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A positive outlook can overcome orthopedic stress
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It is a tough time to be an orthopedic surgeon. Reimbursements are dwindling, third-party intrusions are becoming more oppressive and malpractice stress still looms in the hearts of many. Yet, we all know colleagues who seem to be able to brush off adversity and maintain a positive outlook – regardless of circumstances. What do these resilient ‘superheroes’ share in common?
An emerging body of research appears to indicate that optimism can be learned. In essence, a negative disposition can be gradually transformed into a more positive approach to life. Furthermore, many contemporary authors suggest that thoughts predict reality. Works such as Rhonda Byrne’s The Secret, maintain that we attract into our lives what we think about. This ‘Law of Attraction’ dictates that positive thoughts create positive results and circumstances and that individuals can truly create their own realities.
We, at Orthopedics Today, have assembled a panel of ‘positive thinkers’ who have offered to share their personal experiences and opinions on the value of a positive outlook as it relates to the practice of orthopedics. We sincerely hope the reader will gain insights into attaining more positive energy – and therefore greater means of negotiating the stressors of contemporary orthopedic surgery.
John D. Kelly IV, MD
Moderator
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John D. Kelly IV, MD
Renee K. Fox, MSW
Carlos A. Prietto, MD
Donald H. Johnson, MD, FRCSC John D. Kelly IV, MD: Can one’s outlook affect the practice of orthopedic surgery?
Renee K. Fox, MSW: Yes, definitely. Whether you realize it or not, when you interact with patients you are communicating your thoughts and feelings — both verbally and nonverbally — to them. The patients are not only listening to your words, but, and perhaps more importantly, are subconsciously reading your attitude and nonverbal communication. Are you positive, happy, confident, feeling successful, encouraging participation (both emotional and physical) in the healing process and consistently suggesting they will do well? Or are you stressed, tense and unsure of yourself and imparting the message to them that you are not sure of the outcome and they may have a mediocre result?
Therefore, whether you believe it or not, you are clearly radiating your thoughts and attitude and actually controlling a large part of the surgical outcomes of your patients.
Donald H. Johnson, MD, FRCSC: There is no question that a positive attitude is easily detected by the patient, and I think it imparts a positive feeling in them. I have always maintained that a positive approach to the patient is one of the arts of medicine. True, this is a lot easier to do in sports medicine where we only deal with minor annoyances such as ACL injuries! I find that by saying “You’re looking good today” or “Your knee is really looking good,” encourages the patient to continue with his or her long rehabilitation.
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The real question is how you manage to stay positive every day. Just like your patients, you may be having a ‘bad day,’ but you can’t let that show. Surround yourself with positive people and situations.
Years ago, I was running with a friend every morning before work. It took me about 6 months to figure out why I was not my usual positive self. He was a very negative person and complained about everything during our 45-minute run. I was much better when I went back to running in the morning on my own.
Carlos A. Prietto, MD: Yes, I believe that one’s outlook does effect the practice of orthopedics and being positive can translate to better outcomes. Patients intuitively pick up the doctor’s own attitude and psychology. It may not be on a conscious level, but they read us. Furthermore, I have experienced patients who have picked up my particular mood of the day and probed me about it, noting that I have appeared to them rushed, tired, inattentive or distracted. This is not a usual occurrence but it does happen. Patients do respond to our listening skills, our verbal skills, and our body language. Recognizing this, if we are good listeners and are attentive from the heart not just in appearance, the patient is put at ease and in a better position to begin healing.
How we go about our activities will have an effect on our patients. If a physician presents a positive outlook of himself and for the patient, this will translate into better outcomes for that patient. This is not to discount good medicine, which goes without saying.
Kelly: Does being positive translate to better outcomes?
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Fox: If you choose to have a positive, success-oriented attitude, you will be sharing that vision with your patient and staff. By the day of surgery, the patient and your team will continue to pick up on your thoughts. Encouraged by your optimism, your hospital team will join with you to focus their thoughts and energy on working with the patient to create the best possible surgical results. Your thoughts have prepared your entire team, including the patient, with a strong goal of a positive surgical outcome.
