Are You a Bad Apple? 5 Steps out of The Crab Apple Funk

Much has been made of disruptive physicians, giving birth to “code of conduct” booklets that are required reading for physicians, as well as special coaches that help deal with physician behavior.  In my career, I have met only one disruptive physician, a neurosurgeon who was so dismissive and rude to the staff that I felt embarassed for my profession.  However, I think you may recognize some of the other ‘bad apples’ that can make the work day miserable.  You may even recognize yourself.  We all lapse in to ‘funks’, but if you are see yourself here consistently, time to work out a strategy to change from crab apple to golden delicious!

Types of crab apples:

The jerk: this physician delights in being critical, with out offering concrete suggestions on improvement.  Frequently condescending and short  (rude?).  Favorite comment, “Those ED docs are just sieves, man.  Why don’t they take two minutes and actually think?!”  (Heard last night, during my shift.)

The slacker: looks for as many ways as possible not to do the work.  Finds excuses on why tests and procedures can’t possibly be done.  At one institution where I work, if a particular cardiologist is on call, we all wait until the next day (if possible) to request a consult so we will get a different physician.  This particular cardiologist is famous for writing, “anti-arrythmics per hospitalist team.”

The depressive contrarian:  finds as many ways as possible to tell you that something won’t work.  Is so focused on what is wrong, doesn’t see what is right.  Guaranteed to make you feel as grey as a thunder cloud.  Chief sport is complaining. 

So what is to be done?

Here are steps to golden applehood:

  1. Practice optimism.  Before bringing out the sixshooter to gun down any thing remotely positive, try and think in terms of positive outcomes and solutions.
  2. Be civil.  We have lost much in the way we talk to each.  As your mom said, “If you can’t say anything nice, don’t say anything at all.”  Say please and thank you, don’t interrupt, and pretend to be Emily Post, even just briefly.
  3. Be honest, but not brutal.  Stick with the facts, and don’t embellish with emotions.
  4. Listen actively.  Listen much, talk little.
  5. Focus on  doing the right thing, rather than being right.
  6. Don’t be afraid to seek professional counseling.  Why go through life miserable?

Resources: Bad apples and Anger Blog.


And Now A Little About Me: How ExtraMD is Weathering the Financial Crisis

If only I could get paid for worrying!  I was up last night at 1:30 am, worrying about my company, ExtraMD.  I formed ExtraMD five years ago, when I left the large hospitalist group I was working for.  The hospitalist group was (and still is!) made up of intelligent, caring physicians.  I earned a nice salary, got regular bonuses and had excellent benefits.  I left because, with a young daughter, I wanted to have greater control over my time.  Exit the benefits, nice salary and bonuses.  Enter flexibility and a steep learning curve with respect to business.

I consulted an attorney, created my company, got a designer to make up brochures and business cards and declared myself in business.  I would eagerly check the emails of my new business email, waiting for work.  I was studying to recertify my boards, and so was glad to have some extra time.  I was thrilled when I got my first free lance job, working for anther hospitalist group.

I realized that the jobs weren’t just going to pour in, so I decided to market.  One of my friends is a rep for a pacemaker company, and he suggested I try the “lunch with the doc” approach.   I dutifully called several offices, got their lunch orders, and, on the appointed day, would show up with the food.  I was lucky if the physicians at the office would even come talk to me.  The office staff was always glad to see me and consume quite quickly what ever offerings I had, leaving me to clean up the office lunch room.  I did get business that way, but hated doing it.   The final straw came when I was asked to bring lunch for THIRTY.  I complied, and the office staff barely said hello as they chowed down, chatting amongst themselves as I sat alone.  The physicians never showed up.   Offices didn’t care that I wasn’t a big fancy drug company, they just wanted free food.  End THAT strategy. Besides, it was so darn expensive and time consuming.   Not to mention how it made me feel!  I now have great compassion for drug reps.

I had already sent out masses of introductory letters and brochures, and got only one job that way.  I decided to try a different approach, and created a post card mailing with snappy color graphics.  I laboriously created a postcard on Publisher, and printed it on my trusty home printer.  I created a database of local physicians by website mining, then printed out labels and got my baby sitter to stick them on the post cards.  This approach got people’s attention, and I started getting more work in primary care and urgent care, which was what I was after.

ExtraMD grew by word of mouth, post card mailings, and ads in the local medical newsletters.  Soon physicians started approaching me to work for my company.  We have grown so now there are 6 physicians, providing “local locums” service through out the metropolitan area where I live.  In the past 4 years, ExtraMD has always had more work than it could handle, and has actively been recruiting physicians.   We now have a controller, a board of directors and a virtual assistant.  Things have been going on swimmingly, with steady growth in revenues and profits.

Until this past October.  Which is why I am up worrying about “my people”.  More in the next post.

Enter the YOUR plan to improve your practice and win an Amazon Gift Card!

See the December 29 post and enter your practice’s goals for 2009.  Include a plan by which your will achieve the goals.  The best plan wins a $15 gift card from Amazon.

How Did I get Here from There?

I started out at age 5 wanting to be a doctor, and so that is what I became.  However, it’s not what I expected.  I thought I would save the world, but am not really sure if I have saved anyone.  I have learned that medicine is really a business, and will use this blog to explore my transformation as I try to figure out how to be a physician AND a business person, and hopefully have fun and save the world at the same time!