Patient care is not a spectator sport [PODCAST]

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“Whether led by the patient or by a primary care physician or nurse practitioner, a proper leadership-based problem-solving methodology is a critical tool. The approach itself is not nearly as important as the discipline to use a formal approach. One approach, for example, is a simple, proven framework that, on average, leads to a significant reduction in the time to resolve problems. ”

Jim Sholler is a consultant and author of Solved in 7: The Power of Disciplined Problem-Solving.

He shares his story and discusses his KevinMD article, “Patient care is not a spectator sport.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Jim Sholler. He is a consultant, and he’s author of the book Solved in 7: The Power of Disciplined Problem-Solving. His KevinMD article is titled “Patient care is not a spectator sport.” Jim, welcome to the show.

Jim Sholler: Excellent. Thank you, Kevin. Thanks for having me. I really appreciate it.

Kevin Pho: So we’ll get into your book and article in a little bit, but first off, just share your story and journey to where you are today.

Jim Sholler: You bet. So I spent about the last 27 years with Fidelity Investments, definitely not your typical medical background. It was more managing different problems and trying to find resolutions for groups that were struggling to either perform operationally or deliver software, across many different disciplines at Fidelity Investments. My brand for most of the 27 years was “the fixer.” If things weren’t running well, I was brought in to get them back up and running efficiently again.

That helped me, over these 27 years, to really refine my approach, which, unlike most problem-solving approaches, is a leadership-based approach. I wasn’t the expert in most of these areas. My expertise was being a problem-solving leader and pulling the experts together to resolve problems.

Kevin Pho: So how did you get involved in the health care space?

Jim Sholler: Interestingly, this was kind of my secret power, my superpower, at Fidelity. I never thought of this as something that applied anywhere else outside my job. To me, it was just my secret trick to help me be successful at work.

Unfortunately, in my personal life, in parallel with many of those years, about 13 years, we were researching a very, very rare bleeding disorder that my wife was experiencing. We were with the best doctors from New York City to Boston, and we spent about 13 years and well over a million dollars in medical costs. Her right arm is permanently disfigured from a skin graft. She flatlined from a plasma transfusion. During those 13 years, we learned a lot, became experts in bleeding disorders, and ultimately realized that there is a lack of problem-solving expertise. There are diagnostic abilities, but there’s a lack of problem-solving skills.

When it finally occurred to me to apply what I do at work every day to this problem, we reached the correct diagnosis within seven minutes of the exercise. That’s when it really turned things around for me: It is a sorely needed process, not just a trick I use at work.

Kevin Pho: So let’s go more into that. You talk about it in that KevinMD article titled “Patient care is not a spectator sport.” Now, for those of you who get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Jim Sholler: Absolutely. I was fortunate to take a voluntary buyout from Fidelity about a year ago, and my passion for this activity was to turn it into writing a book. As I researched the book, I started out looking at misdiagnosis and how often misdiagnosis happens. Knowing nothing about this space, I was shocked to learn from a Healthline article by Brian Mastroianni that upwards of 40,000 to 80,000 people die from complications due to misdiagnosis every year. I had to go for a walk when I read that. That was completely shocking to me.

So what I really wanted to get across in the article was the importance of understanding what happens, and what you see, in the vacuum of no practiced diagnosis or problem-solving analytical skills. What I’ve noticed over the years is there are four bad behaviors, or bad practices, that happen. You get stuck in a problem. You get stuck in a theory. You implement workarounds, and sometimes workarounds, like using prednisone to treat inflammation, are absolutely necessary. The problem with the workaround is that then it works, so no one follows up on what the underlying problem was.

That’s what happened in my wife’s case. The first time, 13 years prior, that we had the episode, they treated it with prednisone and said, “Look, swelling went down, bleeding went down, she seems OK,” until it came back. So workarounds are dangerous, because if no one keeps researching, then you’re in trouble.

And finally, the last bad behavior is blame. When no one has full accountability for their space, they don’t think that the problem falls into their area or specialty, and the finger-pointing starts. That could be at other specialists, that they should have seen something, or that the patient is doing something. In our case, we were ultimately actually accused of causing my wife to bleed ourselves. So blame had fully kicked in.

So really, as I put all these pieces together, I thought I have to write about this. I have to empower people to understand that, and I know you’ve had other podcasts about the importance of the patient in providing information, and that’s absolutely critical, but even that’s not necessarily enough. I realized we had to do more than just provide everything we knew. You really realize how important it is to play a leadership role in the diagnosis of a challenging problem, and if someone’s not doing that, then you step up and do that.

That’s what I’m trying to inspire, whether it be physicians, nurse practitioners, or patients themselves, to understand how important it is to be a leader and bring the experts together. I’m not a medical expert, and yet it was the leadership that was required to help us get to the proper diagnosis. So that’s really the point of the article, to just hit home and hopefully inspire people to become leaders in the diagnosis of challenging problems.

Kevin Pho: So give us an example story or case study, and I know that you shared a little bit of that, that really illustrates some of the problems that you’re talking about in health care. What would that look like in real life?

Jim Sholler: A lot of what you’re seeing now is common misdiagnosis, for instance, in the space of ADHD and dyslexia. For instance, my daughter, and there’s a story in the book about this, has severe ADHD and severe dyslexia. She actually has a specific form of dyslexia which causes the letters to look like they’re vibrating and bouncing around for her. As a child, she didn’t know how to explain that. You don’t know that this isn’t what everyone sees.

