The Optimized Doctor

I love empty storefronts. The realtor headshot in the window is a sign of hope. What was here is no more. What is coming will be better.

anyaberkut/Getty Images

I’ve waited a year for one such sign to come down and scaffolding to go up. Just one block from my condo, my curiosity has been slaked: a yoga studio! At first, disappointment; so many potentials unrealized: a coffee shop, cleaners, speakeasy! Yet, I decided to make the best of it. I bought Rainbow sandals, a Lululemon mat, and a pack of 10 classes. As it turns out, yoga can transform your life.

I didn’t realize how beautifully yoga combines physical exertion, meditation, and spirituality. It is both a model for understanding and a ritualistic training for life. Take resting pigeon for example. (Yogis reading this will forgive my imperfect explanation.) This moderately difficult pose opens your hip and stretches your glutes. Imagine doing a split but with your front knee bent and your forehead and arms resting on the floor in front of you. Done correctly, it puts a stretch deep into the hip of the forward leg. It is uncomfortable. Holding it for a minute or 2 is hard. But rather than just focusing on releasing, with each breath you find yourself deepening the stretch. Sweat streams down your arms and the discomfort builds as you hold. All you can think about is your breath. Then, it’s over. You feel freer, lighter than you were before. The deeper the discomfort, the deeper the delight that arises afterward. You are wise, yogis would say, to have chosen “the good over the pleasant.”

We have many opportunities for resting pigeon in everyday life. The patient to be added to your Monday morning clinic – which already had added patients. The Friday afternoon Mohs case that went to periosteum and still needs a flap to close. The “yet another” GI bleed patient that needs to be scoped tonight. These are all deep stretches, uncomfortable hip openings. Part of what I learned from yoga is to not give in to fear of what is ahead. Rather, when you must be uncomfortable, breathe and lean into it. Choosing the good sometimes means choosing suffering, but it isn’t the pain that makes it hard to bear. It is a lack of significance for that difficulty. By choosing what is good, you answer the question: “Who am I?” I am the one able and willing to endure inconvenience or disquiet to help others. This is my job, what I’m here to do. The pose, the call, the case will be over quickly. The freedom you feel after, along with the satisfaction you have served your purpose, will sustain you.

There are many poses and endless lessons from yoga. In fact, doing yoga is called “practicing.” Each time you learn and try. Each time you are imperfect and uncomfortable and reemerge sweaty and satisfied, just a little better human than you were before.
 

Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

I love empty storefronts. The realtor headshot in the window is a sign of hope. What was here is no more. What is coming will be better.

anyaberkut/Getty Images

I’ve waited a year for one such sign to come down and scaffolding to go up. Just one block from my condo, my curiosity has been slaked: a yoga studio! At first, disappointment; so many potentials unrealized: a coffee shop, cleaners, speakeasy! Yet, I decided to make the best of it. I bought Rainbow sandals, a Lululemon mat, and a pack of 10 classes. As it turns out, yoga can transform your life.

I didn’t realize how beautifully yoga combines physical exertion, meditation, and spirituality. It is both a model for understanding and a ritualistic training for life. Take resting pigeon for example. (Yogis reading this will forgive my imperfect explanation.) This moderately difficult pose opens your hip and stretches your glutes. Imagine doing a split but with your front knee bent and your forehead and arms resting on the floor in front of you. Done correctly, it puts a stretch deep into the hip of the forward leg. It is uncomfortable. Holding it for a minute or 2 is hard. But rather than just focusing on releasing, with each breath you find yourself deepening the stretch. Sweat streams down your arms and the discomfort builds as you hold. All you can think about is your breath. Then, it’s over. You feel freer, lighter than you were before. The deeper the discomfort, the deeper the delight that arises afterward. You are wise, yogis would say, to have chosen “the good over the pleasant.”

We have many opportunities for resting pigeon in everyday life. The patient to be added to your Monday morning clinic – which already had added patients. The Friday afternoon Mohs case that went to periosteum and still needs a flap to close. The “yet another” GI bleed patient that needs to be scoped tonight. These are all deep stretches, uncomfortable hip openings. Part of what I learned from yoga is to not give in to fear of what is ahead. Rather, when you must be uncomfortable, breathe and lean into it. Choosing the good sometimes means choosing suffering, but it isn’t the pain that makes it hard to bear. It is a lack of significance for that difficulty. By choosing what is good, you answer the question: “Who am I?” I am the one able and willing to endure inconvenience or disquiet to help others. This is my job, what I’m here to do. The pose, the call, the case will be over quickly. The freedom you feel after, along with the satisfaction you have served your purpose, will sustain you.

There are many poses and endless lessons from yoga. In fact, doing yoga is called “practicing.” Each time you learn and try. Each time you are imperfect and uncomfortable and reemerge sweaty and satisfied, just a little better human than you were before.
 

Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

I love empty storefronts. The realtor headshot in the window is a sign of hope. What was here is no more. What is coming will be better.

anyaberkut/Getty Images

I’ve waited a year for one such sign to come down and scaffolding to go up. Just one block from my condo, my curiosity has been slaked: a yoga studio! At first, disappointment; so many potentials unrealized: a coffee shop, cleaners, speakeasy! Yet, I decided to make the best of it. I bought Rainbow sandals, a Lululemon mat, and a pack of 10 classes. As it turns out, yoga can transform your life.

I didn’t realize how beautifully yoga combines physical exertion, meditation, and spirituality. It is both a model for understanding and a ritualistic training for life. Take resting pigeon for example. (Yogis reading this will forgive my imperfect explanation.) This moderately difficult pose opens your hip and stretches your glutes. Imagine doing a split but with your front knee bent and your forehead and arms resting on the floor in front of you. Done correctly, it puts a stretch deep into the hip of the forward leg. It is uncomfortable. Holding it for a minute or 2 is hard. But rather than just focusing on releasing, with each breath you find yourself deepening the stretch. Sweat streams down your arms and the discomfort builds as you hold. All you can think about is your breath. Then, it’s over. You feel freer, lighter than you were before. The deeper the discomfort, the deeper the delight that arises afterward. You are wise, yogis would say, to have chosen “the good over the pleasant.”

We have many opportunities for resting pigeon in everyday life. The patient to be added to your Monday morning clinic – which already had added patients. The Friday afternoon Mohs case that went to periosteum and still needs a flap to close. The “yet another” GI bleed patient that needs to be scoped tonight. These are all deep stretches, uncomfortable hip openings. Part of what I learned from yoga is to not give in to fear of what is ahead. Rather, when you must be uncomfortable, breathe and lean into it. Choosing the good sometimes means choosing suffering, but it isn’t the pain that makes it hard to bear. It is a lack of significance for that difficulty. By choosing what is good, you answer the question: “Who am I?” I am the one able and willing to endure inconvenience or disquiet to help others. This is my job, what I’m here to do. The pose, the call, the case will be over quickly. The freedom you feel after, along with the satisfaction you have served your purpose, will sustain you.

There are many poses and endless lessons from yoga. In fact, doing yoga is called “practicing.” Each time you learn and try. Each time you are imperfect and uncomfortable and reemerge sweaty and satisfied, just a little better human than you were before.
 

Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

You’ve arrived at an important milestone when someone asks you to give a grand rounds titled ... “Mid-Career Advice.” Yes, I’ve been asked.

sankai/Getty Images

I’m flattered to be asked (although I hope I’m not halfway). Mid-career “crisis!” is what Google expected me to talk about when I searched on this topic. Apparently, mid-career is assumed to be a time of regret as cynicism spreads like mildew and lassitude overtakes you. Yet, this is a great time in life! I’d rather be me today than me in residency – you learn an awful lot in 40K patient visits. Here are a few notes from my journey:

1. Knowing how to care for patients is as important as knowing medicine. The bulk of work to be done in outpatient care depends on bonding, trust, and affecting change efficiently and effectively. Sometimes great diagnostic acumen and procedural skills are needed. Yet, for most, this isn’t hard. Access to differential diagnoses, recommended work-ups, and best practice treatments are easily accessible, just in time. In contrast, it’s often hard to convince patients of their diagnosis and to help them adhere to the best plan.

2. You can do everything right and still have it end up wrong. Medicine is more like poker than chess. In chess, most information is knowable, and there is always one best move. In poker, much is unknown, and a lot depends on chance. You might perform surgery with perfect sterile technique and still, the patient develops an infection. You could prescribe all the best treatments for pyoderma gangrenosum and the disease might still progress. Thinking probabilistically helps me make better choices and sleep better at night, especially when the outcome was not commensurate with the quality of care.


3. Patients are sometimes impertinent, sometimes wrong, sometimes stubborn, sometimes rude. “Restrain your indignation,” Dr. Osler advised his medical students in 1889, and remember that “offences of this kind come; expect them, and do not be vexed.” You might give the best care, the most compassionate, time-generous appointment, and still your patient files a grievance, posts a bad review, fails to follow through, chooses CBD oil instead. Remember, they are just people with all our shortcomings. Do your best to serve and know in your heart that you are enough and have done enough. Then move on; patients are waiting.

4. Adverse outcomes can be devastating, to us as well as to our patients. Any harm caused to a patient or an angry complaint against you can trigger anxiety, regret, and endless ruminating. Sometimes these thoughts become intrusive. Try setting boundaries. Take the time to absorb the discomfort, still knowing you are strong, you are not alone, and failure is sometimes inevitable. Learn what you can, then when you find you’re unable to stop your thoughts, choose an activity (like AngryBirds!) to break your thoughts. You will be a healthier human and provide better care if you can find your equanimity often and early.

You’ve arrived at an important milestone when someone asks you to give a grand rounds titled ... “Mid-Career Advice.” Yes, I’ve been asked.

sankai/Getty Images

I’m flattered to be asked (although I hope I’m not halfway). Mid-career “crisis!” is what Google expected me to talk about when I searched on this topic. Apparently, mid-career is assumed to be a time of regret as cynicism spreads like mildew and lassitude overtakes you. Yet, this is a great time in life! I’d rather be me today than me in residency – you learn an awful lot in 40K patient visits. Here are a few notes from my journey:

1. Knowing how to care for patients is as important as knowing medicine. The bulk of work to be done in outpatient care depends on bonding, trust, and affecting change efficiently and effectively. Sometimes great diagnostic acumen and procedural skills are needed. Yet, for most, this isn’t hard. Access to differential diagnoses, recommended work-ups, and best practice treatments are easily accessible, just in time. In contrast, it’s often hard to convince patients of their diagnosis and to help them adhere to the best plan.

