73. How to Avoid Sacrificing Patient Care While Trying to Be More Efficient

00:05 Dr. Ann Tsung Are you struggling to advance your career and sacrificing time with your loved ones because of endless to-dos, low energy, and just not enough time in the day? If so, then this podcast is for you. I am your host Dr. Ann Tsung, an ER critical care and space doctor, a peak performance coach, a real estate investor, and a mother of a toddler. I am here to guide you on mastering your mind and give you the essential skills to achieve peak performance. Welcome to Productivity MD, where you can learn to master your time and achieve the five freedoms in life.

00:52 Hello. Welcome to Productivity MD Podcast, and I am your show host Dr. Ann Tsung. Today I have Dr. Brad Block. He’s a general ENT surgeon and, also, he is partner at ENT and Allergy Associates in Long Island. Also, he has created the podcast called The Physicians Guide to Doctoring. It’s a personal and professional development podcast for physicians. It has over 400 episodes, half a million downloads. And the reason why I have Dr. Block here actually is because—this is specifically for physicians, but non-physicians can probably take away from this too—how do you see a lot of patients quickly in your day, but at the same time, have them love you and feel like they are heard and understood? So, again, Dr. Block, thank you again for coming onto the show. Can you give us a little bit of reason why you created a podcast like that, and how you got down to maybe distilling down the science of how to see so many people, be productive, and be able to have them be seen, feel like they’ve been heard as well? Thank you.

02:00 Dr. Bradley Block So, first, thanks so much for having me on the show. I have really been looking forward to this. I’ve been a big fan of yours for a while, so it’s really an honor to be here. I mean, my podcast, The Physician’s Guide to Doctoring, I created because — so I’ve been at it for over six years now, right, which makes me pretty old in podcast years. I created the podcast that I needed, that I wanted, because I was a big fan of podcasts to begin with. I heard all of these shows that help people with communication. But they were directed towards sales. They’re directed towards dating, executives, leadership, public speaking. But I really didn’t find anything that was directed specifically towards the nuances of the doctor-patient relationship. So I was like, “You know what? I’ll take all this information that’s out there, and I’ll write a book.” And I never did. I never lifted a laptop. Nothing. So I was like, “Okay. I’m not going to do that. That’s not working. What if I write a blog?” Again, I never opened my laptop to type. I was like, “Okay, fine. I’ll just have my own podcast where I can ask those same people the questions that I have.” And so that was the birth of the podcast. Because I saw my partners were able to see many more patients an hour or a day than me and leave on time, what were they doing differently? What was their communication style that I didn’t have? In residency, I was always really slow at seeing patients. So what did I need to bring to the table, and what can I learn from communications experts that I could bring, to help me move faster without sacrificing patient care or maybe even enhancing patient care? So that was the birth of the podcast.

03:39 The problem was, I couldn’t get these experts in front of me without having an established show. I didn’t know any communication experts, but I did know experts. As physicians, we all know experts. They were our classmates, right? Our classmates are all, now that we’re all attendings—at least, at that point, I was—all my friends are experts in whatever their field is. I’ve got friends from college and high school. All these people did really well, are very accomplished. They’re experts in their own right. And so what I started doing is just kind of a general physician interest. This is stuff physicians should know. And so we did episodes on things that people get wrong about, like the Affordable Care Act or higher return on investment advocacy. Right? You want to advocate for your patients or for your profession. How do you do that without investing a ton of time? So those were the first couple of episodes. Then it just exploded from there. But I always came back to my first drive for doing it, which was communication—improving my own communication with my patients.

04:40 Dr. Ann Tsung Got it, yeah. You know, I know a lot of people are spending time charting after seeing patients. They want to be able to sit down, not charting in front of the patients, so they can be present. Then they’re spending time afterwards charting late into the night. So it’s so important to learn how to be productive, be able to communicate, but at the same time get your charts done and not sacrifice your family time for work. Because you’re not getting paid for those charting time.

05:10 Dr. Bradley Block Yes. I mean, you are. You are, right? It’s part of the package. Just like when I do a surgery, the op note, the post-op care, the ‘global period,’ all of that is built for at the same time in one lump. So you are actually getting paid for it. But it doesn’t need to be as inefficient as it is for some people. And so I’ve actually done — I’ve interviewed a couple of people who are charting coaches. They help people get home sooner. And so I’ve learned some things from them that I’ve incorporated into my own practice. For instance, you mentioned the charting. Let’s talk about charting. One thing that people do is they assume just because there are people in the waiting room—and they’ve maybe been waiting for a while—that you should save your charts for later so that they don’t wait anymore. The problem with that thinking is that if you do it while those patients are presumably breathing down your neck, you’re going to be able to finish that note lickety-split. But if you save it for the end of the day, it’s going to be like a gas where it expands into the space that it’s given. And so, if with no urgency, it’s going to take you much longer to write that note. And so it behooves you to finish that note right after you finish seeing the patient. One, it’s fresh in your mind, so you don’t forget about things that you might not include in the note, which is not good for patient care but also not good for billing, right? You might have a billing, a less complex visit, because you haven’t included some things. So it’s good for the patient. It’s good for the visit, and it’s good for the next patient if you mentally close that browser window. So finish that note.

