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January 2012 Gregory A. Hood, MD, FACP, ACP Governor


From the Governor

Dr. Hood
ACP Chapter Excellence Award

For the second consecutive year the Kentucky chapter has been recognized with the ACP’s chapter excellence award. When you have the opportunity, please join me in thanking our Governor’s Council members, committee members, and Misty Pittman, chapter staff for all their hard work helping make this a reality.
Gregory A. Hood, MD, FACP, Governor

Chapter Excellence Award

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De-escalation – An Essential Physician Skill

With two physician murders in Kentucky in the last two years, and an attack on a Lexington dentist this holiday season the Kentucky ACP chapter is reprinting the following in the hopes that you are able to have a healthy and safe new year. Kentucky ACP is working actively with the national organization in efforts to promote workplace awareness and safety for healthcare workers.

Physicians have the potential to interact with the full range of human emotion at any time, sometimes even with the extremes of human emotion in a single visit. It doesn’t take physicians long in practice to encounter someone who is angry, livid, even potentially violent. Have you had such an encounter and left it feeling that you lost? Either you responded with hostility yourself or ended up feeling like a used door mat?

There are ways to deal with such encounters in which you work with the angry patient and guide them through their emotions, and the accompanying volatility, to the point where it is possible to have a constructive, or at least manageable discussion. These techniques are not simply to use reason with the person. Typically trying to get one who uses anger in order to control an encounter, to intimidate, to avoid personal responsibility, or to make themselves feel more important to see reason is simply a futile effort.

The anger itself must be dealt with, reduced, first. Anger can present itself from a number of fronts. Anger is not only the province of patients. Other physicians, staff, and third parties may present such unreasonable challenges with little warning. Hence, the first step is to make an assessment of your own self. Are you able to perceive the situation as a whole and are you personally and emotionally prepared to constructively intervene on this person’s anger? Are you able, whether you agree with it or not, to perceive the mindset of the other person? Specifically, are you able to take a leap of faith that your erstwhile opponent is someone who could be genuinely trying their best to resolve the problem? Are you sufficiently rested and prepared to be able to engage them without rising to the same level of anger and/or aggression that they are exhibiting? Can you personally accept that this person may still leave your encounter feeling angry and it be through no fault of your own?

If you can answer the above with a reasonable potential of, “yes” then there are a number of techniques to consider, beginning first and foremost with pure, active listening. Many times all that is needed to satisfy an enraged patient is for someone to listen to them, fully, until they have vented all that they have to say. A critical skill in such listening is to be able to listen without interrupting, interjecting, or especially correcting the other person, until they have finished what they have in their mind to say. To interrupt them when they are sailing under the full power of their emotions can only fan the flames further. However, if you let them blow until their winds have ebbed they are typically fatigued, and will be more amenable to your words.

Such attentive listening may and should include signs of active listening, such as excellent (but not glowering) eye contact, head nods, and brief intonations such as “go on”, “mhmm” and so forth. Sometimes all that is then required is to ask “what can I do to help this situation”. Only after such listening and an open response is offered should clarifications and (if appropriate) corrections be introduced in the discussion.

It is very important while listening actively to be mindful of nonverbal speech as well. This means being attentive to body language and other non-verbal cues. Understanding these will not only enhance your understanding of the other person but also may serve as invaluable warnings before the object of your focus escalates the encounter into one of a physical nature. By all means be aware of this, as well as what your own body language is conveying. Further, be aware of the physical proximities and relationships between each of you and your surroundings. Make a point of both maintaining a means of egress for yourself, and also for the other person. If you make them feel physically threatened or trapped you may be inviting disaster.

When the circumstance is one in which you understand their anger and view it as legitimate it can be perfectly acceptable to give them a straightforward acknowledgement. An example could be, ‘I can understand why that experience could make you angry”. If so, it is imperative that you convey this response in a sincere, believable tone. Acknowledging with appropriate respect can pave the way to resolve this problem constructively. This does not endorse the behavior, but rather legitimizes the feeling of the emotion. There is a significant difference here. Once the issue at hand is resolved, issues of behavior and technique can be addressed in a nonthreatening manner.