2. You can do everything right and still have it end up wrong. Medicine is more like poker than chess. In chess, most information is knowable, and there is always one best move. In poker, much is unknown, and a lot depends on chance. You might perform surgery with perfect sterile technique and still, the patient develops an infection. You could prescribe all the best treatments for pyoderma gangrenosum and the disease might still progress. Thinking probabilistically helps me make better choices and sleep better at night, especially when the outcome was not commensurate with the quality of care.


3. Patients are sometimes impertinent, sometimes wrong, sometimes stubborn, sometimes rude. “Restrain your indignation,” Dr. Osler advised his medical students in 1889, and remember that “offences of this kind come; expect them, and do not be vexed.” You might give the best care, the most compassionate, time-generous appointment, and still your patient files a grievance, posts a bad review, fails to follow through, chooses CBD oil instead. Remember, they are just people with all our shortcomings. Do your best to serve and know in your heart that you are enough and have done enough. Then move on; patients are waiting.

4. Adverse outcomes can be devastating, to us as well as to our patients. Any harm caused to a patient or an angry complaint against you can trigger anxiety, regret, and endless ruminating. Sometimes these thoughts become intrusive. Try setting boundaries. Take the time to absorb the discomfort, still knowing you are strong, you are not alone, and failure is sometimes inevitable. Learn what you can, then when you find you’re unable to stop your thoughts, choose an activity (like AngryBirds!) to break your thoughts. You will be a healthier human and provide better care if you can find your equanimity often and early.

You’ve arrived at an important milestone when someone asks you to give a grand rounds titled ... “Mid-Career Advice.” Yes, I’ve been asked.

sankai/Getty Images

I’m flattered to be asked (although I hope I’m not halfway). Mid-career “crisis!” is what Google expected me to talk about when I searched on this topic. Apparently, mid-career is assumed to be a time of regret as cynicism spreads like mildew and lassitude overtakes you. Yet, this is a great time in life! I’d rather be me today than me in residency – you learn an awful lot in 40K patient visits. Here are a few notes from my journey:

1. Knowing how to care for patients is as important as knowing medicine. The bulk of work to be done in outpatient care depends on bonding, trust, and affecting change efficiently and effectively. Sometimes great diagnostic acumen and procedural skills are needed. Yet, for most, this isn’t hard. Access to differential diagnoses, recommended work-ups, and best practice treatments are easily accessible, just in time. In contrast, it’s often hard to convince patients of their diagnosis and to help them adhere to the best plan.

2. You can do everything right and still have it end up wrong. Medicine is more like poker than chess. In chess, most information is knowable, and there is always one best move. In poker, much is unknown, and a lot depends on chance. You might perform surgery with perfect sterile technique and still, the patient develops an infection. You could prescribe all the best treatments for pyoderma gangrenosum and the disease might still progress. Thinking probabilistically helps me make better choices and sleep better at night, especially when the outcome was not commensurate with the quality of care.


3. Patients are sometimes impertinent, sometimes wrong, sometimes stubborn, sometimes rude. “Restrain your indignation,” Dr. Osler advised his medical students in 1889, and remember that “offences of this kind come; expect them, and do not be vexed.” You might give the best care, the most compassionate, time-generous appointment, and still your patient files a grievance, posts a bad review, fails to follow through, chooses CBD oil instead. Remember, they are just people with all our shortcomings. Do your best to serve and know in your heart that you are enough and have done enough. Then move on; patients are waiting.

4. Adverse outcomes can be devastating, to us as well as to our patients. Any harm caused to a patient or an angry complaint against you can trigger anxiety, regret, and endless ruminating. Sometimes these thoughts become intrusive. Try setting boundaries. Take the time to absorb the discomfort, still knowing you are strong, you are not alone, and failure is sometimes inevitable. Learn what you can, then when you find you’re unable to stop your thoughts, choose an activity (like AngryBirds!) to break your thoughts. You will be a healthier human and provide better care if you can find your equanimity often and early.

Teaching a new resident can be a beautiful and exasperating experience. Recently, a stiff-white-coat family medicine resident showed up eager for his first day in dermatology. Working with him reminded me how exciting the journey is from resident to attending. It also reminded me how slow residents are – we’re 10 minutes into a visit and not yet done injecting anesthesia. A simple biopsy and electrodesiccation of a basal cell carcinoma would take 3 minutes – easy, rote, like driving home and being surprised when you arrive. But this task is making my resident so fraught with fear he’s barely moving. He won’t be crawling for long; his journey from novice to confident physician will be quick. Like a student pilot learning to fly, in a few hundred hours he’ll be flying solo.

After a year, most residents are adept, exuding the temerity of an attending. But as any practicing physician knows, medicine can make cowards of us all without warning. An experienced pilot facing an unexpected gusty 25-knot crosswind landing can find himself or herself a trembling beginner just as an excellent clinician can be overwhelmed facing an unexpectedly sick patient.

Not long after my visiting resident, I was back to my own packed clinic. With one swoop of a dermablade, I intended to quickly extirpate a keratoacanthoma on the back of an elderly man’s hand. I hardly had to think about it. However, when I lifted the blade, dark blood pooled where a dorsal saphenous vein used to live. After much electrodesiccation (and sutures) this particular biopsy was safely landed. But it wasn’t without a bit of blood loss and inconvenience for the patient. What might I have done differently? Injected 5-fluorouracil instead? Done an incisional biopsy? Used a different blade? More importantly, what will I do next time?


To avoid adverse outcomes, it might seem like the best strategy is to avoid deteriorating conditions, whether flying or in clinic. That would be a mistake. The journey from apprehension to mastery must pass through discomfort. It is only by working through unease and successfully managing complications that expertise is forged. Our days are mostly routine and the longer the period without adversity, the greater the risk of complacency. Consider seeking difficulty once in awhile and learn how to work through it. No pilot wants to be in a situation he or she hasn’t practiced managing.

For some physicians and residents, an unexpected complication or adverse outcome can make them apprehensive and defensive. I’ve seen doctors choose not to treat complicated diseases or dire lesions because of a previous bad experience or adverse outcome. It is sometimes appropriate to transfer a patient to a different service, but as physicians, it’s also our job to take care of our patient. When it’s your plane, you’ll have to land it.

Much later (or so it seemed), my resident finally finished the electrodesiccation and curettage. He had a look of relief knowing he has landed safely. I hope he realizes that this is a trip that he must take over and over again. One is never done learning to fly.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

Teaching a new resident can be a beautiful and exasperating experience. Recently, a stiff-white-coat family medicine resident showed up eager for his first day in dermatology. Working with him reminded me how exciting the journey is from resident to attending. It also reminded me how slow residents are – we’re 10 minutes into a visit and not yet done injecting anesthesia. A simple biopsy and electrodesiccation of a basal cell carcinoma would take 3 minutes – easy, rote, like driving home and being surprised when you arrive. But this task is making my resident so fraught with fear he’s barely moving. He won’t be crawling for long; his journey from novice to confident physician will be quick. Like a student pilot learning to fly, in a few hundred hours he’ll be flying solo.

After a year, most residents are adept, exuding the temerity of an attending. But as any practicing physician knows, medicine can make cowards of us all without warning. An experienced pilot facing an unexpected gusty 25-knot crosswind landing can find himself or herself a trembling beginner just as an excellent clinician can be overwhelmed facing an unexpectedly sick patient.

Not long after my visiting resident, I was back to my own packed clinic. With one swoop of a dermablade, I intended to quickly extirpate a keratoacanthoma on the back of an elderly man’s hand. I hardly had to think about it. However, when I lifted the blade, dark blood pooled where a dorsal saphenous vein used to live. After much electrodesiccation (and sutures) this particular biopsy was safely landed. But it wasn’t without a bit of blood loss and inconvenience for the patient. What might I have done differently? Injected 5-fluorouracil instead? Done an incisional biopsy? Used a different blade? More importantly, what will I do next time?


To avoid adverse outcomes, it might seem like the best strategy is to avoid deteriorating conditions, whether flying or in clinic. That would be a mistake. The journey from apprehension to mastery must pass through discomfort. It is only by working through unease and successfully managing complications that expertise is forged. Our days are mostly routine and the longer the period without adversity, the greater the risk of complacency. Consider seeking difficulty once in awhile and learn how to work through it. No pilot wants to be in a situation he or she hasn’t practiced managing.

For some physicians and residents, an unexpected complication or adverse outcome can make them apprehensive and defensive. I’ve seen doctors choose not to treat complicated diseases or dire lesions because of a previous bad experience or adverse outcome. It is sometimes appropriate to transfer a patient to a different service, but as physicians, it’s also our job to take care of our patient. When it’s your plane, you’ll have to land it.

Much later (or so it seemed), my resident finally finished the electrodesiccation and curettage. He had a look of relief knowing he has landed safely. I hope he realizes that this is a trip that he must take over and over again. One is never done learning to fly.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

Teaching a new resident can be a beautiful and exasperating experience. Recently, a stiff-white-coat family medicine resident showed up eager for his first day in dermatology. Working with him reminded me how exciting the journey is from resident to attending. It also reminded me how slow residents are – we’re 10 minutes into a visit and not yet done injecting anesthesia. A simple biopsy and electrodesiccation of a basal cell carcinoma would take 3 minutes – easy, rote, like driving home and being surprised when you arrive. But this task is making my resident so fraught with fear he’s barely moving. He won’t be crawling for long; his journey from novice to confident physician will be quick. Like a student pilot learning to fly, in a few hundred hours he’ll be flying solo.

After a year, most residents are adept, exuding the temerity of an attending. But as any practicing physician knows, medicine can make cowards of us all without warning. An experienced pilot facing an unexpected gusty 25-knot crosswind landing can find himself or herself a trembling beginner just as an excellent clinician can be overwhelmed facing an unexpectedly sick patient.

Not long after my visiting resident, I was back to my own packed clinic. With one swoop of a dermablade, I intended to quickly extirpate a keratoacanthoma on the back of an elderly man’s hand. I hardly had to think about it. However, when I lifted the blade, dark blood pooled where a dorsal saphenous vein used to live. After much electrodesiccation (and sutures) this particular biopsy was safely landed. But it wasn’t without a bit of blood loss and inconvenience for the patient. What might I have done differently? Injected 5-fluorouracil instead? Done an incisional biopsy? Used a different blade? More importantly, what will I do next time?


To avoid adverse outcomes, it might seem like the best strategy is to avoid deteriorating conditions, whether flying or in clinic. That would be a mistake. The journey from apprehension to mastery must pass through discomfort. It is only by working through unease and successfully managing complications that expertise is forged. Our days are mostly routine and the longer the period without adversity, the greater the risk of complacency. Consider seeking difficulty once in awhile and learn how to work through it. No pilot wants to be in a situation he or she hasn’t practiced managing.