06:41 There are some tools that you can use to make sure that you finish that note. First of all, that tool is your own brain. Just like recognizing that these are the ways of thinking that got you in trouble in the first place, where you had 20 notes to finish at the end of the day, right? So stop thinking that way. Take care of yourself. Fill your own cup first. Put on your oxygen mask before you put on the patient’s oxygen mask, and take care of that note. That’s one thing. Another tool that I use is dictation. I have a dictation software, so I can dictate the note in front of the patient. The third thing that I’ve been using recently is actually an AI scribe. So the AI scribe, I don’t use it for every visit every time, but it’s always there in case I need it. So sometimes what’ll happen is, I will talk to the patient for a couple of minutes. Then I’ll stand up, start examining the patient. I can keep talking to them while I’m examining them, and the AI scribe continues to listen and build that note for you. So even though you’re not sitting and typing it as the patient is talking, it’s still getting recorded. A note is getting created. And so that allows you to move a little faster. But at the same time, you’re still listening to the patient’s whole story. So there are some things that you can use. I mean, that’s just scratching the surface of all the things that I’ve learned to help me navigate even just the communication. We haven’t even gotten into the communication part of it.

08:03 Dr. Ann Tsung Yeah, I think what you mentioned about saving yourself first in a way, it’s doing that note right then. Flow science, neuroscience. Flow science is a cognitive load, a dump. So you don’t have that attention residue from the last patient. So you can actually be present and focus on the next patient. So it’s not just like you’re trying to rush to the next patient, but then you’re distracted by all the notes that you have to do. That’s doing them a disservice in a way. And so work with your biology. Work with your brain. Dump out that cognitive load you have from the last patient into the note. Be done with it. Make your plan so that, later on, they’re not all jumbled together. What AI scribe? I know there are so many. I wonder which one have you tested and which one did you go with? Again, we’re not endorsing any company here. But yes.

08:54 Dr. Bradley Block So, you know, in medical lectures, we always have to give disclosures. I do have to give a disclosure. They did sponsor my podcast. I use Freed.ai. But that’s the only one I tried. I tried it, and I’ve been using it ever since. It happened on a day where like two of my computers were down. My dictation software wasn’t working, so I was like, “Oh, man. Okay. I’m in trouble.” I’ve got all these crutches, and now they’re all gone. All right. And so that’s when I started using it. I’ve been using it ever since. It took me a little while to figure out just how it fit into my specific flow. Right? Just because it’s recording, it doesn’t mean I have to use that note. Sometimes it’s faster for me to just dictate a quick three lines for the history, if it’s a really simple problem, than to have to copy and paste that note and go through it. It doesn’t always work every time. But for the patients that have a litany of complaints, it’s complicated, they’re going through a lot of different stuff, it’s helpful to have that. So you can also focus on them and not on your note taking, right? You can just look the patient in the eye and be present, which is part of the, you know.

09:59 Now we can get into the communication aspect of it, which is being present. So when I was in med school—I’m not sure if they told you the same thing—they said, “Listen. Make sure you’re listening. Patients want you to listen. Listen, listen, listen.” Yeah, you know what? I can type and listen at the same time. I can. I can take the notes. I can even fill out some of the physical exam while I’m listening. I can. But I’m not present, right? There’s a difference. So it’s important to be present. So you look the patient in the eye, and you really listen to their story by being present and undistracted. That means you need to do, like, you know. You talk about productivity in the flow state a lot. Well, being present with the patient, you’ve got to make sure you set things up to be able to do that. One, minimize distractions so that you’re not looking at the news; you’re not checking your email. I mean, the one part about the AI scribes is your phone ends up doing the recording. So you have the app open on your phone and on your desktop or laptop so that it goes from one to the other. That means I have my phone with me, which is a distraction, which is a problem for me, right? So I end up screwing around a little bit when I shouldn’t because the temptation is there. So you got to take away as many distractions as you can, and make sure your staff as well knows that only disturb me if it’s really, really can’t wait for later so that you can really be present with them. Because the minute you have distraction, it takes you away from the moment. It pulls you out of the story. Then you kind of have to mentally reorient. It’s like multitasking is a farce, right? Multitasking is a farce. Yes, you can listen to a podcast and do the dishes because of the minimal cognitive load required of the dishes. But that’s not what patient care is. And so, as few distractions as possible.

11:43 The thing is, you can’t fake that. You can’t fake being present. So the patients pick up on that. They’re less likely to repeat themselves, right? Patients sometimes perseverate. They’ll say the same things over and over. They’re less likely to do that if you’re really with them and present as they’re telling their story. And so, actually, that’s the second step. The first step is the introduction. Sorry if I’m taking off with this and going ahead. The introduction is: you enter that room with enthusiasm. You set the tone, right? They may be not feeling well, but you are so glad they came to see you. That’s the type of enthusiasm that they want. Whether you’re glad or not is beside the point. But you’re going to enter with the energy that you are glad they came to see you today, and you thank them. We take this from hospitality. “Welcome to the Hilton. Thank you so much for staying with us. Thank you so much for coming to see me today.” They could have chosen a number of emergency departments, a number of practitioners, or they could have chosen to stay home, right? But they chose to see you. “Thank you so much.” Okay? So that little shift in the previous power balance is going to help soften them a little bit to the visit and make them more welcoming to new ideas, making them more receptive to healthcare information because you come up. Your cortisol is firing when you’re sick. You’re at the doctor. You’re worried that something really dangerous or scary is going on. So anything that you can do to make it a more welcoming place is going to lower their cortisol level and make the whole visit go a bit more smoothly. So you enter with enthusiasm. You thank them for coming, and you ask them. What would you like me to call you? Then that also addresses if maybe they have a pronoun that was incorrectly put in the EMR. Maybe they like to be called a certain thing. Maybe they have a nickname that’s not in the chart, right? Maybe they want to be called formally. Call me Mrs. so and so, right? So what would you like me to call you?

13:40 Dr. Ann Tsung That’s good. That’s good. Step one. Even though sometimes I’m thinking about in the ER, they would be like, “I have no choice. They just took me here from the EMS.”

13:52 Dr. Bradley Block No. Hey, listen. I am so glad that you’re such a good advocate for your own health that you called EMS. Thank you for being such a good advocate for your own health. Right?

