Well, physicians haven't quite made it to the level of lawyers by getting paid by the "phone or research minute", but at last some major insurers are agreeing to pay for email communication between doctors and patients!

The trend is described in Insurers look at virtual visits to doctors on The Philadelphia Inquirer website.

And to figure out the "how-to", here is a useful lead article in the CAFP May 2008 newsletter on Practice Management today, devoted to the Virtual Office Visit and including details on:

• how to implement the practice of virtual medical visits (Guidelines for non face-to-face services)
• how to document them (Documenting an Online Visit)
• how to submit the claims for payment (Coding for online visits). (Look up "Billing" in the Archives if you are reading this after May 2008, and access the May 2008 issue)
• how to promote this new practice service to your current and prospective patients (Getting the word out)

An entrepreneurial physician practice owner would do well to evaluate how to use this information to legitimately boost revenues.

And in case you have forgotten about the merits of using online communication with patients, here is a previous blog post on becoming an email savvy practice.

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I hope you moms had a special Mother's Day on Sunday. And if you aren't a mom, I hope you felt affection and appreciation for your own mom!

Personal confession: Mother's Day is a particularly poignant day for me as it used to be a day I dreaded. Until I had my own child rather late in life, I endured the day with a sense of shame and even anger that I hadn't become a mom, contrary to all my adolescent expectations and those of my family and friends from earlier times.

Now I cherish the day with a fierce joy and celebration that exceeds my almost-daily feeling of living a miracle.

The reason I'm sharing this highly personal experience is it aligns with an article I came across (thanks to Jeff Cornwall of The Entrepreneurial Mind) by Susan Brown in Tennessean.com, called "When it's all said and done, substance is far more fulfilling than style".

In questioning why we aren't happier than earlier generations despite our obvious material advantages, Brown writes:

"My generation has lost touch with what it means to be content. We equate contentment with home or bank account size. Are we content? I suppose we could ask the psychiatrists and counselors we regularly visit. Alternatively, maybe look at divorce statistics or observe declining church roles while noting increasing doctor visits for stress-related ailments. Maybe interview local pharmacists who increasingly fill prescriptions for sleep and stress disorders or ask a financial analyst to explain the reason behind the increasing debt ratios.

I wish I had clear-cut answers as to why our generation has taken a 180-degree turn from prior generations. Success is good, but a problem occurs when enough is not enough. Our nation is heading down a destructive road unless our values change. Bigger government is not the answer. A diamond's size does not make a lasting relationship. True beauty is not superficial. House size, career title or bank balance does not equal contentment."

Brown refers to values - a big favorite of mine. She calls out "values of yesteryear" such as family, sacrificial love, quality time and contentment.

To that I would add adventure, generosity, passion, creativity and mystery, amongst others.

Take a hard look at what is stressing you at present. Are your stresses a result of lack of style, or of substance?

• If they belong to the latter, how can you choose a life of greater substance?
• If the former, what are you willing to let go of fretting about? Where are you out of alignment with your core values?

For my part, I was blessed with a Mother's Day of substance, far from style. No jewels, flower arrangements or fancy dinner. Instead, it included a call to my mom in South Africa, a photo assemblage of my daughter's year since last Mother's Day lovingly created by my husband; a hand-dabbled Color-me-mine tea mug (replete with 5-year old paw print!) from my daughter with the assistance of our lovely au pair; a day on a foggy chilly beach spent running away from waves and rescuing stranded (dead) jelly fish; a rental movie, and takeout Chinese.

I could NOT have asked for more!

Dr. Albert Fuchs is an ethical purist. That much is clear from our podcast interview today in which the Beverly Hills internist shares his views on his transition from an overworked less-than-satisfied traditional medical practitioner to a streamlined, calm, happy doctor with no immediate plans to quit his concierge practice.

At a patient's urging, he explored the concierge or retainer practice model, discovering its many variations. And realizing that, by cutting back dramatically on his patient load, he could once again become the real physician he had dreamt of being in his medical school days.

Seeking the mentorship of a family member with business experience, he began the transition several years ago by severing ties with the healthcare insurance industry, first with the PPOs and a year later with Medicare.

Paradoxically, he argues that, instead of contributing to the creation of primary care shortages with this model of care, he sees that students considering medicine as a future career are more likely to consider primary care when exposed to the role models of contented physicians providing the care they most enjoy giving to their patients! As opposed to the image many are witnessing today of harrassed, irritable doctors rushing from patient to patient, handling 5 phone calls between rooms, in order to make their "quota".

His advice:

• decide on whose behalf you are truly willing to work and who your customers really are - insurers or patients?
• take the high road and offer only those services and that care that is evidence-based. Keep it ethical - only offer what you would have done unto you!

Listen to The Entrepreneurial MD Podcast with Dr Fuchs's refreshing account of how he chose to re-align with his deepest professional values, in his quest for his vision of an ideal practice.

And then rejoin us here for your comments and opinion!

From time to time, I speak with physicians who are highly motivated to get into another business, but that is about as far as their enthusiasm takes the. They have the desire -- and can't muster up anything more. They are immobilized with indecision about what business to start. Several ideas have appeal until they are investigated further, and then suddenly they lose their lustre.

What is stopping them from taking the plunge? And what is to be done?