For some physicians and residents, an unexpected complication or adverse outcome can make them apprehensive and defensive. I’ve seen doctors choose not to treat complicated diseases or dire lesions because of a previous bad experience or adverse outcome. It is sometimes appropriate to transfer a patient to a different service, but as physicians, it’s also our job to take care of our patient. When it’s your plane, you’ll have to land it.

Much later (or so it seemed), my resident finally finished the electrodesiccation and curettage. He had a look of relief knowing he has landed safely. I hope he realizes that this is a trip that he must take over and over again. One is never done learning to fly.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

When you fly as a physician, there’s always a chance you’ll get a free drink. It’s not free, of course. For at least a few minutes, you worked. “Is there a physician onboard? – Ah, just how badly do you want that vodka tonic?

I ring my call button, as I’m sure you do. (It’s worth it to see the flight attendant’s face when I reply: “I’m a dermatologist.”) Last time it was for a 68-year-old man who was vomiting. There was no rash.

I responded along with a pediatrician and an ER nurse – gratitude is an ER nurse at 38,000 feet. The patient had chemotherapy-induced nausea. We three managed to get him well enough to finish the flight. Our ER nurse team member ran the show; she was excellent. She asked all the right questions and helped us all make good decisions. Unlike in clinic, I wasn’t an expert here despite my MD.

Several weeks ago, I saw a patient in the office with severe psoriasis. She stood before me erythrodermic. As I was adjusting her orders, I stepped out of the office to call one of my partners for her opinion. She examined the patient and declared: “I don’t think it’s psoriasis. Despite that biopsy, I think this is chronic eczema.” Brilliant.

In contrast to the former story, I was an expert in my office. And yet, success depended in both instances on my recognizing a cognitive bias: I don’t know everything, and worse, I sometimes don’t realize what I don’t know.

There are several biases of overconfidence. One is the expert trap: You believe you are an expert or correct, but you are wrong and you don’t see it. It’s a common mistake and manifests as overconfidence in our own abilities. For example, what decade did Hawaii join the union? Who is on the 20-dollar bill? Which is the farthest planet? You might be 90% confident of your answers, but most of us are more confident than we ought to be. Chances are you’ll be wrong on one. Recognizing this is hard. And yet, it’s what separates the good from the great clinicians.

Short of having your medical assistant whisper in your ear each day “Memento stultus” (remember you’re stupid), avoiding this bias is difficult. Signs that you might be trapped in an expert mindset are: 1. You believe your patients’ failure to improve is due to lack of adherence to your plan. 2. You cannot recall the last time you tried a new treatment. 3. You never ask others for second opinions. 4. Your colleagues stop asking for your opinion. 5. A flight attendant asks if you would mind returning to your seat rather than help with a medical situation.

If you want to be a better doctor, try working on your sense of self-importance. Remember your limitations and those of medicine. Be methodical in questioning your assumptions. Could you be wrong? Could the data you have be misleading? What are you missing? Ask a colleague to review some of your charts or spend time with you during procedures. Join (or start!) a journal club. Share your difficult cases with others and take note of how their advice differs from your approach.

By recognizing when you might be wrong and humbly stepping aside or taking the time to learn, you might just earn that free drink.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

When you fly as a physician, there’s always a chance you’ll get a free drink. It’s not free, of course. For at least a few minutes, you worked. “Is there a physician onboard? – Ah, just how badly do you want that vodka tonic?

I ring my call button, as I’m sure you do. (It’s worth it to see the flight attendant’s face when I reply: “I’m a dermatologist.”) Last time it was for a 68-year-old man who was vomiting. There was no rash.

I responded along with a pediatrician and an ER nurse – gratitude is an ER nurse at 38,000 feet. The patient had chemotherapy-induced nausea. We three managed to get him well enough to finish the flight. Our ER nurse team member ran the show; she was excellent. She asked all the right questions and helped us all make good decisions. Unlike in clinic, I wasn’t an expert here despite my MD.

Several weeks ago, I saw a patient in the office with severe psoriasis. She stood before me erythrodermic. As I was adjusting her orders, I stepped out of the office to call one of my partners for her opinion. She examined the patient and declared: “I don’t think it’s psoriasis. Despite that biopsy, I think this is chronic eczema.” Brilliant.

In contrast to the former story, I was an expert in my office. And yet, success depended in both instances on my recognizing a cognitive bias: I don’t know everything, and worse, I sometimes don’t realize what I don’t know.

There are several biases of overconfidence. One is the expert trap: You believe you are an expert or correct, but you are wrong and you don’t see it. It’s a common mistake and manifests as overconfidence in our own abilities. For example, what decade did Hawaii join the union? Who is on the 20-dollar bill? Which is the farthest planet? You might be 90% confident of your answers, but most of us are more confident than we ought to be. Chances are you’ll be wrong on one. Recognizing this is hard. And yet, it’s what separates the good from the great clinicians.

Short of having your medical assistant whisper in your ear each day “Memento stultus” (remember you’re stupid), avoiding this bias is difficult. Signs that you might be trapped in an expert mindset are: 1. You believe your patients’ failure to improve is due to lack of adherence to your plan. 2. You cannot recall the last time you tried a new treatment. 3. You never ask others for second opinions. 4. Your colleagues stop asking for your opinion. 5. A flight attendant asks if you would mind returning to your seat rather than help with a medical situation.

If you want to be a better doctor, try working on your sense of self-importance. Remember your limitations and those of medicine. Be methodical in questioning your assumptions. Could you be wrong? Could the data you have be misleading? What are you missing? Ask a colleague to review some of your charts or spend time with you during procedures. Join (or start!) a journal club. Share your difficult cases with others and take note of how their advice differs from your approach.

By recognizing when you might be wrong and humbly stepping aside or taking the time to learn, you might just earn that free drink.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

When you fly as a physician, there’s always a chance you’ll get a free drink. It’s not free, of course. For at least a few minutes, you worked. “Is there a physician onboard? – Ah, just how badly do you want that vodka tonic?

I ring my call button, as I’m sure you do. (It’s worth it to see the flight attendant’s face when I reply: “I’m a dermatologist.”) Last time it was for a 68-year-old man who was vomiting. There was no rash.

I responded along with a pediatrician and an ER nurse – gratitude is an ER nurse at 38,000 feet. The patient had chemotherapy-induced nausea. We three managed to get him well enough to finish the flight. Our ER nurse team member ran the show; she was excellent. She asked all the right questions and helped us all make good decisions. Unlike in clinic, I wasn’t an expert here despite my MD.

Several weeks ago, I saw a patient in the office with severe psoriasis. She stood before me erythrodermic. As I was adjusting her orders, I stepped out of the office to call one of my partners for her opinion. She examined the patient and declared: “I don’t think it’s psoriasis. Despite that biopsy, I think this is chronic eczema.” Brilliant.

In contrast to the former story, I was an expert in my office. And yet, success depended in both instances on my recognizing a cognitive bias: I don’t know everything, and worse, I sometimes don’t realize what I don’t know.

There are several biases of overconfidence. One is the expert trap: You believe you are an expert or correct, but you are wrong and you don’t see it. It’s a common mistake and manifests as overconfidence in our own abilities. For example, what decade did Hawaii join the union? Who is on the 20-dollar bill? Which is the farthest planet? You might be 90% confident of your answers, but most of us are more confident than we ought to be. Chances are you’ll be wrong on one. Recognizing this is hard. And yet, it’s what separates the good from the great clinicians.

Short of having your medical assistant whisper in your ear each day “Memento stultus” (remember you’re stupid), avoiding this bias is difficult. Signs that you might be trapped in an expert mindset are: 1. You believe your patients’ failure to improve is due to lack of adherence to your plan. 2. You cannot recall the last time you tried a new treatment. 3. You never ask others for second opinions. 4. Your colleagues stop asking for your opinion. 5. A flight attendant asks if you would mind returning to your seat rather than help with a medical situation.

If you want to be a better doctor, try working on your sense of self-importance. Remember your limitations and those of medicine. Be methodical in questioning your assumptions. Could you be wrong? Could the data you have be misleading? What are you missing? Ask a colleague to review some of your charts or spend time with you during procedures. Join (or start!) a journal club. Share your difficult cases with others and take note of how their advice differs from your approach.

By recognizing when you might be wrong and humbly stepping aside or taking the time to learn, you might just earn that free drink.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

The best way to ensure that I’ll run late in clinic is to start late. I avoid such delayed starts as scabies, yet, sometimes it’s unavoidable. I walked into my 1:30 appointment at 1:35. “Can I ask you a question?” my bony, patient with the long gray beard asked. “Sure.” I replied. “Is your time important to you?” he snapped.

Oh, boy. Here we go.

“I’m sorry I’m running late and kept you waiting,” I offered, “but I had a sick patient this morning.” When he retorted that his time was important, too, I interrupted him.

“Please sit on the exam table and tell me how I can help you so we don’t waste any more of your time.” He went on to complain that the treatments for his facial seborrheic dermatitis did not resolve the problem. When he stops treatment, it flares. I explained that this was a chronic condition and that he could manage it with my help. He resisted, but with each parry, his aggressiveness weakened. We reviewed behavior, product, and medication options for him. By the end of the visit, he was (mostly) pleased and left with a plan and prescription to help.

Early in my career, this appointment might have been disastrous: It would have ruined my afternoon and possibly led to a formal patient complaint. His antagonistic comments and boorish behavior would have unsettled me. But it didn’t now.

I had the confidence to know his diagnosis and how to help him, despite his dissatisfaction. Confidence is one of the key differences that distinguish good doctors from great doctors. Those with strong self-confidence not only have better patient satisfaction and higher quality but also are more efficient and have high level of satisfaction with their career. When your confidence is low, medical decision making and managing patient expectations become difficult. This is particularly true when a patient comes “informed.” Often their knowledge is helpful but, as we know, sometimes it’s bogus, even detrimental. Although we ought to have come a long way from the brash doctor-knows-best days of our past, we also ought not capitulate to patients. Sometimes, you have to be the doctor. Balancing confidence with compassion is tricky yet essential to success.


When I meet with our young doctors, I try to provide feedback not only on their medical acumen but also on their confidence to deploy that expertise. Like a skill, self-confidence can be improved. The best way is to recognize difficult conversations and do not avoid them. When you feel your face flush and heart race, take a good belly breath and step into it. You don’t have to confront or argue with your patient, you do have to assert and negotiate. Helping a difficult patient can feel like you’ve done something wrong, but chances are, you haven’t. Reframe the situation, think of it as you doing the hard work to help them. Being confident is as important as getting the diagnosis right. Even when you don’t know the diagnosis, you can be most helpful when you are direct and say so. “I’m not sure what you have, but here is how I’m going to help you.”