If warranted and actual apology may be appropriate at this time. This should only be the case when you feel that a clear error or injustice is involved. It is important to recognize here, and in how you deliver your potential apology, that this does not infer that you are taking responsibility for something for which you are not to blame. If, for example, you cannot find an error that has taken place it is still possible to respond with, “I’m sorry that this situation has made you feel this way”.

If there is only a portion of what they are saying that you agree with, you can say so, no matter how small that portion may be. In so doing you will often be able to defuse the anger without surrendering the facts of the larger issue. Once the anger is no longer an obstruction the remainder of the points of dispute may be handled more effectively and dispassionately.

If the encounter is not appearing to make progress it may be because your “opponent” is holding back additional points that are making them angry. As hard as that may be to conceive of as you listen to them offering an invitation of, “it seems like there may be still other things on your mind, making you upset. Go ahead and tell me everything on your mind. I want to hear all that you have to say”. While this may lead to additional points and duration of the tirade it should also make it possible for them to vent fully and lose the fire stoking their emotionality.

Given enough time in practice we all will have encounters with such individuals. By keeping in mind these guidelines and practicing them with open eyes and an open mind successful outcomes become dramatically more likely. These techniques have the potential to prevent such encounters from culminating in visits to the courtroom or even an emergency room.

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Kentucky ACP Annual Meeting a Big Success

At the September ACP Kentucky chapter meeting we honored the work of the soldier and family assistance center as a part of the Warrior Transition Battalion at Fort Knox. Attended by seven representatives from Fort Knox, we heard presentations from battalion surgeon, doctor Major Beezer Moolji and Master Sergeant Pannash. They recounted their own combat injuries and the work of the battalion with wounded soldiers.

More information on how they support wounded active duty service people is available here.

We also enjoyed presentations from Dr. Bob Deweese, ACP President Dr. Virginia Hood, and ACP’s senior vice president of government affairs Bob Doherty.

During the reception at the Pendennis Club, Dr. Hilton Brooks received the Laureate award, the highest award our chapter bestows.

The chapter annual meeting is held each year in conjunction with the KMA meeting.

Drs.Virginia Hood and Greg Hood

Virginia Hood, MBBS, FACP accepts a token of appreciation from the Kentucky chapter presented by Greg Hood, MD, FACP

Major Moolji speaking

The KY ACP listens to Major Moolji at the Pendennis Club on September 13th.

Get to know your governing council members

Pravin Avula, MD, FACP
Phillip Bressoud, MD, FACP
J. Hilton Brooks, MD, FACP
David Bybee, MD, MACP
Harry Carloss, MD, MACP
Barbara Casper, MD, FACP
Mary Duke, MD, FACP
Albert B. Hoskins, MD, MACP
Elizabeth A. Riley, MD, FACP
Catherine Rodriguez, MD
Peter Sawaya, MD, FACP
David Smotherman, MD
John Stewart, MD
Jill R. Watson, MD, FACP
Joseph Weigel, MD, FACP

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Joseph E. Johnson Leadership Day Grants

Funding Available for Young Physician, Associate, and Medical Student Members to Attend Leadership Day 2012

Twenty-four grants are available to cover young physician, Associate, and medical student members’ expenses to attend Leadership Day 2012, being held on June 6-7, 2010. To apply for a Leadership Day Grant, members must complete the application and submit it electronically by February 15, 2012. Each $750 grant will be given to the chapter for the Governor to distribute.

Go here for more information about eligibility requirements and the process for awarding grants, see

If you have any questions, please contact Patty Moore, Governance & Council Relations Coordinator.

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Working Effectively as a Team

Lori W.Wagner, M.D., M.A., F.A.C.P. Director, Primary Care Education Program, Associate Professor, University of Louisville

We are often asked to address issues in healthcare through a team approach. So what is the definition of a team, as opposed to a committee or task force, for example? A team is a “small group of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable.”1

The ideal size of the group is about five to ten individuals; this allows for enough members such that different skill sets are available, but also keeps the group small enough that accountability is maintained. Additionally teams that are too large may tend to fraction, or sub-group, creating unintended and unnecessary conflict.