14:03 Dr. Ann Tsung Nice.

14:03 Dr. Bradley Block There’s a there’s an opportunity there. And it takes a second. It takes a second. A lot of the things I say are going to take time, right? But they’re investments in the longer visit, in relationship development.

14:16 Dr. Ann Tsung Yes, I can think of maybe when psych patient’s suicidal ideation came in like a few weeks ago and walked up to the fire station herself, realized had the insight that she was suicidal from hearing these voices. Next time that happens, that would be a good opportunity for me to thank her for having that insight to be able to go to the fire department and to come here.

14:40 Dr. Bradley Block What does that tell her? What does that tell her that her doctor is thanking her for coming in? Like, “Oh, now you’re giving me the ability to take care of you. And if you hadn’t done that, I wouldn’t have that ability. So thank you for giving me the opportunity to help you.” Right? It shifts the power balance, and it makes the visit just go a lot smoother.

15:01 Dr. Ann Tsung I’m going to start using that. That’s a great tip. I think I learned it one time in residency from my attending. Then after that, I actually just stop doing it. Especially in the ICU, being in fellowship, you just get your patients up. It just gets shift up from the ER. It gets shift up from, you know, upgraded from the from regular medicine floor or wherever. You just don’t do that anymore. It’s just like report. You just get the report from other people, and it’s almost like the patient is the third person in the room.

15:28 Dr. Bradley Block Yeah, right.

15:31 Dr. Ann Tsung Acknowledge them. Thank them. Ask them for how they would like to be called, and then being present. Listen, so they feel like you’re actually focused and paying attention to them. Usually, how many steps do we have?

15:44 Dr. Bradley Block You know what? Total? How many steps do we have total? The thing is, I give this talk in a bunch of, you know. I have a lot of different tips, and we’ll see what we have time for. Because we go through the introduction, we can go through some sticking points. We can go through ways of earning trust, right? So there’s a lot of different angles to this, and not every visit requires all of them. You might not remember all of them every single time. You’ve got enough to worry about. You’re trying to actually take care of the patient, not just, you know. You’re taking care of the patient’s medical issues, but you’re also taking care of their psychosocial issues as well and trust building. So I don’t have it in a formal step, like this is the order that you do things, or these are the number of things. Maybe I should though. Maybe I should log it in a more formal way.

16:35 Dr. Ann Tsung Like non-negotiable must-do top three to make the most difference in the interactions. In your experience, was there something that every time you said it, 90% of the time you did it, that it was like I must do this next time? Is there something like that?

16:54 Dr. Bradley Block So one thing is, like, maybe not a non-negotiable but you’ll notice that some visits get hung up on an issue. Where you’re like, “Oh, I figured out their problem.” Great. Now they can go home, but they’re resistant. You haven’t delivered it in such a way that they’re satisfied with this answer. You’re like, “I figured out your problem. Great. Here’s this medicine. Now you can go home.” And you’re stuck.

17:24 Dr. Ann Tsung Abdominal pain but no etiology in the ER. Pan-scan lab is normal, but they still have pain. I think that’s a common one in the ER.

17:32 Dr. Bradley Block Okay. So one thing that you can ask would be, “What worries you about this? What worries you about this problem?” Listen. I don’t have the answer to make this problem go away. We scanned you. We know that it’s not a tumor. We know that it’s nothing life-threatening. But that doesn’t seem like it’s satisfying. You still seem uneasy about this situation. What worries you about this? Because maybe, maybe there’s something that they haven’t said. Because patients are afraid of being judged, right? The doctor is going to think I’m crazy. The doctor is going to think this about me. I’m not going to say that because then they’re going to — this gives them permission to relax a bit and divulge that bit of information that they may have been keeping from you. What worries you about this? And so then, for a lot of our patients, they come in to see an ENT with globus, which is a sense of something stuck in your throat. A lot of them come in because it’s just an annoying sensation, and they’d like to make it go away. But some of them, it’s not that annoying. They just want to make sure they don’t have cancer, and they may not verbalize that. But you by saying, “What worries you about this,” they’re like, “Gosh, doc. You know, my uncle died of throat cancer. I just want to make sure I don’t have throat cancer.” So we’ll do an endoscopy on them in the office, and we’ll have made sure that there’s nothing there. But unless I specifically say those words, I don’t see any cancer. You let me take a really good look down there. I didn’t see any cancer. That’s not something you need to worry about now. That needs to be verbalized. And so it doesn’t apply to every visit. But where it does, it’s absolutely non-negotiable. That phrase is going to get you places.

19:12 Dr. Ann Tsung Mm-hmm. I agree. That’s good. That’s good. I have used it very few times. Because we’re always in a rush in the ER. It’s almost like you want to be sit down, be willing to listen to what they give you. You don’t want to ask that question because you don’t know how long it’s going to take. I’m going to use it though. I’m going to use it.

19:31 Dr. Bradley Block No, but it’s the investment. You’ve got to recognize that some of these are investments to those patients that otherwise are going to end up taking up a lot more of your time, because you haven’t let them say that. Another similar one would be like, “Listen, you had abdominal pain before and haven’t gone to the emergency department.” Everyone gets stomach aches from time to time. What was different about this one that says, “You know what? It’s time to go to the ER.” It’s something similar, similar question, but another way to get that information to help them bridge that gap between the information that they have that they haven’t divulged yet about their problem.

20:10 Dr. Ann Tsung Yeah, you know what? You’re right.

20:12 Dr. Bradley Block It may prevent further visits. It may prevent them from going. Listen. Actually, here’s a different way to think about it. So that the next time it happens, use this information to help you determine whether it’s the appropriate thing to go to the emergency department or not.