To improve self-confidence you’ll have to practice. When you have a difficult visit that ultimately ended well, make a note of it. Reflect on it. The next time you have a challenging patient, remember your previous success and how you felt. Then breathe and do it again. After all, you are the doctor.

Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

The best way to ensure that I’ll run late in clinic is to start late. I avoid such delayed starts as scabies, yet, sometimes it’s unavoidable. I walked into my 1:30 appointment at 1:35. “Can I ask you a question?” my bony, patient with the long gray beard asked. “Sure.” I replied. “Is your time important to you?” he snapped.

Oh, boy. Here we go.

“I’m sorry I’m running late and kept you waiting,” I offered, “but I had a sick patient this morning.” When he retorted that his time was important, too, I interrupted him.

“Please sit on the exam table and tell me how I can help you so we don’t waste any more of your time.” He went on to complain that the treatments for his facial seborrheic dermatitis did not resolve the problem. When he stops treatment, it flares. I explained that this was a chronic condition and that he could manage it with my help. He resisted, but with each parry, his aggressiveness weakened. We reviewed behavior, product, and medication options for him. By the end of the visit, he was (mostly) pleased and left with a plan and prescription to help.

Early in my career, this appointment might have been disastrous: It would have ruined my afternoon and possibly led to a formal patient complaint. His antagonistic comments and boorish behavior would have unsettled me. But it didn’t now.

I had the confidence to know his diagnosis and how to help him, despite his dissatisfaction. Confidence is one of the key differences that distinguish good doctors from great doctors. Those with strong self-confidence not only have better patient satisfaction and higher quality but also are more efficient and have high level of satisfaction with their career. When your confidence is low, medical decision making and managing patient expectations become difficult. This is particularly true when a patient comes “informed.” Often their knowledge is helpful but, as we know, sometimes it’s bogus, even detrimental. Although we ought to have come a long way from the brash doctor-knows-best days of our past, we also ought not capitulate to patients. Sometimes, you have to be the doctor. Balancing confidence with compassion is tricky yet essential to success.


When I meet with our young doctors, I try to provide feedback not only on their medical acumen but also on their confidence to deploy that expertise. Like a skill, self-confidence can be improved. The best way is to recognize difficult conversations and do not avoid them. When you feel your face flush and heart race, take a good belly breath and step into it. You don’t have to confront or argue with your patient, you do have to assert and negotiate. Helping a difficult patient can feel like you’ve done something wrong, but chances are, you haven’t. Reframe the situation, think of it as you doing the hard work to help them. Being confident is as important as getting the diagnosis right. Even when you don’t know the diagnosis, you can be most helpful when you are direct and say so. “I’m not sure what you have, but here is how I’m going to help you.”

To improve self-confidence you’ll have to practice. When you have a difficult visit that ultimately ended well, make a note of it. Reflect on it. The next time you have a challenging patient, remember your previous success and how you felt. Then breathe and do it again. After all, you are the doctor.

Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

The best way to ensure that I’ll run late in clinic is to start late. I avoid such delayed starts as scabies, yet, sometimes it’s unavoidable. I walked into my 1:30 appointment at 1:35. “Can I ask you a question?” my bony, patient with the long gray beard asked. “Sure.” I replied. “Is your time important to you?” he snapped.

Oh, boy. Here we go.

“I’m sorry I’m running late and kept you waiting,” I offered, “but I had a sick patient this morning.” When he retorted that his time was important, too, I interrupted him.

“Please sit on the exam table and tell me how I can help you so we don’t waste any more of your time.” He went on to complain that the treatments for his facial seborrheic dermatitis did not resolve the problem. When he stops treatment, it flares. I explained that this was a chronic condition and that he could manage it with my help. He resisted, but with each parry, his aggressiveness weakened. We reviewed behavior, product, and medication options for him. By the end of the visit, he was (mostly) pleased and left with a plan and prescription to help.

Early in my career, this appointment might have been disastrous: It would have ruined my afternoon and possibly led to a formal patient complaint. His antagonistic comments and boorish behavior would have unsettled me. But it didn’t now.

I had the confidence to know his diagnosis and how to help him, despite his dissatisfaction. Confidence is one of the key differences that distinguish good doctors from great doctors. Those with strong self-confidence not only have better patient satisfaction and higher quality but also are more efficient and have high level of satisfaction with their career. When your confidence is low, medical decision making and managing patient expectations become difficult. This is particularly true when a patient comes “informed.” Often their knowledge is helpful but, as we know, sometimes it’s bogus, even detrimental. Although we ought to have come a long way from the brash doctor-knows-best days of our past, we also ought not capitulate to patients. Sometimes, you have to be the doctor. Balancing confidence with compassion is tricky yet essential to success.


When I meet with our young doctors, I try to provide feedback not only on their medical acumen but also on their confidence to deploy that expertise. Like a skill, self-confidence can be improved. The best way is to recognize difficult conversations and do not avoid them. When you feel your face flush and heart race, take a good belly breath and step into it. You don’t have to confront or argue with your patient, you do have to assert and negotiate. Helping a difficult patient can feel like you’ve done something wrong, but chances are, you haven’t. Reframe the situation, think of it as you doing the hard work to help them. Being confident is as important as getting the diagnosis right. Even when you don’t know the diagnosis, you can be most helpful when you are direct and say so. “I’m not sure what you have, but here is how I’m going to help you.”

To improve self-confidence you’ll have to practice. When you have a difficult visit that ultimately ended well, make a note of it. Reflect on it. The next time you have a challenging patient, remember your previous success and how you felt. Then breathe and do it again. After all, you are the doctor.

Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

Just how good are you? Are you a pretty good doc? A better-than-average leader? Or, are you truly an eminently qualified physician?

For all the talk about maintenance of certification and continuing medical education, it isn’t easy to know if you really are a good physician, teacher, or leader. In medicine, we’re careful to show respect to each other and tend to be slow to be critical. This might seem a kind approach to feedback, but I wonder if it is.

There are other professions where evaluations and feedback are more direct. In the military, performance standards are often quite explicit. The Marines, for instance, take performance evaluations seriously. This is evident if you’ve ever completed, or been a recipient of, a U.S. Marine Corps fitness report. Reading it, I realized many of the criteria could apply to us in medicine. Here are a few examples from that form (lightly modified for physicians).

Think about your clinical and technical expertise. Would you grade yourself as “competent. Possesses requisite range of skills and knowledge commensurate with training and experience?” Or maybe the next grade “demonstrates mastery of all required skills. Expertise, education and experience consistently enhance department. Innovative troubleshooter and problem solver. Effectively imparts skills to trainees.” Or perhaps you’re a “true expert in the field. Knowledge and skills impact far beyond those of peers. Translates broad-based education into forward-thinking, innovative actions. Makes immeasurable impact on department. Peerless teacher, selflessly imparts expertise to peers, residents, students.”

What about your effectiveness under stress?

Do you act “commensurate with your training and role?” Or do you have an “uncanny ability to anticipate requirements and quickly formulate original solutions?” Do you always “take decisive, effective action?”

How about your leadership performance?

Are you simply “engaged, providing instruction and direction?” Or do you “achieve a highly effective balance between direction and delegation, effectively tasking subordinates and clearly delineating standards expected?” A few of us even “engender willing loyalty and trust that allow subordinates to overcome their perceived limitations.” And exhibit “leadership that fosters the highest levels of motivation and morale, ensuring accomplishment in the most difficult circumstances.”

We might even mitigate physician burnout better if we had better performance standards. For example, do you simply “deal confidently with issues pertinent to subordinate welfare and recognize suitable courses of action?” Maybe you’re at the next level, “actively fostering the development of and uses of support systems for subordinates which improve their ability to perform.” I’m fortunate to know a few physician leaders who “noticeably enhance subordinate well-being, resulting in measurable increase in department effectiveness and proactively energize team members to ‘take care of their own.’ Widely recognized for techniques and policies that produce results and build morale.” By codifying what the standard should be, we can better hold ourselves accountable for our performance. In doing so, we might be better at recognizing and reducing burnout in our direct reports and peers.

The final question on the Marine fitness report is a comparative assessment. The evaluating officer checks one of the following boxes: 1. Unsatisfactory; 2. A qualified Marine; 3. One of many highly qualified Marines; 4. One of the few exceptionally qualified Marines; or, 5. The eminently qualified Marine.

Which are you? Can you describe yourself as “the eminently qualified physician?” You’ll have to define that standard in order to reach it.

This post was inspired by the “Set Standards. Aspire to Achieve Them” episode of Jocko Podcast.

Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

Just how good are you? Are you a pretty good doc? A better-than-average leader? Or, are you truly an eminently qualified physician?

For all the talk about maintenance of certification and continuing medical education, it isn’t easy to know if you really are a good physician, teacher, or leader. In medicine, we’re careful to show respect to each other and tend to be slow to be critical. This might seem a kind approach to feedback, but I wonder if it is.

There are other professions where evaluations and feedback are more direct. In the military, performance standards are often quite explicit. The Marines, for instance, take performance evaluations seriously. This is evident if you’ve ever completed, or been a recipient of, a U.S. Marine Corps fitness report. Reading it, I realized many of the criteria could apply to us in medicine. Here are a few examples from that form (lightly modified for physicians).

Think about your clinical and technical expertise. Would you grade yourself as “competent. Possesses requisite range of skills and knowledge commensurate with training and experience?” Or maybe the next grade “demonstrates mastery of all required skills. Expertise, education and experience consistently enhance department. Innovative troubleshooter and problem solver. Effectively imparts skills to trainees.” Or perhaps you’re a “true expert in the field. Knowledge and skills impact far beyond those of peers. Translates broad-based education into forward-thinking, innovative actions. Makes immeasurable impact on department. Peerless teacher, selflessly imparts expertise to peers, residents, students.”

What about your effectiveness under stress?

Do you act “commensurate with your training and role?” Or do you have an “uncanny ability to anticipate requirements and quickly formulate original solutions?” Do you always “take decisive, effective action?”

How about your leadership performance?

Are you simply “engaged, providing instruction and direction?” Or do you “achieve a highly effective balance between direction and delegation, effectively tasking subordinates and clearly delineating standards expected?” A few of us even “engender willing loyalty and trust that allow subordinates to overcome their perceived limitations.” And exhibit “leadership that fosters the highest levels of motivation and morale, ensuring accomplishment in the most difficult circumstances.”

