Things People Want from Their (Healthcare) Leader

This is Dr. Ken Richmond, Board Certified Psychiatrist, organizational consultant, and Telepsychiatrist.

Today, I want to talk about the three things that patients want when they meet with their health care provider. As a psychiatrist, I listen to patients, we hear a lot of their problems, also a lot of their success and victories, but the three things that I think that patients want from their healthcare provider. Let’s take a look at them.

Simply put, patients want to be seen. It’s not merely the fact that they’re on yourchedule, it’s the fact that they want to be seen for more than being a diagnosis. For example, patients don’t want to be seen as the
“Schizophrenic patient.” They’d rather be seen as a patient with Schizophrenia.  There is a slight but powerful difference in that the patient’s so-called name is not synonymous with their clinical diagnosis.

The second thing patients want from healthcare provider is to be listened to.  This is very different than wanting to be heard.  I should mention that listening requires a higher cognitive ability; whereas, hearing is processing sounds that are usually coming from the external environment.  Listening requires one to get a deeper meaning from what the patient or individual may be saying to you. Oftentimes you have to listen to what is being said, but also what is not being said.

The third thing that patients want from their healthcare provider is to be understood. And that’s a very deep, deep level of involvement and engagement with your patient. It does require individuals to have an empathic approach to recognizing what’s going on with that individual. An example would be, being able to empathize with a patient because you understand where they’re coming from. Understanding the patient is cannot be understated.  Doing so allows me, you, and anyone to give that patient what they may need from you.

Those three things I believe are essential to improving healthcare encounters.  However, these insights can also be translated to the workplace or in any type of relationship.  Again, individuals need to be seen, listened to, and understood.  How many of those do you currently use or will consider utilizing more when you have interactions with patients?  How about in business?  Are any of these insights worth developing?   Let me know your thoughts.

I am Dr. Ken Richmond. I help corporate leaders pinpoint leadership issues so they can develop thriving workplaces with less turnover, improved workplace morale, and increased organizational performance.  You can follow me on all social media platforms @DrKenRichmond.

Costly Mental Health Issues and You Pt. 1

This is Dr. Ken Richmond, Board Certified Psychiatrist, organizational consultant, and Telepsychiatrist.

Do you realize we spend a significant amount of time in the workplace?  One of the things that that came to mind was just identifying at least some of the mental health conditions that are affecting individuals in the workplace as well as in their lives. This a realization rang true for me today because I had to write some return to work documents allowing patients (and some organization’s employee) to be out of work for a period of weeks to months.  More importantly, was having to determine when those individuals can return to work. And it had me thinking a little bit more about some of the mental health conditions that employers also have to manage.

I wanted to do this talk in a three-part series. The first one I’m going to talk about which is anxiety, but then give mention to the subsequent two that I will be reviewing which is depression and substance abuse disorders. Stay tuned for those posts.

For anyone who has ever struggled or experienced anxiety, having to experience that level of this emotional distress oftentimes makes it difficult for that individual to articulate their symptoms. It is a downright scary experience when anxiety happens.  Worse yet, anxiety can be provoked (i.e. you know what triggered it) or unprovoked (i.e. you have no idea what may be going on with you).  What I’d like to do is begin with mentioning some of the common symptoms, briefly mention some of the treatment options that one may ask about when meeting [mental] healthcare provider, and to acknowledge that anxiety not only impacts the individual, anxiety affects our workforce and society in general.

How many of us have ever experienced anxiety in some form? How many of us knew it was anxiety when we first experienced it? For individuals experiencing anxiety they can have the following symptoms: increased heart rate, that’s where you feel like your heart is attempting to beat outside of your chest; there’s an intense thunder and pounding sensation, which is uncomfortable when that starts to happen; there’s usually chest tightness, which can make individuals feel as though they are unable to take a deep breath. Usually our recommendation is to do deep breathing, but it’s difficult to do that when that individual feels like their chest is so tight that it’s hard to breathe to begin with. They may also experience things like what we called paresthesias or numbness, prickly sensations that can occur in the fingertips. You can also become hot and sweaty (also known as diaphoretic).