20:25 Dr. Ann Tsung Yeah, I think, a lot of times, in terms of asking what’s different about this, or you have this for a whole month or a whole year, why now? That sometimes makes them divulge information, what they were truly worried about, like you said. Because the quality exchange, whatever, whatever, or the family. Anything else that you think is — well, either if there are a must do or a non-negotiable? Or we can talk about top mistakes to not do.

20:56 Dr. Bradley Block Another one that’ll help is, the patients want you to see them for more than just the sum of their symptoms, right? How do we talk about patients? The diabetic in Room 3 or the facial fracture in Room 12. We talk about them as their pathology, right? It’s shorthand. We do it to lift the cognitive load, right? We see tons of patients every day that are complicated, with gobs of information in each of them, and we need to lift the cognitive loads off our own brain. So we do that as a shorthand to make it easy. Yes, it’s a little depersonalizing but it serves a purpose for our own well-being. So we can continue to help them, right? Well, Mrs. Francis in Room 12, well, which one is she? Right? But in order to help us not see them that way and help them recognize that we don’t see them that way is, you identify something on their person that you can ask them about. “Those are really cool earrings. Where did you get them? Oh, you’re an Alabama fan.” Because they’re wearing an Alabama sweater, right, or their hat, or their key chain. You notice something on their person or they said like, “Oh, man. This all started after I got back from my trip.” Oh, where did you go? The worry I get that they’re just going to open up this — it’s going to open up a Pandora’s box, and they’re going to tell you all these information. But most people pick up on social cues. They’ve divulged a little bit of information. That’s enough. They want to be seen as more than the sum of their symptoms. And so ask them something personal about themselves that is readily attainable information, that helps you connect to them. So those little things are really going to go a long way towards that trust building.

22:50 You know, it’s interesting. There are some patients that you see—and I know you do it—in the emergency room where you can come up with the diagnosis in 10 seconds of walking in. You walk in; you know exactly what’s going on with that patient. Right? You know how to help them. You know what lab sort. You know what you’re going to get. You know what imaging study you’re going to get. If anything, you know how to help them, right? So what’s the point of this conversation? What’s the point of talking to the patient if you know exactly what to do? Trust building. Trust building. A lot of the communication that we do with the patients is not just information collection. It’s trust building. And so once you recognize that that is part of the point of communicating, it’s going to help you navigate the process a little bit better. It’s not just information collection; it’s trust-building.

23:39 Dr. Ann Tsung Yeah, and you want to build that trust so that when you give an advice or when you are speaking with patients regarding various options, that you guys are not coming like butting heads against each other and causing terrible experience, causing people to leave against medical advice, et cetera, because they don’t trust you. Sometimes that just happens. I do want to take note that everything you said, whoever’s listening to this, even though you’re not medical, this still applies to whoever you’re interacting with. Maybe you have clients. Maybe you have in the work environment, people, your team, et cetera. They want to be heard as well. They want to be seen. They want to feel your presence. You want to ask them something about their personal, whatever’s on them, right? So don’t just take this and say, “Oh, it’s only for physicians.” Okay. Anyway, anything else or any top mistakes?

24:39 Dr. Bradley Block Yeah, so top mistakes. Okay. Jokes. Jokes aren’t a mistake. Jokes are important. Telling jokes can — we talked about it at the beginning. That cortisol level is elevated. You’re in the emergency department. You’re at the doctor’s office. You’re worried that something is wrong. You’re uncomfortable because of your symptoms, right? It’s going to make it hard to understand complex health information. It’s going to make it hard to be open to new ideas. So maybe your diagnosis that you give them isn’t what they thought it was, and they’re going to have to be open to new ideas. One way to make them more receptive to new complex information or new ideas is to lower that cortisol level. Make them laugh. But there are rules to this. How do you make people laugh appropriately in a healthcare setting? There’s a fundamental rule here. That is: the goal of humor is to comfort the afflicted and afflict the comfortable. Comfort the afflicted and afflict the comfortable. Our patients are, by definition, the afflicted. So the patient can never be the butt of your joke, right? Never punch down, never make fun of the patient, okay? You can make fun of yourself. Self-deprecation humor is fine and acceptable and a good one. Just never make a joke that’s going to erode their confidence in your abilities.

26:01 You want to make a joke about the handwriting. You may want to make a joke about your typing abilities. Don’t make a joke about your surgical skills, or you fumbled the pencil or something like that. Right? So there are some things. You can say a bad joke. You can say, “Hey, listen. It’s a good thing that I am an ER doctor because my comedy tour would not have worked out.” Right? You can try. Listen. The patients come in with such a low expectation of their doctor’s sense of humor, that it only takes a little bit like the classic dad jokes, these corny, not so funny jokes. You just need to get just something, right? But make sure it’s appropriate. The mistake would be inappropriate jokes. Inappropriate jokes would be punching down, right? Inappropriate jokes would be anything like shock humor. It would be inappropriate. You just use profanity or something like that in a completely inappropriate setting. Race, religion, politics—you want to stay away from that stuff, right? You really want the benign stuff, right? You’re sitting there typing on the computer. Say something like, “I’m sorry, this is going to take a little while. We still use dial-up.” Right? “You see that fax machine over there. I think someone’s on the line. They’re using the modem. This is going to be a little while.” Right? You can make silly, stupid jokes, right? It’s not that funny, but the bar is so low. It’ll help to break the ice and help them relax. So the mistake would be one of those inappropriate jokes or punching down. Not okay.

27:33 Dr. Ann Tsung I’m guessing you’ve heard of all these incidents of what not to do. That’s why you’re bringing it up.

27:39 Dr. Bradley Block Well, no.

27:40 Dr. Ann Tsung Which is surprising.