We might even mitigate physician burnout better if we had better performance standards. For example, do you simply “deal confidently with issues pertinent to subordinate welfare and recognize suitable courses of action?” Maybe you’re at the next level, “actively fostering the development of and uses of support systems for subordinates which improve their ability to perform.” I’m fortunate to know a few physician leaders who “noticeably enhance subordinate well-being, resulting in measurable increase in department effectiveness and proactively energize team members to ‘take care of their own.’ Widely recognized for techniques and policies that produce results and build morale.” By codifying what the standard should be, we can better hold ourselves accountable for our performance. In doing so, we might be better at recognizing and reducing burnout in our direct reports and peers.

The final question on the Marine fitness report is a comparative assessment. The evaluating officer checks one of the following boxes: 1. Unsatisfactory; 2. A qualified Marine; 3. One of many highly qualified Marines; 4. One of the few exceptionally qualified Marines; or, 5. The eminently qualified Marine.

Which are you? Can you describe yourself as “the eminently qualified physician?” You’ll have to define that standard in order to reach it.

This post was inspired by the “Set Standards. Aspire to Achieve Them” episode of Jocko Podcast.

Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

Just how good are you? Are you a pretty good doc? A better-than-average leader? Or, are you truly an eminently qualified physician?

For all the talk about maintenance of certification and continuing medical education, it isn’t easy to know if you really are a good physician, teacher, or leader. In medicine, we’re careful to show respect to each other and tend to be slow to be critical. This might seem a kind approach to feedback, but I wonder if it is.

There are other professions where evaluations and feedback are more direct. In the military, performance standards are often quite explicit. The Marines, for instance, take performance evaluations seriously. This is evident if you’ve ever completed, or been a recipient of, a U.S. Marine Corps fitness report. Reading it, I realized many of the criteria could apply to us in medicine. Here are a few examples from that form (lightly modified for physicians).

Think about your clinical and technical expertise. Would you grade yourself as “competent. Possesses requisite range of skills and knowledge commensurate with training and experience?” Or maybe the next grade “demonstrates mastery of all required skills. Expertise, education and experience consistently enhance department. Innovative troubleshooter and problem solver. Effectively imparts skills to trainees.” Or perhaps you’re a “true expert in the field. Knowledge and skills impact far beyond those of peers. Translates broad-based education into forward-thinking, innovative actions. Makes immeasurable impact on department. Peerless teacher, selflessly imparts expertise to peers, residents, students.”

What about your effectiveness under stress?

Do you act “commensurate with your training and role?” Or do you have an “uncanny ability to anticipate requirements and quickly formulate original solutions?” Do you always “take decisive, effective action?”

How about your leadership performance?

Are you simply “engaged, providing instruction and direction?” Or do you “achieve a highly effective balance between direction and delegation, effectively tasking subordinates and clearly delineating standards expected?” A few of us even “engender willing loyalty and trust that allow subordinates to overcome their perceived limitations.” And exhibit “leadership that fosters the highest levels of motivation and morale, ensuring accomplishment in the most difficult circumstances.”

We might even mitigate physician burnout better if we had better performance standards. For example, do you simply “deal confidently with issues pertinent to subordinate welfare and recognize suitable courses of action?” Maybe you’re at the next level, “actively fostering the development of and uses of support systems for subordinates which improve their ability to perform.” I’m fortunate to know a few physician leaders who “noticeably enhance subordinate well-being, resulting in measurable increase in department effectiveness and proactively energize team members to ‘take care of their own.’ Widely recognized for techniques and policies that produce results and build morale.” By codifying what the standard should be, we can better hold ourselves accountable for our performance. In doing so, we might be better at recognizing and reducing burnout in our direct reports and peers.

The final question on the Marine fitness report is a comparative assessment. The evaluating officer checks one of the following boxes: 1. Unsatisfactory; 2. A qualified Marine; 3. One of many highly qualified Marines; 4. One of the few exceptionally qualified Marines; or, 5. The eminently qualified Marine.

Which are you? Can you describe yourself as “the eminently qualified physician?” You’ll have to define that standard in order to reach it.

This post was inspired by the “Set Standards. Aspire to Achieve Them” episode of Jocko Podcast.

Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

Hurray! We’re getting a version update of our electronic medical record (EMR) this month. Of course, I might be overplaying my excitement here: EMR updates are emotionally closest to a trip to the dentist – usually turn out fine, but hardly worth circling on the calendar.

copyright BrianAJackson/Thinkstock

Like a good dental cleaning however, these updates can be beneficial. Although uncomfortable, EMR redesigned menus and shortcuts can help – once you’re used to them. It typically doesn’t take long for most of us to learn the “improvements” so we’re at least not worse off. It is also a good time to update customized features. I try to use updates as an opportunity to refresh SmartPhrases, update order preferences, or rearrange my desktop to be more efficient.

Given how much my quality of life depends upon my EMR skills, it’s a shame I don’t make an effort to work on it more often. Really, why wait to make improvements just once a year? Why not get better every day?

This idea of continuous improvement is a popular meme in the self-improvement community right now. Instead of working on goals or adjusting your routine episodically, set an intention to get better, just a little, daily. Sometimes it’s described as the 1% model. The idea is that improving your habits or work flow by 1% each day will yield compound benefits with time. It is an aggregation of marginal gains with a surprising payout. For example, daily 1% improvements would mean you are 37 times more effective by the end of a year. Now, I don’t believe this mathematical model is necessarily accurate or even necessary. But the concept that a little development done daily yields lasting improvement seems to be true.

The corollary, that if you got a little worse each day, you’d be much worse off at the end of a year, is also reasonable. That’s how most health problems set in: continuous and insidious aggregation of bad choices. Why then not use that same principle for good instead?

The Japanese thought of this idea a generation ago. Applied to manufacturing, they called it Kaizen, “continuous improvement.” It was a managerial principle that reminded people to look for opportunities to improve, just a little, wherever they were in the process and to do so each day. It led to remarkable reductions in waste and became a key to their economic success.

Opportunities for relentless improvement abound in our work too. For example, when you write an order or work up a diagnosis, rather than just enter it, you might save it as a panel. When you find yourself using the same word or phrase, save it to your dictionary to pull it up with minimal keystrokes. When you research a difficult disease you’ve not seen lately, save the diagnostic questions as a template so you can pull it up in real time the next time it walks in. When you set up your procedure tray, place items so they can be picked up efficiently and moved out of the way quickly. No matter how good your setup or template is today, you can find a tiny improvement that would make it a little better tomorrow. And you’ll reap gains from that day forward.

I don’t expect this EMR update will have much impact on my quality of life. It will however be a reminder that like flossing, improvements are best done daily. You and your dentist will thank me someday.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

Hurray! We’re getting a version update of our electronic medical record (EMR) this month. Of course, I might be overplaying my excitement here: EMR updates are emotionally closest to a trip to the dentist – usually turn out fine, but hardly worth circling on the calendar.

copyright BrianAJackson/Thinkstock

Like a good dental cleaning however, these updates can be beneficial. Although uncomfortable, EMR redesigned menus and shortcuts can help – once you’re used to them. It typically doesn’t take long for most of us to learn the “improvements” so we’re at least not worse off. It is also a good time to update customized features. I try to use updates as an opportunity to refresh SmartPhrases, update order preferences, or rearrange my desktop to be more efficient.

Given how much my quality of life depends upon my EMR skills, it’s a shame I don’t make an effort to work on it more often. Really, why wait to make improvements just once a year? Why not get better every day?

This idea of continuous improvement is a popular meme in the self-improvement community right now. Instead of working on goals or adjusting your routine episodically, set an intention to get better, just a little, daily. Sometimes it’s described as the 1% model. The idea is that improving your habits or work flow by 1% each day will yield compound benefits with time. It is an aggregation of marginal gains with a surprising payout. For example, daily 1% improvements would mean you are 37 times more effective by the end of a year. Now, I don’t believe this mathematical model is necessarily accurate or even necessary. But the concept that a little development done daily yields lasting improvement seems to be true.

The corollary, that if you got a little worse each day, you’d be much worse off at the end of a year, is also reasonable. That’s how most health problems set in: continuous and insidious aggregation of bad choices. Why then not use that same principle for good instead?

The Japanese thought of this idea a generation ago. Applied to manufacturing, they called it Kaizen, “continuous improvement.” It was a managerial principle that reminded people to look for opportunities to improve, just a little, wherever they were in the process and to do so each day. It led to remarkable reductions in waste and became a key to their economic success.

Opportunities for relentless improvement abound in our work too. For example, when you write an order or work up a diagnosis, rather than just enter it, you might save it as a panel. When you find yourself using the same word or phrase, save it to your dictionary to pull it up with minimal keystrokes. When you research a difficult disease you’ve not seen lately, save the diagnostic questions as a template so you can pull it up in real time the next time it walks in. When you set up your procedure tray, place items so they can be picked up efficiently and moved out of the way quickly. No matter how good your setup or template is today, you can find a tiny improvement that would make it a little better tomorrow. And you’ll reap gains from that day forward.

I don’t expect this EMR update will have much impact on my quality of life. It will however be a reminder that like flossing, improvements are best done daily. You and your dentist will thank me someday.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

Hurray! We’re getting a version update of our electronic medical record (EMR) this month. Of course, I might be overplaying my excitement here: EMR updates are emotionally closest to a trip to the dentist – usually turn out fine, but hardly worth circling on the calendar.

copyright BrianAJackson/Thinkstock

Like a good dental cleaning however, these updates can be beneficial. Although uncomfortable, EMR redesigned menus and shortcuts can help – once you’re used to them. It typically doesn’t take long for most of us to learn the “improvements” so we’re at least not worse off. It is also a good time to update customized features. I try to use updates as an opportunity to refresh SmartPhrases, update order preferences, or rearrange my desktop to be more efficient.

Given how much my quality of life depends upon my EMR skills, it’s a shame I don’t make an effort to work on it more often. Really, why wait to make improvements just once a year? Why not get better every day?

This idea of continuous improvement is a popular meme in the self-improvement community right now. Instead of working on goals or adjusting your routine episodically, set an intention to get better, just a little, daily. Sometimes it’s described as the 1% model. The idea is that improving your habits or work flow by 1% each day will yield compound benefits with time. It is an aggregation of marginal gains with a surprising payout. For example, daily 1% improvements would mean you are 37 times more effective by the end of a year. Now, I don’t believe this mathematical model is necessarily accurate or even necessary. But the concept that a little development done daily yields lasting improvement seems to be true.

