09 at 7 am! CPOE usage is now hospital wide with rare exception. Observing behaviors over the past decade has been quite instructive, and I would like to share with you what I have learned and welcome others’ inputs from their experiences.

1. No need to respond to every comment – people appreciate your undivided attention, not being interrupted and having your “ear.” Many providers like to blow off steam and feel better after they vent frustrations. Active listening is an art form.

2. Physicians love to complain at nursing stations especially when they have an audience. The more the merrier- other physicians, nurses, ancillary personnel, students, etc. Try to remember #1, but it is even more difficult here.

3. Isolate spills—if the conversation in #2 becomes loud, heated or adversarial, do your best to move the conversation to a more private venue with a smaller audience.

4. Travel in “packs”—this applies to support during major go lives. Rounding on units alone makes you more vulnerable on many levels. When traveling with multiple experts or super users, you may be more likely to furnish an answer to urgent issues.

5. Don’t promise what you can’t deliver. A common question- “I can’t believe the system can’t do _______. What is going on here???? Consider, “Thank you for the great input, I will take this back to the team.”

6. My wife came up with this idea—if a physician is screaming at you, imagine him or her in a playpen shaking a rattle. All of a sudden, you don’t feel angry or threatened—but make sure you don’t laugh. If you do, you’re on your own.

7. Most physicians who have yelled at me, called me within a week to apologize-often within hours. Try not to argue. For further information, see #1.

8. Information technology personnel are people too. They are often criticized and seldom praised. Invite them to your presentations and praise them publicly. Let the audience see they are human.

9. Give out your cell phone number. The help desk’s toughest customers are physicians, and physicians like to speak with physicians.

10. Physicians sometimes go “over your head” and speak with administrators in the “C suite.” Don’t take it “personally”… take it “professionally.”

11. See #1

12. Many practitioners are nice, patient and appreciative. Don’t forget to thank them. They can be inconspicuous, but they are there!

13. Make house calls and office calls. Spending time with providers in their own environment is much appreciated.

14. To be continued….!


Submitted by Jonathan Sternlieb, M.D., F.A.C.G.