I suspect that any one or more of the following are flaring up:

1. Difficulty with tolerating the unknown: As physicians, we necessarily require a low tolerance for uncertainty. It is what urges us to relentlessly pursue the diagnosis until it is known. This attitude, however, costs us dearly when it comes to exploring options that affect our lives and livelihood.
   
2. Risk-aversion: Perhaps this originates in our choice of profession and the self-selection involved. Medicine is generally thought to be a "safe" career with a guarantee of employment.
   
3. Habitual thinking: We get lazy in our thinking - habits are easier to adhere to than to break.
   
4. Lack of confidence: It's hard to picture a physician truly lacking confidence as the demands of the career require a certain level of self-esteem. Instead, what I think what is at play here is a concern about not making the perfect decision. The one we know is absolutely right for us and guaranteed to produce a successful outcome.
   
5. Avoidance of taking responsibility: This is where we get to play the victim of our circumstances and sidestep the challenge of taking ownership of our lives and choices.
   
6. Confusion: A truism is that the confused mind always opts for "no". It's the safest way out of a mental challenge.
   
7. Expectations: This is on a par with habits. We get used to having our expectations met at a certain level -- financial, lifestyle, social, psychological -- and it is uncomfortable imagining living with anything different or less.

The unifying emotion in all seven circumstances seems to be fear!

Well then, how can one overcome fear, and create enough mental and spiritual space to foster the opposite - courage? 

In this article on positive psychology and courage from PsyBlog, "How to Build Courage Through Personality Traits and States of Mind", the author British blogger Jeremy Dean reviews a new model of courage and offers suggestions as to how to increase the positive factors that promote courage.

The factors from the blog post are (I encourage you to read the article for details as it is very helpful):

Courageous character traits

1. Openness to experience.

2. Conscientiousness.

3. Core self-evaluation

Courageous states of mind

1. Self-efficacy.

2. Means efficacy.

3. State hope.

4. Resilience.

Convictions and social forces

1. Inner convictions.

2. Social forces. 

My take on how to overcome the negative forces is to do what one client has opted for:

• work hard to set up a situation that allows time for reflection, thinking and for simply being.
• be willing not to know immediately
• trust that the subconscious and conscious minds are deeply engaged with the questions that matter
• find a "thought partner" who is equally comfortable sitting with the unknown and doesn't feel impelled to do the "doctor" thing and rush in and fix it
• become a doodler, journaller, list-maker, vision board creator. If you have to do something, let it be unstructured, random, irrational
• get physical - ride a horse, go for long walks, do yoga, jog, go kayaking

When you are feeling stuck, what works for you?

It was curious to spot an article titled "Can you become a creature of new habits?" in the Business section of the New York Times last Sunday. Kind of squishy topic for a business person to get a hold of, don't you think?

Turns out, it's an article on creativity and innovation.

What gave it lustre for me was the neuroscience about neural pathways that I've been increasingly aware of, and that very much pertains to coaching:

'... it seems antithetical to talk about habits in the same context as creativity and innovation. But brain researchers have discovered that when we consciously develop new habits, we create parallel synaptic paths, and even entirely new brain cells, that can jump our trains of thought onto new, innovative tracks.

Rather than dismissing ourselves as unchangeable creatures of habit, we can instead direct our own change by consciously developing new habits. In fact, the more new things we try — the more we step outside our comfort zone — the more inherently creative we become, both in the workplace and in our personal lives.

... “The first thing needed for innovation is a fascination with wonder,” says Dawna Markova, author of “The Open Mind” and an executive change consultant for Professional Thinking Partners. “But we are taught instead to ‘decide,’ just as our president calls himself ‘the Decider.’ ” She adds, however, that “to decide is to kill off all possibilities but one. A good innovational thinker is always exploring the many other possibilities.”'

I emphasize the phrase in the last paragraph to highlight just how our brains are trained to work as physicians. In our quest for a diagnosis, and an explanation for a set of signs and symptoms, we effectively kill of all differential diagnostic possibilities until we get to the One Answer that explains our observations and the patient's experience.

In effect, we are necessarily "anti-creative" in our trained medical thinking.

The challenge for entrepreneurial physicians then is to overcome the tendency to be reductive thinkers. Entrepreneurship demands significant creativity. We physician entrepreneurs need to see more opportunities, not fewer. To generate more ideas, create a greater number of options, or ways to skin a cat.

According to the article, researchers in the late 1960s discovered that humans are born with the capacity to approach challenges in four primary ways: analytically, procedurally, relationally (or collaboratively) and innovatively. At puberty, however, the brain shuts down half of that capacity, preserving only those modes of thought that have seemed most valuable during the first decade or so of life. (emphasis all mine)

We are stuck with how we were encouraged and naturally inclined to think.

The good news is that we can still innovate and create, despite our inherent limitations. It seems the trick is to push ourselves out of our comfort zones.

This interesting article goes on to describe:

"...three zones of existence: comfort, stretch and stress. Comfort is the realm of existing habit. Stress occurs when a challenge is so far beyond current experience as to be overwhelming. It’s that stretch zone in the middle — activities that feel a bit awkward and unfamiliar — where true change occurs."

When we stretch ourselves and expand our possibilities is when we feel truly alive. That belief lies at the heart of a great coaching relationship.

Markova, a PhD executive change consultant and author of "The Open Mind" is quoted as saying:

“You cannot have innovation,” she adds, “unless you are willing and able to move through the unknown and go from curiosity to wonder.”

I couldn't agree more.

What do you think?