Johnson: There is no question that a healthy dose of positive energy exhibited by the physician will translate into making the patient feel better. Positive communication is a strong deterrent to a patient unhappy with his or her outcome and considering legal action against the physician. I had a patient who had septic arthritis post ACL reconstruction and she told me later that she was considering a lawsuit, and even went to a lawyer. She said that she wanted me to continue with her care (which has continued for 20 years) because she liked me! The lawyer said you can’t have it both ways. You can be sure if you sue him that is the end of the professional relationship.
Kelly: Do our thoughts create reality?
Fox: Yes. Some time ago, I learned the concepts “We create our own reality …. that whatever occurs in our lives is a result of our own thoughts …and that our lives are a reflection of our inner thoughts.” I did not believe it until I began to focus on it.
Here are some examples:
- Have you ever thought about someone who you have not seen for a long time and then within a day you hear about that person or that person enters your life?
- Have you ever received a call from someone as you were about to call them? or
- Have you ever seen people as “lucky” while others always have “bad luck?”
Pay close attention and you will find that everyone’s predominant thoughts are exactly on the outcome they are receiving. Like a seed attracts water and nutrients from the soil in order to grow, our thoughts lead us to be attracted to certain things, and in turn we attract things to us.
Some people analyze situations only in terms of what can go wrong, rather than what can go right. It appears that bad things always seem to happen to them. Conversely, people who focus on what they want in life and what they want to accomplish, always seem to have luck on their side.
If you think about your predominant thoughts you will know exactly what thoughts and choices led you to where you are today. The genie of the universe says to us each day: “Your wish is my command.”
Johnson: Yes, but you have to lay the infrastructure for these things to happen. It is just like saying “I would like to have a million dollars” or “ I would like to run a marathon next week” There is a certain amount of preparation and work to be done to make that happen, not just idly wishing. However; if you don’t have positive thoughts, good things may not happen to you.
The philosophy of Yogi Berra, who said “When you come to a fork in the road, take it,” will probably not result in the outcomes you want. It is important to realize in our careers that we are able to make choices, both good and bad. Just make sure that the choices that you make are the right ones. In these situations advice from a mentor can be very helpful. He or she may be able to see the big picture better and give you another option.
Prietto: More defined, I believe that our thoughts create our own reality. Our personal perceptions of the world drive our thoughts, which then become our own personal reality. We all have had patients with the hangnail looking for morphine for his or her 10/10 pain while on the other gurney is the patient with a partial finger amputation looking for a Band-Aid. That may be an extreme example, but each of those patients perceived the reality of their problem and pain differently.
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On a more practical level, if you look at your line-up for the day and perceive it is going to be rough, it will probably turn out that way. On the other hand, if you look at the same line-up with a twinkle and a grin, it takes on a whole new perception to go from thought to reality. Good coaches know a lot about this and are probably the best at creating a reality of winning. Believing in, and the intention to, are a big part of winning traditions.
Kelly: How does one’s attitude help deal with the stressors of orthopedics and life?
Fox: If you have a positive attitude toward orthopedics and life, you know that, even in stressful situations, by having inner strength and calm, you can overcome and grow from each obstacle. By holding a positive outcome in your mind, you are telling those around you verbally, and nonverbally, that you are confident in your ability to face life as it comes.
Studies have discussed the existence of two parts of the mind: conscious and subconscious. The conscious mind is the everyday mind that thinks, plans and makes decisions. The subconscious mind absorbs verbal and nonverbal information and stores it for later use. When the conscious mind gives instructions, the subconscious mind goes to work to execute the instructions. Therefore, as one faces the stress in his or her life with a positive attitude and vision, not only is he or she communicating and receiving positive answers from those around them, but the subconscious mind is using internal resources including creativity and imagination, to solve problems and reach one’s goals.
Johnson: Learning how to deal with the stress of orthopedics is one of the most important rules to learn early in your practice. Everyone has a different limit of stress that he or she can handle, but you have to know your envelope of tolerance. If you get outside of this envelope, you will lose balance, and life suddenly becomes stressful. There are many warning signs of being out of balance. Feeling that your job is overwhelming, that you have no control over the busy clinic, that you have no time for family, hobbies, or vacation, or finally that the operating room is stressful. If you are losing your temper or are having complications, then you are out of balance. The solution is to reduce the number of patients in the clinic, or take a holiday with your family to recharge the batteries. When I was busy, doing 1,000 cases per year, I always took 1 week off in 6 to go to a meeting, or on a family holiday.