The corollary, that if you got a little worse each day, you’d be much worse off at the end of a year, is also reasonable. That’s how most health problems set in: continuous and insidious aggregation of bad choices. Why then not use that same principle for good instead?

The Japanese thought of this idea a generation ago. Applied to manufacturing, they called it Kaizen, “continuous improvement.” It was a managerial principle that reminded people to look for opportunities to improve, just a little, wherever they were in the process and to do so each day. It led to remarkable reductions in waste and became a key to their economic success.

Opportunities for relentless improvement abound in our work too. For example, when you write an order or work up a diagnosis, rather than just enter it, you might save it as a panel. When you find yourself using the same word or phrase, save it to your dictionary to pull it up with minimal keystrokes. When you research a difficult disease you’ve not seen lately, save the diagnostic questions as a template so you can pull it up in real time the next time it walks in. When you set up your procedure tray, place items so they can be picked up efficiently and moved out of the way quickly. No matter how good your setup or template is today, you can find a tiny improvement that would make it a little better tomorrow. And you’ll reap gains from that day forward.

I don’t expect this EMR update will have much impact on my quality of life. It will however be a reminder that like flossing, improvements are best done daily. You and your dentist will thank me someday.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

There is little to want for living in San Diego, America’s Finest City. The weather here is 72 and sunny year round. Yet, there are shortcomings. For one, there are no Forsythia. Forsythia are the deciduous shrubs that act as the harbingers of spring, blooming brilliant yellow across cold gray damp parts of the United States right now.

KiHoon/Getty Images

I grew up in New England where Forsythia bushes flower this time of year – a most welcome sign that the winter’s worst was over. Along with the purple crocus plants popping up in the warm bits of grass that breaks through the snow, seeing the Forsythia bloom always evoked that most appealing of feelings, hope. Hope that the discomfort of winter has passed. Hope that the beauty of nature will return. A promise that this year’s cycle of life will continue.

Hope is what we give our patients every day. Whatever their disease, their cancer, their distress, we can see a future that is better for them. A future with less suffering or with more joy. And as their doctors, we can help them get there.

A newly insured patient came to see me today. She had severe psoriasis. Her face, masked with red scaly patches, was heavy with the burden of the long winter she had endured. She was itchy and flaky and so embarrassed as to struggle to make eye contact with me. When I told her that we could help her, that there are treatments for her that would clear up the psoriasis and relieve her symptoms, she started to cry. Her husband intervened, apologizing for her. “I’m sorry. She has had this for so long, and you are the first person to tell her that she can get better. You have given us hope.”

Milenius/Getty Images

When I walked back to my office I noticed the Rhode Island flag that I have mounted. Under the stars and blue anchor on it is the word “hope.” In 1664, when the state seal was created, it was the most important of ideas. It is why the settlers of Rhode Island risked their lives to cross an ocean to start anew, why my ancestors came from Italy two centuries later, why my parents sent me to college, why I decided to try for medicine. It is what most of us give every day. Hope, the ability to see into the future and bring that feeling back to the present. The belief that whatever and wherever you are, soon it will be even better. It cannot, however, be commanded. You can’t insist a patient hope any more than you can make them love. You must first understand what they see and feel, then show them how things might be better through trust.

Throughout life, hope creates possibilities. It unites us. It motivates us. It is the destroyer of winter and of burnout and of disease. It is one of the most important gifts that we give patients, and we do it everyday. Tomorrow in your practice, notice how often you foster it. Pay attention to how your patient changes the moment you give it to them. Watch the Forsythia bloom as you reassure them that their spring will return again.

“We must accept finite disappointment, but never lose infinite hope.” – Martin Luther King Jr.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

There is little to want for living in San Diego, America’s Finest City. The weather here is 72 and sunny year round. Yet, there are shortcomings. For one, there are no Forsythia. Forsythia are the deciduous shrubs that act as the harbingers of spring, blooming brilliant yellow across cold gray damp parts of the United States right now.

KiHoon/Getty Images

I grew up in New England where Forsythia bushes flower this time of year – a most welcome sign that the winter’s worst was over. Along with the purple crocus plants popping up in the warm bits of grass that breaks through the snow, seeing the Forsythia bloom always evoked that most appealing of feelings, hope. Hope that the discomfort of winter has passed. Hope that the beauty of nature will return. A promise that this year’s cycle of life will continue.

Hope is what we give our patients every day. Whatever their disease, their cancer, their distress, we can see a future that is better for them. A future with less suffering or with more joy. And as their doctors, we can help them get there.

A newly insured patient came to see me today. She had severe psoriasis. Her face, masked with red scaly patches, was heavy with the burden of the long winter she had endured. She was itchy and flaky and so embarrassed as to struggle to make eye contact with me. When I told her that we could help her, that there are treatments for her that would clear up the psoriasis and relieve her symptoms, she started to cry. Her husband intervened, apologizing for her. “I’m sorry. She has had this for so long, and you are the first person to tell her that she can get better. You have given us hope.”

Milenius/Getty Images

When I walked back to my office I noticed the Rhode Island flag that I have mounted. Under the stars and blue anchor on it is the word “hope.” In 1664, when the state seal was created, it was the most important of ideas. It is why the settlers of Rhode Island risked their lives to cross an ocean to start anew, why my ancestors came from Italy two centuries later, why my parents sent me to college, why I decided to try for medicine. It is what most of us give every day. Hope, the ability to see into the future and bring that feeling back to the present. The belief that whatever and wherever you are, soon it will be even better. It cannot, however, be commanded. You can’t insist a patient hope any more than you can make them love. You must first understand what they see and feel, then show them how things might be better through trust.

Throughout life, hope creates possibilities. It unites us. It motivates us. It is the destroyer of winter and of burnout and of disease. It is one of the most important gifts that we give patients, and we do it everyday. Tomorrow in your practice, notice how often you foster it. Pay attention to how your patient changes the moment you give it to them. Watch the Forsythia bloom as you reassure them that their spring will return again.

“We must accept finite disappointment, but never lose infinite hope.” – Martin Luther King Jr.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

There is little to want for living in San Diego, America’s Finest City. The weather here is 72 and sunny year round. Yet, there are shortcomings. For one, there are no Forsythia. Forsythia are the deciduous shrubs that act as the harbingers of spring, blooming brilliant yellow across cold gray damp parts of the United States right now.

KiHoon/Getty Images

I grew up in New England where Forsythia bushes flower this time of year – a most welcome sign that the winter’s worst was over. Along with the purple crocus plants popping up in the warm bits of grass that breaks through the snow, seeing the Forsythia bloom always evoked that most appealing of feelings, hope. Hope that the discomfort of winter has passed. Hope that the beauty of nature will return. A promise that this year’s cycle of life will continue.

Hope is what we give our patients every day. Whatever their disease, their cancer, their distress, we can see a future that is better for them. A future with less suffering or with more joy. And as their doctors, we can help them get there.

A newly insured patient came to see me today. She had severe psoriasis. Her face, masked with red scaly patches, was heavy with the burden of the long winter she had endured. She was itchy and flaky and so embarrassed as to struggle to make eye contact with me. When I told her that we could help her, that there are treatments for her that would clear up the psoriasis and relieve her symptoms, she started to cry. Her husband intervened, apologizing for her. “I’m sorry. She has had this for so long, and you are the first person to tell her that she can get better. You have given us hope.”

Milenius/Getty Images

When I walked back to my office I noticed the Rhode Island flag that I have mounted. Under the stars and blue anchor on it is the word “hope.” In 1664, when the state seal was created, it was the most important of ideas. It is why the settlers of Rhode Island risked their lives to cross an ocean to start anew, why my ancestors came from Italy two centuries later, why my parents sent me to college, why I decided to try for medicine. It is what most of us give every day. Hope, the ability to see into the future and bring that feeling back to the present. The belief that whatever and wherever you are, soon it will be even better. It cannot, however, be commanded. You can’t insist a patient hope any more than you can make them love. You must first understand what they see and feel, then show them how things might be better through trust.

Throughout life, hope creates possibilities. It unites us. It motivates us. It is the destroyer of winter and of burnout and of disease. It is one of the most important gifts that we give patients, and we do it everyday. Tomorrow in your practice, notice how often you foster it. Pay attention to how your patient changes the moment you give it to them. Watch the Forsythia bloom as you reassure them that their spring will return again.

“We must accept finite disappointment, but never lose infinite hope.” – Martin Luther King Jr.
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

For most things, the harder you work at it, the more successful you’ll be. Except when it comes to sleep. Nothing frightens sleep away faster than an all-out effort to find it. And yet, it should be the easiest of all health habits to cultivate. Sleep should be a hardwired, physiologic, default condition (sort of like eating and sex, all are which are evolutionary imperatives). And yet, lack of sleep is a common and grave problem even in our safe and comfortable modern environment.

tru/E+/Getty Images

Sleep really is the keystone to your health, without which all other healthy choices would fall to the ground, ineffectual. Lack of sleep depletes your willpower, making it less likely you’ll actually go to the gym or be able to resist that bear claw pastry calling you back to the break room. Poor sleep impairs your ability to lose and keep off weight. It can lead to mistakes of inattention – a problem if you’re flying a plane or screening for melanoma.

As a recovering insomniac, I’ve scouted out the territory for you and have taken a few notes as a Baedeker on your journey to better sleep. Tracking sleep is easy; most any fitness tracker or smart watch outfitted with the right app will do the work for you. I’ve used my Apple Watch and Pillow for years. (I’ve no conflict of interest). I’ve found that the quality score it provides each night is interesting, but not all that important. Using pad and paper you could just as easily quantify your sleep: How many hours were you in bed, asleep, and how did you feel the next day.

Here is something important I learned about myself: I don’t need 8 hours. You might not either. Most articles say that we adults need 7-8 hours of sleep. I wasted a lot of effort trying to keep it above the 7-hour mark. Then I realized that even on nights when I got 6-7, I felt fine the next day! Don’t assume you need 8 hours. It could be 6 or it could be 9. It might in fact change depending on how you slept recently, what is happening in your life, or which season it is. If you feel alert and well rested, then you’ve likely found all the sleep you need.

Let’s assume you aren’t well rested. Now what? Like most of good health, a behavioral approach is needed to get you on the right path. You’ve likely heard that bright, particularly blue, light is harmful to falling asleep. Good news! Most devices will let you filter blue light out if you must continue that “Better Call Saul” binge. Better options: Leave your tablet in the living room and plug in your phone on the opposite side of the room (with a short cord). Invest instead in a book light and actual books. There is something about the patina of paper that can encourage sleep to come find you.