27:42 Dr. Bradley Block You see it online, right? You see a lot of these influencers who make fun of patients, the things that they say and the things that they do, for clout and for likes. It’s not okay. Take for instance the crowned prince of comedy in medicine, Will Flannery, “Dr. Glaucomflecken.” You will never see him punching down. He is always punching up. He’s at the insurance companies, at the healthcare systems. He’s hilarious, but he’s always, always punching up. But you do see a lot of people punching down online, and it is just not okay. It’s easy. It’s easy. It’s easy to make jokes when you’re punching down, when you’re making fun of those who are vulnerable, right? Not okay.

28:24 Dr. Ann Tsung Yeah, I agree. I agree. Anything else? I haven’t really been making any jokes now that I think about it. I need to look at, like make some jokes. Even though in the ER setting, my cortisol is up. It’s probably going to help my cortisol. Because my cortisol is elevated the entire shift probably, all 10 hours. So it’ll probably help me if I laugh a little bit at my own jokes.

28:51 Dr. Bradley Block It helps you enjoy it a little more. It does. It does. It helps you enjoy it a little more. And you’ll end up using the same jokes because you see the same stuff, right? As much as the emergency department, people think it’s like this huge variety of stuff, right? There is a huge variety. But a lot of the stuff that you see is the same stuff over and over and over, which is why you’re able to make diagnoses really fast, right? Because you’ve seen it so many times. You walk in the room and you’re like, “I know what that is.” And so you end up making the same jokes up. You’ll see what gets a laugh, and you’ll see what doesn’t. You’ll end up being able to hone your stick like a comedian on the road. Because the jokes that you made when you did stand up in Milwaukee are not the same as — it’s the same different audience in Cleveland. You have a different audience every five minutes.

29:40 Dr. Ann Tsung Yeah, maybe put a little play into your work, you know. I know so many people in the ER. They’re all burned out. Nobody has time for jokes. Nobody can think of a joke every time a patient comes. When it’s a busy time, it’s just like, “Oh, okay. Next. Can I get a breather?” You know, so I’ll try this out, and I’ll see how it goes.

30:00 Dr. Bradley Block Just little things. Like, “I’m going to need that pen back. That’s my favorite pen.” It’s some disgusting, like, you know, that you got from the Hyatt five years ago. There’s barely an ink left or something like that. Or another one is Dr. Google. Someone looks stuff up, Dr. Google. “Oh, I went to med school with Dr. Google. Yeah, I don’t think he graduated. He tells everyone — I think he’s got a clinic somewhere where he just tells everyone that they have cancer.”

30:28 Dr. Ann Tsung Oh my God. That’s so good. I’m laughing. I’m going to use that.

30:32 Dr. Bradley Block “And I think he sells supplements. He tells everyone he has cancer, and he sells supplements online, I think.” You know, because when people come in, they’ve looked stuff up. For me, listen, it’s fine that they look stuff up. I just always tell them, listen, when you end up looking stuff up when it’s your symptoms, you’re trying to be the doctor. Sometimes you can get it right, and sometimes not. But when you come here and we give you a diagnosis, Google the heck out of that. Google that. Google that, right? Because then you’ll come up with a lot of great information and much less misinformation. So I don’t want the listeners to think like I’m not okay with patients looking stuff up. I am. But it’s still okay to joke about it, right? You’re not making fun of their Googling abilities. You’re just making fun of the fact that anytime you Google a symptom, it tells you you have cancer.

31:20 Dr. Ann Tsung True. True. Anything else that is a mistake, not to make, like definitely not to make that? I don’t know if you have like, let’s talk about like — we talked one. Maybe two more.

31:31 Dr. Bradley Block Another one mistake would be lack of eye contact. We’re so concerned with documentation that sometimes we do it to the detriment of that connection. It’s not that you have to be making eye contact the whole time. Because, as you said at the beginning, it’s important that we finish our notes so that we’re not up all night away from our families and our other goals and our hobbies and our self-care. But you still need to make eye contact. And so in order to avoid the mistake of not making enough eye contact, I recommend that you notice the patient’s eye color. So if you notice the patient’s eye color, you’ve definitely made eye contact. Right? You haven’t had to stare longingly into their eyes, this loving stare where you’re staring all the time, right? It’s just that, if you’ve done that, you’ve definitely made eye contact. Certainly, you should make more eye contact from that. But if you’re someone who tends to stare at their computer a lot because you’re documenting appropriately, just make sure that you look up long enough while they’re talking, while you’re talking. That you at least notice their eye color. That’s a mistake. It’s that lack of eye contact.

32:40 Dr. Ann Tsung Yeah, I think for me, one tactic the listeners can try, I just take quick notes on pen and paper literally when I’m in the room. A pen and paper, real quick. Then I see two, three patients. Usually, maximum two, two patients in the ER. I go back and dictate on the Dragon based on my notes, and I pretty much remember both. Then I go back to see the next two. That’s what I usually do.

33:06 Dr. Bradley Block Would you be able to take a laptop into the room with you so that you can dictate in front of the patient? Would that work in the emergency department? Because it doesn’t always, right? Because you guys are seeing people in the hallway. I know where I used to take call, the hallway became an emergency room in and of itself because they just ran out of space.

33:30 Dr. Ann Tsung Yeah, just clunky to lug around. I can move faster, talk to them. It’s not that long of a note, and I can speak. I have all these smart phrases in Dragon that I can do a note in like two minutes after. In residency, I did do that. I had a little laptop with me. Actually, iPad with a keyboard. That got me so fast. Like see patients, order. See patients, order. See patient, order. I got really fast. So it depends on the system. Of course, if you can wheel something right outside the patient’s room or something, you come out. I’ve seen people come out, do the note real quick, put in the orders and just move on. That’s another way too.