Prietto: A positive attitude can most definitely help with the stressors of orthopedics and life. A positive attitude, however, is a conscious decision. That decision, in my opinion, must be made on a daily basis. It requires some sort of a self-reflective practice to be in place. This can be done in many ways. Part of my own personal practice is meditation. Regardless of the form of practice, it allows one to reflect on one’s daily interactions with patients, co-workers and family. Intentions can be set to improve all types of interactions. We are trained in residency about reviewing our surgical performance after a case so that next time it will be better. The same can be done with our relationships with patients, coworkers, and family.
Kelly: Can one learn to become more positive?
Fox: One can definitely learn to become more positive. First: Become aware of your predominant thoughts, which Napoleon Hill in Think and Grow Rich compares to a garden — learn to weed out your negative thoughts and replace them with positive thoughts and a vision of what you would like to have happen.
Second: Focus on gratitude and being thankful and grateful for what you have and who you are. A person who is grateful finds the good in life and is a joy to be around.
Third: Know that, as Hill wrote, “Every adversity, every failure and every heartache carries with it the seed of equivalent or a greater benefit.” If you understand and believe that even when things do not go as planned, there is a valuable lesson to learn – you will understand that even difficult times carry a silver lining.
Johnson: Essentially this is learning what works for you. For me, the best control of stress is to exercise regularly. It is difficult to have road rage driving to work if you just ran hard 4 or 5 miles on the treadmill. You are mellow and have some degree of runners high. Aerobic exercise releases endorphins that create a very positive attitude. This is not just some new age myth, but has been confirmed scientifically in a study done in Germany by Becker. A PET scan was done on runners’ brains before and after a 2-hour run. A standard psychological test was also administered before and after the run. The scan showed that endorphins were released, and attached to the limbic and prefrontal areas of the brain which are associated with emotions. The psychological testing confirmed the positive attitude of increased sense of well being after the exercise period. A secondary benefit was to increase their pain tolerance after long periods of exercise. This seems to happen only after a couple of hours of endurance exercise, so that is a drawback for most people. On the other hand, it is hard to tell by the look on their faces that they are actually enjoying running. Maybe it just feels good when you quit!
Prietto: There are many ways that one can become more positive. The daily practice, as mentioned above, is one; balance in life and work is another. A more positive attitude is attained if rest, exercise, diet and work load are balanced. A popular modality utilized today to engender a more positive attitude and approach is guided imagery. It has been shown that patients going through a guided imagery program prior to a surgical procedure have less pain and better outcomes. This modality can also be used by anyone to help balance the stressors of life. It is no different than the elite high jumper who visualizes every sequential step of his approach and jump. Taking quiet time to focus on the upcoming activity whatever it is, and making that intention for positivity and good will result in better performance.
Kelly: I agree and would like to share that a dedication to positive thinking does produce positive results. I personally find that imagining surgeries going well before I step into the operating room, translates to a more “flowing” nature to the surgery.
Also, when I look for the good and focus on the good that I can do for my patients, I find that the office hours are far less stressful.
I would like to thank the panelists for their time and insightful comments.
For more information:
- Renee K. Fox, MSW, can be reached at 5929 East Via Del Cielo, Paradise Valley, AZ 85253, 480-607-9991; e-mail: imagemaker@cox.net.
- Donald H. Johnson, MD, FRCSC, can be reached at Sports Medicine Clinic, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6; 613-520-3510; e-mail: Johnson_don@rogers.com.
- John D. Kelly IV, MD, can be reached at Temple University, Department of Orthopedic Surgery, 3401 N. Broad St., Philadelphia, PA 19140; 856-985-0851; e-mail: johndkellyiv@aol.com.
- Carlos A Prietto, MD, can be reached at Orthopaedic Specialty Institute, 280 S. Main St., Suite 200, Orange, CA 92868; 714-634-4567; e-mail capchino@cox.net