Keep the room comfortably cool. What’s important here is the temperature drop. That is, going from warm to cool. This is why a warm shower or bath before getting into bed can help you. Your temperature will drop, a signal for sleep.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

For most things, the harder you work at it, the more successful you’ll be. Except when it comes to sleep. Nothing frightens sleep away faster than an all-out effort to find it. And yet, it should be the easiest of all health habits to cultivate. Sleep should be a hardwired, physiologic, default condition (sort of like eating and sex, all are which are evolutionary imperatives). And yet, lack of sleep is a common and grave problem even in our safe and comfortable modern environment.

tru/E+/Getty Images

Sleep really is the keystone to your health, without which all other healthy choices would fall to the ground, ineffectual. Lack of sleep depletes your willpower, making it less likely you’ll actually go to the gym or be able to resist that bear claw pastry calling you back to the break room. Poor sleep impairs your ability to lose and keep off weight. It can lead to mistakes of inattention – a problem if you’re flying a plane or screening for melanoma.

As a recovering insomniac, I’ve scouted out the territory for you and have taken a few notes as a Baedeker on your journey to better sleep. Tracking sleep is easy; most any fitness tracker or smart watch outfitted with the right app will do the work for you. I’ve used my Apple Watch and Pillow for years. (I’ve no conflict of interest). I’ve found that the quality score it provides each night is interesting, but not all that important. Using pad and paper you could just as easily quantify your sleep: How many hours were you in bed, asleep, and how did you feel the next day.

Here is something important I learned about myself: I don’t need 8 hours. You might not either. Most articles say that we adults need 7-8 hours of sleep. I wasted a lot of effort trying to keep it above the 7-hour mark. Then I realized that even on nights when I got 6-7, I felt fine the next day! Don’t assume you need 8 hours. It could be 6 or it could be 9. It might in fact change depending on how you slept recently, what is happening in your life, or which season it is. If you feel alert and well rested, then you’ve likely found all the sleep you need.

Let’s assume you aren’t well rested. Now what? Like most of good health, a behavioral approach is needed to get you on the right path. You’ve likely heard that bright, particularly blue, light is harmful to falling asleep. Good news! Most devices will let you filter blue light out if you must continue that “Better Call Saul” binge. Better options: Leave your tablet in the living room and plug in your phone on the opposite side of the room (with a short cord). Invest instead in a book light and actual books. There is something about the patina of paper that can encourage sleep to come find you.

Keep the room comfortably cool. What’s important here is the temperature drop. That is, going from warm to cool. This is why a warm shower or bath before getting into bed can help you. Your temperature will drop, a signal for sleep.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

For most things, the harder you work at it, the more successful you’ll be. Except when it comes to sleep. Nothing frightens sleep away faster than an all-out effort to find it. And yet, it should be the easiest of all health habits to cultivate. Sleep should be a hardwired, physiologic, default condition (sort of like eating and sex, all are which are evolutionary imperatives). And yet, lack of sleep is a common and grave problem even in our safe and comfortable modern environment.

tru/E+/Getty Images

Sleep really is the keystone to your health, without which all other healthy choices would fall to the ground, ineffectual. Lack of sleep depletes your willpower, making it less likely you’ll actually go to the gym or be able to resist that bear claw pastry calling you back to the break room. Poor sleep impairs your ability to lose and keep off weight. It can lead to mistakes of inattention – a problem if you’re flying a plane or screening for melanoma.

As a recovering insomniac, I’ve scouted out the territory for you and have taken a few notes as a Baedeker on your journey to better sleep. Tracking sleep is easy; most any fitness tracker or smart watch outfitted with the right app will do the work for you. I’ve used my Apple Watch and Pillow for years. (I’ve no conflict of interest). I’ve found that the quality score it provides each night is interesting, but not all that important. Using pad and paper you could just as easily quantify your sleep: How many hours were you in bed, asleep, and how did you feel the next day.

Here is something important I learned about myself: I don’t need 8 hours. You might not either. Most articles say that we adults need 7-8 hours of sleep. I wasted a lot of effort trying to keep it above the 7-hour mark. Then I realized that even on nights when I got 6-7, I felt fine the next day! Don’t assume you need 8 hours. It could be 6 or it could be 9. It might in fact change depending on how you slept recently, what is happening in your life, or which season it is. If you feel alert and well rested, then you’ve likely found all the sleep you need.

Let’s assume you aren’t well rested. Now what? Like most of good health, a behavioral approach is needed to get you on the right path. You’ve likely heard that bright, particularly blue, light is harmful to falling asleep. Good news! Most devices will let you filter blue light out if you must continue that “Better Call Saul” binge. Better options: Leave your tablet in the living room and plug in your phone on the opposite side of the room (with a short cord). Invest instead in a book light and actual books. There is something about the patina of paper that can encourage sleep to come find you.

Keep the room comfortably cool. What’s important here is the temperature drop. That is, going from warm to cool. This is why a warm shower or bath before getting into bed can help you. Your temperature will drop, a signal for sleep.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com.

There were lots of lovely books published last year. As usual, I’ve only finished some of the many I purchased. Here are a few I liked that you might also enjoy.

Bellott/Getty Images

“Enlightenment Now: The Case for Reason, Science, Humanism, and Progress,” by Steven Pinker, PhD (New York:Viking, 2018). Think life was better 50 years ago? 100? 500? Steven Pinker would say you’re wrong. Whether or not we feel it, empirically, life is better today than it ever has been. We are living longer, healthier lives, have better access to health care, have fewer war-related deaths and food shortages and higher levels of literacy and equal rights. However, Dr. Pinker acknowledges our shortcomings (e.g., providing a living wage) and potential societal pitfalls (e.g., increasing tribalism), although he could have addressed other crucial issues such as climate change more fully. If you’re looking for an optimistic, science-based outlook on humanity, look no further than this book.

“Aware: The Science and Practice of Presence – The Groundbreaking Meditation Practice,” by Daniel J. Siegel, MD (New York:TarcherPerigee, 2018). A clinical professor of psychiatry and director of the UCLA Mindful Awareness Research Center, Dr. Siegel, in his latest book, constructs a compelling argument for practicing presence that is supported by ample scientific evidence. His “Wheel of Awareness” is a tool to cultivate presence, self-awareness, and compassion. He deftly shows how developing “open awareness” and “kind intention” has not only psychological benefits, but also physical ones, such as improving immune function and increasing neural integration in the brain. As he writes, “The scientific findings are now in: Your mind can change the health of your body and slow aging.” That’s a message both we physicians and our patients could benefit from hearing more often.

“When: The Scientific Secrets of Perfect Timing,” by Daniel H. Pink (New York: Riverhead Books, 2018). In his latest book, Mr. Pink delves into timing, and the evolving science of timing, which draws from fields that include biology, psychology, neuroscience, and economics. Through extensive research (he analyzed over 700 studies) and fascinating real-life examples, the data are clear: We overwhelmingly perform optimally in the morning, suffer a mid-day slump, then rally once more in the evening (of course, there are productive night owls too). These peaks and dips affect both our moods and decision-making abilities, resulting in real-world impact (judges, for example, are more lenient in sentencing following a break). With practical takeaways you can immediately incorporate into your daily routine, you can start to feel more productive, energized, and happy, which is good news for both you and your patients.

“Natural Causes An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer,” by Barbara Ehrenreich, PhD (New York:Twelve, 2018). Infuriating, tender, disquieting, moving. Barbara Ehrenreich’s latest book is provocative. As a septuagenarian and cancer survivor who has forsworn most future medical measures, including Pap smears and cancer screenings (even though she has medical insurance), Dr. Ehrenreich castigates both the traditional medical and integrative holistic health establishments. Yes, she’s critical of us and nurses and fitness gurus and mindfulness coaches and Silicon Valley. Why should I read this you ask? Because it’s good to understand contrarian views, especially when they are thoughtfully articulated. Because there are many patients who share her beliefs, and understanding opposing perspectives might help us become better clinicians. Because she may cause you to be reflective. Do we order too many tests? Do we overprescribe meds? Are we setting up patients for false hopes of longevity? Is providing more care always the best option? This exercise is beneficial for all types of healers.

“Leadership in Turbulent Times,” by Doris Kearns Goodwin, PhD, (New York:Simon & Schuster, 2018). I’m a presidential biography junkie. As physicians in what some may rightly call a turbulent health care culture, we face challenges each day that require our best intentions, our best diagnostic skills, our best empathic efforts, our best selves. Dr. Goodwin, in her prototypical engaging and informative prose, shows us four American presidents, Abraham Lincoln, Theodore Roosevelt, Franklin D. Roosevelt, and Lyndon B. Johnson, who persevered through devastatingly turbulent times. While we don’t have to make decisions regarding warfare, we do have an unmistakable impact on the lives of thousands of patients, and this book provides insights that can help all of us become better informed, better prepared leaders for our patients, our coworkers, and our communities at large.

“You and I Eat the Same: On the Countless Ways Food and Cooking Connect Us to One Another,” edited by Chris Ying; foreword by René Redzepi (New York:Artisan, 2018). Open a newspaper or turn on the news, and it’s difficult not to feel as if we live in an alarmingly polarized society. We can find many issues that divide us, but as healers, I hope we also strive to find ways to connect us. In 19 engaging and thought-provoking essays, this book explores the various ways that food connects us as humans. Whether it’s an historical deep dive into our love of meat wrapped in flatbread (which we’ve been doing for over 1,000 years) or tackling philosophical questions like, “Is there such a thing as a ‘non-ethnic’ restaurant?” this book will inform, inspire, and delight, and provide delicious topics for a bite of small talk with your patients.

“The Great Alone,” by Kristin Hannah (New York:St. Martin’s Press, 2018). Lured by Alaska’s majestic splendor and remoteness, the Allbright family (former POW, Ernt; abused wife, Cora; and coming-of-age daughter, Leni) are happy with their new life. For a minute. What ensues, namely punishing 16-hour days of darkness punctuated by episodes of oppressive snowfall, paranoia, and domestic violence, is grueling: “Night swept in like nothing Leni had ever seen before, like the winged shadow of a creature too big and predatory to comprehend.” Yet, this book is also a story about the bonds of family, both those we are born into and those we choose, love, sacrifice, and resilience.

If you have any books you read over the last to year to add to this list, please write to me at dermnews@mdedge.com.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter.

There were lots of lovely books published last year. As usual, I’ve only finished some of the many I purchased. Here are a few I liked that you might also enjoy.

