This month, we're exploring the topic of 'help-resistance' in physicians. Why do we acknowledge the need to maintain and optimize the health of our bodies, but scoff at doing the same for our minds or mental well-being? Why do support programs flounder from lack of participation? Why is the notion of even 'self-help' so foreign and...icky?

In this 'listicast', Dr. Pensa explores the top ten(ish) reasons for help-resistance in physicians. This has practical implications as to why physicians often do not access support programs, and why they may resist external or even self-help instruction.

These concepts are each briefly explored, with particular focus on the physician experience (though, of course, other clinicians and high achieving professionals may have similar experiences.)

Ten Reasons Behind 'Help-Resistance' in the Physician

1) Internal core beliefs and identity of the physician (and traits including exceptionalism and perfectionism)

2) External collective beliefs and medical culture

3) Inability to recognize when help is indicated (or avoidance coping)

4) Lack of awareness of various modalities of 'help' (what does 'help' even mean?)

5) Family of origin (or culture of origin) taboos; expectations of the family high achiever

6) Absent help infrastructure (or a hush-hush help infrastructure)

7) Terminal uniqueness

8) Fear (of discovery, judgment, licensure/discipline threats)*

9) Friction

10) Change resistance and inflexible thinking (or dichotomous thinking)

*To learn more about Dr. Lorna Breen, the Dr. Lorna Breen Heroes Foundation, and their work addressing the origins of this fear, go to https://drlornabreen.org/

More about Dr. Pensa: https://doctorsandlitigation.com/about-gita-pensa

Disclaimer: Dr. Pensa is not a therapist or psychiatrist, and this discussion is not meant as treatment for any specific mental health disorder. This list is based on Dr. Pensa's personal and professional experience, and her coaching work with other physicians in the realm of litigation stress and burnout.

In this first episode of Season 2, Dr. Pensa talks with attorney Saira Pasha, an EMR audit trail expert. What else besides the words in your chart does your electronic medical record track? Are 'secure messages' discoverable? (Spoiler: yes, they can be!) How can an audit trail help your case -- or hurt it? How does an audit trail expert 'read between the lines' of who's looking at what entries in the record, and when, and for how long?

Take home points:

• The EMR creates a trail that tracks not only your substantive words on the chart, but evidence of all the people who were in a given chart, at what time, looking at what, for how many seconds or minutes, what they did next in the chart, whether a template or smart phrase was deployed. It tracks and times views, edits, additions, deletions, changes, and any printing or searches. These are not part of the initial requested 'medical record,' but can be obtained through the request of an EMR audit trail.
• The timing of changes to the record can imply that charting was slanted in a way to be defensive or misleading (or at least, a plaintiff’s attorney is going to try to do that, even if your intention was well-meaning.)
• Attorneys may infer the importance of a part of the record by seeing how many people were in a chart at a given time, and what they were all looking at, for how long. This information can act like a big red arrow pointing at a specific medication order or radiology result, for example, even if there is no explicit mention of it in anyone's notes.
• Secure messages, FYI's, Best Practice Advisories, and other prompts are all discoverable (with a little sleuthing) as part of an EMR audit within a few years of their appearance in the chart.
• If you cosign notes using a template that suggests you did a substantive review of another clinician's care (such as an APP or midwife), be mindful of the fact that the EMR tracks how long you spent in that note, or reviewing that patient's chart or imaging.

Dr. Pensa references this 2021 case in which efforts to alter EMR records were exposed.

More about Dr. Pensa and how to contact her can be found at doctorsandlitigation.com.

Dr. Pensa tells the story of her own life after litigation in an interview with Dr. Mel Herbert.

This is the last episode of Season One.  But follow along -- a new season is in the works!  We'll talk about topics at the intersection of litigation, coaching, risk, and medicine -- and how to stay human through all of it.