The selection of the individuals is extremely important. They all must accept the idea of shared leadership and responsibility; the individual who facilitates each meeting should rotate, they should all hold each other accountable for their assignments, and no one individual’s perspective is held as more important than another’s. This characteristic differs significantly from a committee, which has a defined chair or leader. The individuals should also have complementary skills: specific, diverse perspectives or capabilities that are unique to each team member. Plus each team member should be aware of the distinguishing strength that they bring to the group.

Teams demand trusting relationships among the members. In addition to sharing the leadership role, the members need to be willing to embrace the varied points of view with active listening and respect. Conflict may need to be embraced to illicit the best result. And the team result should be paramount to individual concerns. Members must also be able to acknowledge their own limitations without fear of reprimand. To be an effective team member, they will need to have self-awareness of their traits and temperaments, to be unafraid of conflict, and to be able to build consensus through active listening and shared leadership.2

When utilized for the correct situations, the team approach can offer institutions or organizations an end product that could not have been previously achieved through the conventional, single-leader committee. Teams are most appropriate when the problem or solution is complex and a multitude of perspectives is necessary. With the rapid increasing complexity of our healthcare system, the use of teams has become more commonplace and is anticipated to increase. Physicians can expect to experience this role soon, if they haven’t already!

1. Katzenbach JR, Smith DK. The Wisdom of Teams. Boston: Harvard Business School Press, 1993.
2. Grigsby RK. Are You Really a Team Player? Academic Physician & Scientist July/August 2006: 4-5.

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ACP Medical Home Builder

Medical Home Builder Logo

The ACP Medical Home Builder (MHB) tool provides affordable, accessible, online guidance to help identify opportunities for practice improvements and, if desired, prepare your practice for recognition as a Patient-Centered Medical Home (PCMH). • Designed for all practices, ACP’s Medical Home Builder will help • Improve office efficiency • Increase patient satisfaction • Optimize patient care • Develop policies and procedures with downloadable forms • Prepare for PCMH accreditation or recognition

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ACP Special Interest Groups

An online forum for members only. Sign up to connect with peers now. During this initial pilot, participation will be limited.

Physicians know the power of collaboration. ACP Special Interest Groups is member-driven — you set the agenda and fuel the dialogue in this private, secure physician online community. Share experiences and questions, inform with creative solutions and ideas, and gather with like-minded physicians at your convenience. Exclusive and free to ACP members — another way your membership works for you!

Interest Groups

Connect with your ACP Colleagues. Participate in one or more groups. We welcome ideas for additional groups.

  • Hospital Medicine... Discuss work schedule, practice type, inpatient or observation status; share tips for getting the most out of committee work.
  • Small Practices... Share ideas and insights about daily concerns, such as coding questions, operations, and personnel management, as well as issues like ICD10.
  • Work/Life Balance... Reflect on lifestyle trends that affect you and your family, covering such topics as child care and continuing education requirements.
  • ACOs/New Practice Models... Chat about ACOs and other practice delivery and payment activities.
  • Emerging Technologies... Confer on professional technology needs and resources; and learn about the benefits of new communication tools and methods.
  • Physician Educators... Share experiences, methods, ideas, and questions related to medical education.

Sign up online to connect with ACP peers now. For questions, contact ACP Customer Service at 800-523-1546, x2600

The Kentucky chapter can be reached at anytime on facebook, or by email addresses KentuckyACP@gmail.com (governor) and KYACPstaff@gmail.com (staff). To facilitate our ability to communicate with you about breaking news, chapter activities and opportunities as well as save money on communication costs please make sure we have an accurate email address for you. You can verify your email address information at www.acponline.org by checking under “my membership” and editing your contact information.

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Save the Date

***The Kentucky Chapter Scientific Meeting is moving to Wednesday so that more of our KMA colleagues can attend!***

Wednesday, September 12, 2012
Hyatt Regency Hotel
Louisville, Kentucky

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