Bellott/Getty Images

“Enlightenment Now: The Case for Reason, Science, Humanism, and Progress,” by Steven Pinker, PhD (New York:Viking, 2018). Think life was better 50 years ago? 100? 500? Steven Pinker would say you’re wrong. Whether or not we feel it, empirically, life is better today than it ever has been. We are living longer, healthier lives, have better access to health care, have fewer war-related deaths and food shortages and higher levels of literacy and equal rights. However, Dr. Pinker acknowledges our shortcomings (e.g., providing a living wage) and potential societal pitfalls (e.g., increasing tribalism), although he could have addressed other crucial issues such as climate change more fully. If you’re looking for an optimistic, science-based outlook on humanity, look no further than this book.

“Aware: The Science and Practice of Presence – The Groundbreaking Meditation Practice,” by Daniel J. Siegel, MD (New York:TarcherPerigee, 2018). A clinical professor of psychiatry and director of the UCLA Mindful Awareness Research Center, Dr. Siegel, in his latest book, constructs a compelling argument for practicing presence that is supported by ample scientific evidence. His “Wheel of Awareness” is a tool to cultivate presence, self-awareness, and compassion. He deftly shows how developing “open awareness” and “kind intention” has not only psychological benefits, but also physical ones, such as improving immune function and increasing neural integration in the brain. As he writes, “The scientific findings are now in: Your mind can change the health of your body and slow aging.” That’s a message both we physicians and our patients could benefit from hearing more often.

“When: The Scientific Secrets of Perfect Timing,” by Daniel H. Pink (New York: Riverhead Books, 2018). In his latest book, Mr. Pink delves into timing, and the evolving science of timing, which draws from fields that include biology, psychology, neuroscience, and economics. Through extensive research (he analyzed over 700 studies) and fascinating real-life examples, the data are clear: We overwhelmingly perform optimally in the morning, suffer a mid-day slump, then rally once more in the evening (of course, there are productive night owls too). These peaks and dips affect both our moods and decision-making abilities, resulting in real-world impact (judges, for example, are more lenient in sentencing following a break). With practical takeaways you can immediately incorporate into your daily routine, you can start to feel more productive, energized, and happy, which is good news for both you and your patients.

“Natural Causes An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer,” by Barbara Ehrenreich, PhD (New York:Twelve, 2018). Infuriating, tender, disquieting, moving. Barbara Ehrenreich’s latest book is provocative. As a septuagenarian and cancer survivor who has forsworn most future medical measures, including Pap smears and cancer screenings (even though she has medical insurance), Dr. Ehrenreich castigates both the traditional medical and integrative holistic health establishments. Yes, she’s critical of us and nurses and fitness gurus and mindfulness coaches and Silicon Valley. Why should I read this you ask? Because it’s good to understand contrarian views, especially when they are thoughtfully articulated. Because there are many patients who share her beliefs, and understanding opposing perspectives might help us become better clinicians. Because she may cause you to be reflective. Do we order too many tests? Do we overprescribe meds? Are we setting up patients for false hopes of longevity? Is providing more care always the best option? This exercise is beneficial for all types of healers.

“Leadership in Turbulent Times,” by Doris Kearns Goodwin, PhD, (New York:Simon & Schuster, 2018). I’m a presidential biography junkie. As physicians in what some may rightly call a turbulent health care culture, we face challenges each day that require our best intentions, our best diagnostic skills, our best empathic efforts, our best selves. Dr. Goodwin, in her prototypical engaging and informative prose, shows us four American presidents, Abraham Lincoln, Theodore Roosevelt, Franklin D. Roosevelt, and Lyndon B. Johnson, who persevered through devastatingly turbulent times. While we don’t have to make decisions regarding warfare, we do have an unmistakable impact on the lives of thousands of patients, and this book provides insights that can help all of us become better informed, better prepared leaders for our patients, our coworkers, and our communities at large.

“You and I Eat the Same: On the Countless Ways Food and Cooking Connect Us to One Another,” edited by Chris Ying; foreword by René Redzepi (New York:Artisan, 2018). Open a newspaper or turn on the news, and it’s difficult not to feel as if we live in an alarmingly polarized society. We can find many issues that divide us, but as healers, I hope we also strive to find ways to connect us. In 19 engaging and thought-provoking essays, this book explores the various ways that food connects us as humans. Whether it’s an historical deep dive into our love of meat wrapped in flatbread (which we’ve been doing for over 1,000 years) or tackling philosophical questions like, “Is there such a thing as a ‘non-ethnic’ restaurant?” this book will inform, inspire, and delight, and provide delicious topics for a bite of small talk with your patients.

“The Great Alone,” by Kristin Hannah (New York:St. Martin’s Press, 2018). Lured by Alaska’s majestic splendor and remoteness, the Allbright family (former POW, Ernt; abused wife, Cora; and coming-of-age daughter, Leni) are happy with their new life. For a minute. What ensues, namely punishing 16-hour days of darkness punctuated by episodes of oppressive snowfall, paranoia, and domestic violence, is grueling: “Night swept in like nothing Leni had ever seen before, like the winged shadow of a creature too big and predatory to comprehend.” Yet, this book is also a story about the bonds of family, both those we are born into and those we choose, love, sacrifice, and resilience.

If you have any books you read over the last to year to add to this list, please write to me at dermnews@mdedge.com.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter.

There were lots of lovely books published last year. As usual, I’ve only finished some of the many I purchased. Here are a few I liked that you might also enjoy.

Bellott/Getty Images

“Enlightenment Now: The Case for Reason, Science, Humanism, and Progress,” by Steven Pinker, PhD (New York:Viking, 2018). Think life was better 50 years ago? 100? 500? Steven Pinker would say you’re wrong. Whether or not we feel it, empirically, life is better today than it ever has been. We are living longer, healthier lives, have better access to health care, have fewer war-related deaths and food shortages and higher levels of literacy and equal rights. However, Dr. Pinker acknowledges our shortcomings (e.g., providing a living wage) and potential societal pitfalls (e.g., increasing tribalism), although he could have addressed other crucial issues such as climate change more fully. If you’re looking for an optimistic, science-based outlook on humanity, look no further than this book.

“Aware: The Science and Practice of Presence – The Groundbreaking Meditation Practice,” by Daniel J. Siegel, MD (New York:TarcherPerigee, 2018). A clinical professor of psychiatry and director of the UCLA Mindful Awareness Research Center, Dr. Siegel, in his latest book, constructs a compelling argument for practicing presence that is supported by ample scientific evidence. His “Wheel of Awareness” is a tool to cultivate presence, self-awareness, and compassion. He deftly shows how developing “open awareness” and “kind intention” has not only psychological benefits, but also physical ones, such as improving immune function and increasing neural integration in the brain. As he writes, “The scientific findings are now in: Your mind can change the health of your body and slow aging.” That’s a message both we physicians and our patients could benefit from hearing more often.

“When: The Scientific Secrets of Perfect Timing,” by Daniel H. Pink (New York: Riverhead Books, 2018). In his latest book, Mr. Pink delves into timing, and the evolving science of timing, which draws from fields that include biology, psychology, neuroscience, and economics. Through extensive research (he analyzed over 700 studies) and fascinating real-life examples, the data are clear: We overwhelmingly perform optimally in the morning, suffer a mid-day slump, then rally once more in the evening (of course, there are productive night owls too). These peaks and dips affect both our moods and decision-making abilities, resulting in real-world impact (judges, for example, are more lenient in sentencing following a break). With practical takeaways you can immediately incorporate into your daily routine, you can start to feel more productive, energized, and happy, which is good news for both you and your patients.

“Natural Causes An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer,” by Barbara Ehrenreich, PhD (New York:Twelve, 2018). Infuriating, tender, disquieting, moving. Barbara Ehrenreich’s latest book is provocative. As a septuagenarian and cancer survivor who has forsworn most future medical measures, including Pap smears and cancer screenings (even though she has medical insurance), Dr. Ehrenreich castigates both the traditional medical and integrative holistic health establishments. Yes, she’s critical of us and nurses and fitness gurus and mindfulness coaches and Silicon Valley. Why should I read this you ask? Because it’s good to understand contrarian views, especially when they are thoughtfully articulated. Because there are many patients who share her beliefs, and understanding opposing perspectives might help us become better clinicians. Because she may cause you to be reflective. Do we order too many tests? Do we overprescribe meds? Are we setting up patients for false hopes of longevity? Is providing more care always the best option? This exercise is beneficial for all types of healers.

“Leadership in Turbulent Times,” by Doris Kearns Goodwin, PhD, (New York:Simon & Schuster, 2018). I’m a presidential biography junkie. As physicians in what some may rightly call a turbulent health care culture, we face challenges each day that require our best intentions, our best diagnostic skills, our best empathic efforts, our best selves. Dr. Goodwin, in her prototypical engaging and informative prose, shows us four American presidents, Abraham Lincoln, Theodore Roosevelt, Franklin D. Roosevelt, and Lyndon B. Johnson, who persevered through devastatingly turbulent times. While we don’t have to make decisions regarding warfare, we do have an unmistakable impact on the lives of thousands of patients, and this book provides insights that can help all of us become better informed, better prepared leaders for our patients, our coworkers, and our communities at large.

“You and I Eat the Same: On the Countless Ways Food and Cooking Connect Us to One Another,” edited by Chris Ying; foreword by René Redzepi (New York:Artisan, 2018). Open a newspaper or turn on the news, and it’s difficult not to feel as if we live in an alarmingly polarized society. We can find many issues that divide us, but as healers, I hope we also strive to find ways to connect us. In 19 engaging and thought-provoking essays, this book explores the various ways that food connects us as humans. Whether it’s an historical deep dive into our love of meat wrapped in flatbread (which we’ve been doing for over 1,000 years) or tackling philosophical questions like, “Is there such a thing as a ‘non-ethnic’ restaurant?” this book will inform, inspire, and delight, and provide delicious topics for a bite of small talk with your patients.

“The Great Alone,” by Kristin Hannah (New York:St. Martin’s Press, 2018). Lured by Alaska’s majestic splendor and remoteness, the Allbright family (former POW, Ernt; abused wife, Cora; and coming-of-age daughter, Leni) are happy with their new life. For a minute. What ensues, namely punishing 16-hour days of darkness punctuated by episodes of oppressive snowfall, paranoia, and domestic violence, is grueling: “Night swept in like nothing Leni had ever seen before, like the winged shadow of a creature too big and predatory to comprehend.” Yet, this book is also a story about the bonds of family, both those we are born into and those we choose, love, sacrifice, and resilience.

If you have any books you read over the last to year to add to this list, please write to me at dermnews@mdedge.com.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter.