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My most frequently asked question on my website
is some version of “How do I deal with
the doctor who is closed to the idea of complementary
modalities?” Because of the number of
people asking similar questions, I decided to
write an article on the topic recognizing that
many more readers are thinking about the question
than those who actually send me an e-mail. I
will be using my own experience at Mercy in
Durango as the basis for the article, recognizing
that each of us will have our own unique settings,
culture, and requirements.
Here Are Several Ideas About Interacting With
Reluctant Physicians.
First, it is most helpful to have a
physician champion of the program who can talk
with other physicians. It is even better
if you have a few physician champions. It is
even better if those physicians are in different
sections of the hospital (e.g., a surgeon, a
primary care doctor, a psychiatrist, and/or
an oncologist.)
Second, if the nurses are the stronger
advocates, you might choose to go through nursing
services to initiate the program. That
is what we did at Mercy. That allowed me to
go to the individual physician department meetings
and talk about the program as a FYI rather than
getting their entire buy-in at the beginning.
I did ask them if they would prefer to order
the program or simply give their permission
for nurses to ask the TLC team for sessions.
They preferred to give permission since most
of them didn't feel like they understood complementary
modalities enough to order them. I then asked
if they would like to be called for each patient
or sign blanket permission. Initially, all physicians
in each department meeting asked to be called.
Over the course of the next year, nearly every
doc signed a blanket permission both to prevent
the hassle of being called about each patient
and because they saw that the program was effective.
Probably three things were equally
important in swaying the doctors toward the
program. We asked each patient their
anxiety and pain levels (0-10 scale) before
and after each session so that we could accumulate
statistical data that I could give to the doctors
in a brief report every 3 months. Having the
data helped doctors to approve of the program.
Equally important was the subjective response
of their patients who kept telling them that
it was one of the most important parts of their
healing process. Finally, it was essential that
we had respectful holistic nurses who understood
hospital culture as the TLC team kept political
issues from building up during the time that
we were changing the hospital culture.
It is important to offer education
about the modalities to physicians.
Right before we began the program, I did give
a CME on the modalities that we were using and
the research behind them, but it was poorly
attended by the doctors. I think it was primarily
of political importance in that it let them
know that there was enough research to put on
a CME session. I did, however, write up a one-page
summary of the talk and put it in each doctor's
mailbox. I don't know if they read it, but again
the effort was made to keep them informed every
step of the way.
Education is important, but experience
may be even more powerful. We offered
TLC sessions for doctors' day and that gave
some more doctors an opportunity to experience
what we were talking about. I offered to meet
individually with reluctant doctors to discuss
the literature in detail. My experience was
if they were that reluctant, they didn't usually
want to spend their time getting educated about
the program, but, again, the effort on my part
was worth the while. Mostly, we simply carried
on as usual and gradually doctors came to appreciate
and embrace the program.
As with any innovative program, we
still have an occasional reluctant physician.
With the sway of the entire hospital
culture of 130 other doctors and having met
with them to discuss the literature and our
results with over 3000 sessions over 4 years
at Mercy, at this point we are simply telling
their patients that they must ask their reluctant
doctors for permission to have a TLC session.
It is admittedly dropping water on a stone,
but with the improving understanding of patients'
rights, I think eventually these doctors will
change their minds. There gets to be a point
where if you push too hard, physicians tend
to dig in their heels and claim professional
privilege, so I don't want to push too hard.
Nearly every program that introduces
complementary therapies will encounter this
issue. I hope that my experiences and
thoughts are helpful to you as you face issues
in your program. If you have other ideas about
working with reluctant physicians, please share
them with me.
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