34:03 Dr. Bradley Block Because I find dictating in front of the patient sometimes helps them. Because when they speak to us, they often speak to us in terms of the urgency of their symptoms, not in chronological order. And so they have this completely disjointed story that starts in the middle and then goes to the end and then goes to the beginning and then back to the middle. Right? And so if they hear you dictate it in chronological order, they’re like, “Oh my God. I’ve never thought of my own story like that.” Right? Things can start to coalesce in their own minds a little differently, and they know you were listening. It’s another cue that you were present with them and listening the whole time, right? Because there might have been distractions in there, but them hearing you dictate their own symptoms — then if you make a mistake, they’ll be like, “No, no, no, actually, it started Wednesday. Not Thursday.” Oh, okay. I don’t say it doesn’t matter. It might not be of significance, but there might also be something of significance that you make a mistake with, and then they’re able to correct you because you misremembered something. I mean, yes, you’re taking notes so you wouldn’t misremember. But yeah, it does help them to hear their story again.

35:13 Dr. Ann Tsung Yeah, to make them feel like they have been heard. That’s basically repeating back what you heard. Repeating the question back. Repeating like, “I heard you. This is what you said. It sounds like…” Same concept. That’s awesome. What about the third thing? Is there a third thing that’s never, never do? Don’t just not look at them. We said that don’t make jokes.

35:34 Dr. Bradley Block Make inappropriate jokes.

35:36 Dr. Ann Tsung Inappropriate jokes.

35:38 Dr. Bradley Block Don’t just listen for symptoms. So when you’re listening to the patient, don’t just listen for symptoms. If you do, you’ll get the diagnosis right, the same as you always have. You’ll be able to take care of the patient the same way you always have. But you’re going to miss something. So you’re not just listening for content; you’re listening for emotion. So you listen for emotion. You’re able to then validate that emotion, right? Patient comes to me with vertigo. For all the listeners, vertigo is not a diagnosis. It’s a symptom. It’s the sensation that the room is spinning around you. So if you’ve never experienced it, imagine you’re on a Tilt-a-Whirl, but you’re not on a Tilt-a-Whirl. You’re just standing there and, suddenly, everything starts spinning around you. Right? It’s terrifying. It’s awful. A lot of people just start vomiting. Right? So if a patient comes to me and they’re telling me about their vertigo, I’m like, “Mm-hmm, Mm-hmm, Mm-hmmm. It’s interesting. Yeah. Okay. And then what happened?” as opposed to, “Oh, that sounds awful.” Right? I mean, as I’m saying it now, it kind of sounds performative and a little forced. But that’s because they’re not a person telling me symptoms in front of me.

36:53 The other mistake would be just listening for content without listening for emotion. You listen for the emotion too, and you reflect it back to them. You validate that emotion. Again, these things take a second to say. It just takes an extra second. I know I’ve told you a bunch of stuff, and all of them together are going to take you a whole minute between all of them. One, you’re not going to remember every one of them every visit. I don’t. I have lecture on this stuff, right? So you’re not going to remember it every visit, every time. Not all of it applies every time. But remembering these few things and kind of peppering them into your visits are going to make it, one, more fulfilling for you. Because you’re going to connect more with the patients. Human connection is super important. It really brings some of the joy back into our professional lives when we’re not just thinking of them as the sum of their symptoms. We’re really connecting with them as people. So it makes it a more enjoyable experience for the doctor and, a lot of times, it’ll save you time on the visit. Because they’re more likely to be like, “This doctor is really cool. They get me. They understand me. I’m totally going to listen, take their advice on this.” Right? “I’m not going to resist their advice. I’m not going to push back. I’m not going to quit. I’m not going to move the goalpost, which is a lot of times what patients do. You’ll address all of their concerns, and then they’ll just keep moving and keep moving and keep moving the goalpost and adding more stuff on top of it. And so all that stuff is less likely to happen. You’re going to be more satisfied; they’re going to be more satisfied. In the end, it’ll cumulatively save you time.

38:27 Dr. Ann Tsung Yeah. So it sounds like, as a summary, number one, thank them for coming. Number two, you ask them how they like to be called. And also, throughout their visit, make eye contact with them. Validate their emotions, not just listening for their symptoms. Validate their emotions. Do some appropriate jokes with them. Notice something that’s on them, on their person, and make a comment about that. In general, just view them as human beings and connect with them as human beings—like your family, like your friends—and not just another patient who’s coming through that you have to get through.

39:05 Dr. Bradley Block I’ve had people push back on this advice. Because they’re like, “You should be treating every patient like they’re a family member.” The reality of the situation is, you see so many patients all the time that unless you have systems like these in place, it’s really easy to go through your day and turn it into like a mill where you’re just seeing patient after patient. You’re just trying to check them off your list. So yes, it does kind of sound like you’re forcing some of this stuff. But it’s not that you’re forcing it. It’s just that you’re remembering to do it. You’re sprinkling this stuff in to help with connection. Because if you don’t have these systems in place—these ideas in place of how you can navigate these visits—then you’re not going to do those things, and you’re missing out on a lot of opportunities.

40:01 I just want to add one more thing. I know we’ve talked about a lot today, but it’s one of my favorite things to do. I’ll give you an example. So I see a lot of kids for tongue tie. I’ll see like a five-day-old for a tongue tie, right? They come in. The parents aren’t getting any sleep. They’ve got this fresh newborn at home. It was impossible to make it to their appointment on time. Often, they don’t. But we’ll still see them, right? Because just getting out of the house with a newborn is really hard, right? You know that. They make it to the visit. Whether or not there’s a tongue-tie present, it’s kind of besides the point of what I’m about to say, but that’s a feat in and of itself. And so just putting your hand on their shoulder and be like, “You guys are doing great. You’re doing great. Your kid is doing great. You’re doing all the right stuff. Thanks so much for coming. No, this is not a tongue-tie. It’s blah, blah, blah, whatever. We don’t need to do anything.” Or, “It is, and let’s cut it. It’s a good thing you guys came in. You’re doing a great job.” They feel like they’re doing such a crap job. They don’t know what they’re doing. Patients often feel like that about a litany of things. And so anything that you can do to help their self-efficacy kind of build them up as a person. They’re here to see you as a doctor because they’re here about something that’s important to them, something that they’re unsure about, and something that you’re an authority in. So the juxtaposition of those three things—something important, something they’re not sure about, and something you’re the authority in—makes you very influential. And if you take that opportunity to help build that person’s self-efficacy—whatever they’re in there for, like we said earlier, congratulating them on being an advocate for their own health—but if there are any other opportunities, like someone struggling with managing their diabetes, someone struggling with their medication, someone struggling with something, and you just tell them, “Listen, you’re doing great.” Like, they’re bringing their sick kid in. “I don’t even know if I should have brought him in. I don’t know if it’s the right thing to do.” No. Mom, mom, you’re doing great. You did the right thing. You were doing a great job looking after your kid. Right? How good is it going to feel to say that to someone, and how good is it going to make them feel to hear that? Right? So you’re going to have these opportunities in your life—not necessarily just in the exam room—to improve someone’s self-efficacy, their self-worth. Take those opportunities when you can. The minute you start looking for those opportunities, you’re going to see more of them. It’s an awesome feeling for the person saying it and awesome for the person hearing it. So you find those opportunities and take them.

42:43 Dr. Ann Tsung Yes, that’s very important. I agree because I’ve been on the receiving end of it, actually. I took my kids to the pediatrician. I’m a physician. I was like, “I don’t know if I should go. I don’t want to treat my own kids.” Then my pediatrician was like, “No, you did the right thing. You did great. You’re doing a great job, mom.” I’m like, oh, I feel better.

43:04 Dr. Bradley Block Yeah, because it’s like, you feel you’re like you’re a mess. You’re like, “When was the last time I showered?” You know, I don’t know. Maybe I forgot to bring diapers, so now the kid is soaked in pee. You just feel like you’re the worst. You don’t know what you’re doing. So to hear like, “Actually, no. You’re doing great. You’re doing great.” Take those opportunities and spread the love. We need more of that in the world.

43:29 Dr. Ann Tsung Yes, yes, I’m going to notice more of those. I have not been taking those opportunities, I think, as much as I can in the ER. I’m going to notice more of that. And for those of you guys, if you guys are teachers listening to this, I’ve been on the receiving end as a parent with my toddler child. I went to one school where the teacher didn’t say anything to us. Then we changed schools and the teacher, after a few days, was like, “You guys are doing such a wonderful job with your son.” I’m like, “Oh, thank you.” So teachers, it also counts.

44:05 Dr. Bradley Block Yes, anyone who’s in a position of authority, use it.

44:10 Dr. Ann Tsung Yes, thank you, thank you. I think I will give you one last question. Because I know you have three kids of your own. Your family also manages, your wife manages a short-term rental as well, invested in real estate. So it’s not like you don’t have a very full family life as well. You know, in Productivity MD, we’re always talking about being productive—not just in work but in your family, your own life, your own self-care, your kids—being present and productive with them. So how are you able to manage it and be able to set your family as non-negotiables, or self-care as non-negotiables?

44:51 Dr. Bradley Block You know, a couple of things. One is, right now, I have three boys—five, seven and eight. They’re not going to be this age forever. And so if I do have career goals, or productivity goals, or fitness goals, I recognize that when they are a little older and more self-sufficient, I will have more time. And so, right now, in terms of physical fitness, I just work out on the weekends. I do. I just work out on the weekends. I don’t work out during the week. I should, right? I should wake up a little earlier. But I can either snuggle with them on the couch, because they wake me up in the morning. My wife gets them in the middle of the night. We’re still not sleeping through the night. Sorry to say. So we still get some wake-ups from time to time. She gets them in the middle of the night. I get them in the morning, which gives her a little extra time to sleep. And so I could either work out, which I did for a little while. Actually, when they were even younger, they would sleep later, right? But now it’s this different age. Then I will eventually get back to it more. I heard Tom Hanks talking about this. He was like, “I was in such better shape in my 60s than I was in my 30s. Because I was just in it with the kids, and now I’m not. So now I’m in better shape.” And so working out is important to me. Listen. I used to be like — you should see my gym. I have a CrossFit-style gym in my house with Olympic weightlifting. I put together a platform to be able to do powerlifting and Olympic lifts. I mean business when I’m working out. In fact, this weekend in the snow, I have a harness. I put them on the sled, and I pulled them around the backyard in the snow. So you can integrate the workout.

46:27 One is, you recognize that it’s a fluid balance. It’s not a static balance. And so I take the opportunities when I can, but I also recognize that they’re not going to be this age forever. Also, when I’m with them, I try my best to be present. One thing that helps me to be present and make the most of this time—it’s going to sound a little dark—is something called ‘negative visualization.’ So negative visualization comes from the field of positive psychology, because it helps you appreciate what you have. So I will visualize my kids as teenagers that don’t want to snuggle with me anymore. Then there I am, present in the moment, enjoying every moment of snuggling them when I can, doing bedtime. Sometimes they are pains in the butt about bedtime and it takes forever, right? I’ve got stuff I need to do. I’ve got a podcast. I’ve got my practice. We’ve started a podcast network for doctors. I’ve got a lot on my plate, and so I really need to get to my work. But I don’t know how many cuddles I’ve got left. I don’t know how many snuggles I got. You know, there are going to be some stinky teenagers soon where they’re like, that’s not just not going to happen anymore. So when it does happen, I use something called negative visualization. Imagine my life without it. Not in a dark way, not like the kids being gone, but just being older where it’s not something that happens. It helps me be more present and be in the moment.

47:52 When I was pulling them around the backyard in the sled, I had to set ground rules. Like, no cursing and no slowing your brother down. You weren’t allowed. Because man, it was so much easier last year when they were lighter and I was younger. But it’s gotten so much harder to pull them around on that sled. So you can’t get in your brother’s way. It slows it down because I just don’t have much energy left in me. You know, it took all the fun out of it. Then I thought for a moment and I’m like, “Come on, Brad. Just stop being so negative about it. Let them have fun. You have fun with them. Because next year, they’re going to be bigger and heavier, and it just might not be fun for them anymore. So enjoy it while you can.” So, one, just recognize the fluidity of what’s important and how it can change from month to month and year to year, and will change. And so you set priorities on a fluid basis. Two is that negative visualization so that you do savor everything that you can to be as present as you can with them.

48:48 Dr. Ann Tsung Yeah, it’s a balancing life. It’s not a balanced life. It’s always a balancing life. You give and take. You got your setup in your house. You’ve decreased the commute, so it’s there when you need it on the weekend. You just go super hard on the weekend and, on the weekdays, you focus on your kids. That’s awesome. Then making sure that the negative visualization, visualizing down the line when you don’t have it, so you can cherish what you have now and being grateful for it now. That is awesome advice. Like you said, my son, sometimes he wants to read more books and more books and more books. Then now he’s in the stage of more hugs, more hugs, more hugs. I’m like, oh, okay. Fine. More hugs. Then we just keep hugging.

49:30 Dr. Bradley Block You’re like, I have all this stuff on my to-do list, and it’s hard. I can’t say that I never do that. I do that. I do it a lot. I do it a lot, where I’m like, “Oh God, I got to get to my to-do list. These are all these things I need to do.” But you’ll find, too, as your kids get a little older, they get more self-sufficient. And when they get more self-sufficient, that frees up a lot more time, you know. Then they’re going to get a little older, they’re going to start entertaining each other and playing with each other. That gives you even more time. And so it ends up getting easier. Then sports start, and then you’ll have even less time.

50:05 Dr. Ann Tsung It’s all a cycle. Yeah, just going with it. It’s a fluid life essentially, right?

50:10 Dr. Bradley Block Exactly.

50:11 Dr. Ann Tsung So I know we talked about a lot. So, for our audience, if they were to take one action or two, what would it be after this?

50:19 Dr. Bradley Block So I guess, for the doctors, it’s really, since we’ve covered most in the exam room, I think the one easy take away that I think will benefit the patient and the doctor would be: find something to connect with the patient with that has nothing to do with why they’re there. Right? Find something on their person or about them that you can ask them about, that’ll help you connect better with them because it’ll help you enjoy. Those connections are what, you know, that’s what I think the meaning of life is really—connection, right? What are we finding? We’re finding that one of the best predictors of health and longevity, if not the best predictor, is the strength of your social connections. And so that’s not a social connection. It’s not your social life, right? It’s a professional life. These are not your friends. They’re your patients. But still, these little connections go a long way for you and for them—you enjoying the visit and for them appreciating you. So I think if you’re going to do one thing — and to your point, it’s not just for the doctors. It’s in lots of professions, right? You’re someone’s accountant. You’re a salesperson. Notice something about them that you can ask them about that helps you see them for more than just what they came to see you about.

51:29 Dr. Ann Tsung Awesome. Thank you so much for coming on to the show. Thank you again to the audience for your presence, your attention. Of course, everything that we talk about is going to be in the show notes, productivityMD.com. Where can they find you, either social media, your website?

51:47 Dr. Bradley Block So physiciansguidetodoctoring.com. I’m on the socials @PhysiciansGuide—on Threads, on Instagram, on Bluesky. On LinkedIn, it’s Bradley Block, MD. The podcast is The Physicians Guide to Doctoring. You can find it on Apple and Spotify and Overcast—they’re apparently the three most popular that people find me—on YouTube as well. Then if you’re a physician and you’re thinking about starting a podcast, or you have a podcast, join our network, Doctor Podcast Network. So go to doctorpodcast.co. Sorry. Doctorpodcastnetwork.co.

52:21 Dr. Ann Tsung There we go. Doctorpodcastnetwork.co. Everybody, please go to follow your podcast, okay, as well. So please subscribe. Go follow if you want more tips on communication or anything that has to do with patients, doctoring, et cetera. Again, thank you so much, Brad, for coming onto the show. I learned a lot. For my own ER shifts coming up, I will test it out and I will let you know how it goes.

52:52 Dr. Bradley Block Please. Thank you so much for having me.

52:54 Dr. Ann Tsung Yeah, of course.

52:55 Dr. Bradley Block It’s been a lot of fun.

52:56 Dr. Ann Tsung It has. I learned. These are all very practical, and I think what you teach will have the ripple effect. If one physician can impact a lot of patients, increase self-efficacy, then perhaps there’s a ripple effect of the health span, increasing their health span. I wonder. So thank you again. And just remember, to the audience, everything that we need is within us now. Thank you.

53:25 Disclaimer: This content is for general information purposes only and does not constitute the practice of medicine. No doctor or patient relationship is formed. The use of this information linked to this content is at the user’s own risk. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical conditions they may have and should seek the assistance of their healthcare professionals for any such conditioans. The views are personal views only and do not represent any university or government institution.