So she went through all of the typical bad behaviors. She’s probably not doing the homework. She’s probably not trying hard enough. The blame: She’s just lazy. We went through it, and we’re not the first ones to go through this. It’s so common, especially in the dyslexia space, to have those behaviors rear their ugly head. It wasn’t until the leadership role, until we realized again that there had to be a leadership role in this and started to walk through: What are the facts? What are the questions? Let’s take the emotions out of this.

And what you also learn a lot of times is you can say the same things, ask the same questions: Have you tested for this? Have you tested for that? When they come across in an aggressive manner, they’re not heard. They’re just not received the way you want them to be received. When you put a framework and a process around it, and it’s just one of five questions that has to be answered, you’re more likely to actually get to the facts that you’re looking for.

Dyslexia is a tough one because there really is no physiological test to see that you have it as of yet, at least not that I’m aware of. So it’s incumbent upon the patients, the parents, and the child to really do the proper research, get the right experts involved, do the right testing, and just learn the facts. Ask the right questions and learn the facts. That’s one example we’ve seen where it’s just: Don’t accept the bad behaviors. Keep pushing.

Kevin Pho: So from a patient point of view, what are some specific things that they can do to take more of a leadership role and implement some of your ideas in practice?

Jim Sholler: I think one of the most important things is discipline. There’s a myriad of problem resolution practices out there. The issue is actually being disciplined about using them. In my wife’s case, she was phenomenally disciplined about recording every fact, everything that happened. That’s the most important thing. Don’t fly by the seat of your pants. Don’t run in ready to fire off five questions off the top of your head in an emotional manner. What’s important is documenting. Document the facts, document the questions, and think about it as a learning process. You’re not trying to prove a diagnosis. You’re not trying to guess a diagnosis. You’re trying to learn the diagnosis.

So you document the facts, document the questions, and you just keep cycling through those. New facts will bring up new questions, and you just keep cycling through. So I think that’s the number one thing, to just be disciplined about writing everything down. Facts can be the day of the week or the temperature outside. It could be anything. You just never know what’s going to be an important fact, but the documentation is critical to supporting the problem-solving process.

Kevin Pho: You’re also the author of the book Solved in 7: The Power of Disciplined Problem-Solving. So what are some of the key points that you want readers to come away with after reading your book?

Jim Sholler: I’m hoping that readers come away feeling empowered and inspired to play this role. Even the title can sound intimidating, like, “This is something that I use at work. Well, I’m retired. That doesn’t apply to me.” Well, it applies, and that’s what I’ve tried to do in the book, go through professional examples, personal examples, and medical examples. What I’m hoping is people are inspired to say, “This seems pretty easy.” As I like to say, connecting the dots is easy. The hard part is inspiring leaders to identify the right dots. That’s hopefully what people will take away from this, that they’re compelled and inspired.

That’s one thing I learned early on. In a corporate career, you go to a lot of different trainings, and the only ones that stick are the ones that had a compelling story behind them. So I’ve tried to put a simple framework in place with very compelling stories.

Kevin Pho: We’re talking to Jim Sholler. He is a consultant, and he is the author of the book Solved in 7: The Power of Disciplined Problem-Solving. His KevinMD article is “Patient care is not a spectator sport.” Jim, for the clinicians listening to you on this podcast, what are some lessons that they can take away from what you’re talking about?

Jim Sholler: Again, I think it’s the discipline to use a process, but also, if you read the book, you have to move from the fear of being a leader. It’s easy to refer people, to send people to the right expert, because “I don’t know that space.” For me, maybe I’m a little more comfortable with it because I’ve always been thrown into the deep end when I didn’t know how to swim, and for some reason, I’m OK with that. I’m comfortable with it. I think that’s the hard part for a lot of people, being comfortable pulling in specialists, experts in areas that you know nothing about. But what you become comfortable with is that your expertise is being a problem-solving leader, pulling people together.

One of the key steps is actually educating people on the process. Once they understand the process, they’ll participate. They’ll become followers. You’re the leader, and you’d be amazed how much you learn through the whole process. I mean, I know so much about factor XIII, hemophilia deficiencies, and all kinds of weird genetic disorders that I would have never known anything about if I didn’t go down this process.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Jim Sholler: One thing that I’m trying to work on to support this is an app that would hopefully provide a platform to do this. I say that, and I’m certainly not marketing it, because I’m way at the early stages, but it’s to really undermine the importance of being disciplined about using it. It doesn’t have to be my methodology. Pick a methodology, but be disciplined about using it, and you’d be amazed. Start with something simple.

I have people ask me all the time, “Well, what if people don’t want to participate in your process, they don’t want to hear you?” I think the best way around that is to start with a problem that is your problem and pull experts in to help you. People usually like to help someone else. They like to give advice. They like to help. Once they see the benefit of what you’re doing, they’re more likely to ask you to come do that. Often at work, people would say, “We need you to do that thing you do.” When you get to the point where people are saying, “Do that thing you do,” then you know you’ve established yourself as a problem-solving leader.

So I think that’s the most important thing, just not to be afraid of becoming a leader in this space and pulling the experts in. You’ll learn from them.

Kevin Pho: Jim, thank you so much for sharing your time and insight. Thanks again for being on the show.

Jim Sholler: Thanks, Kevin. I appreciate it. Thanks for having me.

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