In addition, the five (5) senses can also be affected. That means that their ability to hear may “go in and out,” their vision can get blurry. The term “tunnel vision” is often used to describe the sudden change in one’s ability to see.  There are also instances where the mouth becomes very.  A patient can also have a condition called globus hystericus or aphonia, basically where there’s a sensation of a lump in that individual’s throat. It makes it difficult to speak.  Headaches are another neurological symptoms that may or may not happen during bouts of anxiety. Psychic symptoms, or internal symptoms, can also be things like racing thoughts. An intense need to escape from their immediate environment. A sense of impending doom, catastrophic thinking, which means that they just fear the worst, that you know something bad is going to happen. And that’s usually how they perceive that experience.
Take a second to imagine working with or managing someone whose primary responsibility is to answer the phone.  For more clarity, let’s imagine the individual works at a Call Center or an employee at your favorite credit card company.  What do you imagine could happen during a call if a customer begins to yell and scream when he or she does not feel their request is able to be met?  Of course some people may be able to handle the customer service issue with proficiency and skill.  The employee may recall all the trainings they received regarding validating the customer, restating their concerns, quoting their policy, and so on. But, what about that employee who is struggling with anxiety?  What about that employee who has their first panic attack in the workplace?  Imagine if that employee has such severe anxiety, experiences aphonia and is unable to speak.  What training skillset would be referenced in that moment?  I have to admit, we frequently ask: Do you want some water?  Well, it’s at least a step to show concern for someone we recognize is in distress.  In the above example, I trust you can see how uncontrolled anxiety can significantly impact one’s ability to function in the workplace or even their daily life.

When these symptoms happen in a very short period of time, and they can be unpredictable, they can be provoked, unprovoked. Let’s say it happens when that individual is driving a car, they can pull over. If they’re at home they can be inconsolable. If they’re at work they would obviously want to leave work. Sometimes unexplained absences can happen as a result of them having such intense symptoms, and that’s what’s called a panic attack. They may also feel like they’re having a heart attack and they want to go to an emergency room to be assessed only to be told, “This is just anxiety.” I’m sure we’ve had patients or even loved ones, friends who’ve had an experience like that where they went thinking that it was something ominous and, hopefully, were relieved to know that it was a mental health condition called anxiety.

I suspect we are clearer that anxiety can be a pretty dreadful and distressing.  More importantly, I want you to know there is hope.  Treatment options would consist of medications antidepressants (i.e. serotonin reuptake inhibitors or SRI). Although the class of medications are called antidepressants, they treat both–depression and anxiety. Beta blockers are sometimes used off-label to address the physical symptoms of anxiety.  Caveat: we do our best to avoid using beta blockers in individuals with asthma or other respiratory issues to avoid precipitating acute breathing issues. Lastly, benzodiazepines typically are used with extreme caution to minimize the risk of patients becoming addicted to them.

This was an overview of one mental health condition that affects individuals, the workplace, and society.  Look forward to others posts on depression, substance abuse conditions, and many others in the near future.  We cannot escape the reality that untreated mental health conditions impact one’s ability to function personally, occupationally, even if they were in school, secondary to them being untreated.

I am Dr. Ken Richmond. I help corporate leaders pinpoint leadership issues so they can develop thriving workplaces with less turnover, improved workplace morale, and increased organizational performance.  You can follow me on all social media platforms @DrKenRichmond.

Leave your comments in the comment section below.

Personality Types Among Us

I am Dr. Ken Richmond Board Certified psychiatrist and telemedicine specialist. I help corporate leaders pinpoint leadership issues so they can develop thriving workplaces with less turnover, improved workplace morale, and increased organizational performance.

Today’s topic is about personality disorders.  Have you ever interacted with someone where you just had this feeling of you don’t understand why they do certain things? Or you tell yourself, I just don’t get you?  I mean, seriously.  You simply don’t get that individual, you don’t know where they’re coming from, you don’t understand their basis for some of the things they say, or even some of the things they do.

As a psychiatrist, one of the things we are skilled at recognizing what is to be considered normal behavior versus abnormal behavior. And in doing so we can determine if somebody needs to be treated with such options like medications, therapy, or if it’s part of normal development.  That is, maybe there are some things we simply must learn to get used to.  And as I’m discussing personality disorders, this is going to be a very general overview of the different types of personality disorders that are out there. Keep it in mind that we all may have different degrees and of the traits from the various traits presenting itself.

So it doesn’t mean because you have certain traits that you have a disorder. The word disorder really implies that there is an impairment in your ability to function in social, occupational, in your personal life, academic life. Okay, so we’re going to start off with the overview of the personality disorders and end with at least three tips that way, you know, that I think would be successful for, you know, allowing you to have positive interactions.

The ODDs are:
The first personality disorder, Schizoid personality disorder, relates to those individuals who may act a bit oddly in the workplace, or in social settings, or even within families. They just have a different way of seeing the world or viewing the world.

Schizotypal personality disorders: those are individuals who may feel like they have special powers, or abilities, or just magical way of thinking. They may feel like they can communicate with celestial beings, for example.  For some individuals, we can see how that can morph into more severe forms of mental illness.  Again, the focus here again is on personality disorders.

A paranoid personality disorder is an individual who may feel like everybody’s out to get them, him or her. No matter what is going on, that’s just how they view the world, right? Everybody’s out to get me or a strong sense that “I have to get them first.”

The Wild Wild Workplace
The next set of personality disorders I will, that I want to discuss begins with borderline personality disorder.  We can usually tell when there’s a patient with borderline personality disorder patient on the unit.  There is usually turmoil among the clinical staff due to patient’s behaviors which can cause rifts among the staff.  These individuals typically have very inflexible ways of thinking. In other words they may see situations in the absolute.  That is, everything is seen as black or white. There is no in between and definitely no gray zone. You either love me or you don’t. You either think I’m the best employee, or do you think I’m the worst employee. You either give me an award or you don’t.  It’s probably fair to say that you can see how this behavior can create some conflict and dysfunction in interpersonal relationships, as well as in the workplace.

The next personality disorder is histrionic personality disorder. When somebody is histrionic, they tend to want and crave being the center of attention. Does anyone close to you come to mind?  At the very least, let’s not look too far from ourselves as we can be the classic example. Individuals with histrionic tendencies can be very colorful in what they do (i.e. in their dress and appearance).  In other words, there’s always this flare to them.  Some people may have outgoing personalities in general which can be normal.  Again, the word disorder, as it is used here, means that there’s impairment in how that individual functions.

Narcissistic personality disorder is next.  Do we know anybody or seen instances or know of instances where we’ve seen narcissism demonstrated?  A narcissistic person tends to believe they are always right.  Yes, I do mean always. They can do no wrong, however, their insistence on always being in the right can create frequent instance of conflict in relationships. To be clear, having narcissistic traits isn’t unhealthy.   In any event, narcissistic personality disorder and those, the traits that are associated with that individual can result in problems in the workplace as well as functioning socially.

The next personality disorder is Antisocial personality disorder. The behaviors associated with antisocial personality disorder is very different than somebody who does not want so socialize when they attend an event. Oftentimes, we hear people say, “Hey, I’m antisocial.” In that context, they just mean that they don’t want to be around other people.  The definition that I use in here is an individual who may tend to be charming, downright charismatic with no bounds. In addition, they may also have legal histories.  These individuals have very little remorse for some of the things that they do.


A Dependent personality disordered individual is someone who may find it difficult to make decisions without someone else being present or having to run it by multiple people in order to make decisions. We can see this behavior play out in co-dependent relationships where one partner feels incapable of making decisions unless the other partner is involved. That person with dependent personality would find it very difficult to function or to thrive in their daily life.

Obsessive personality disorder. Often perfectionistic in their actions. These are individuals who obsess over their need to do everything correctly. If it’s not done right, their belief and perception is that [their] world will end. An example would be somebody who’s handwriting a letter. If they get to the end of the letter and they made an error they would feel compelled to start over. That is, instead of one putting one line through the error and moving ahead, they may trash that paper and restart their work. I am sure that you can imagine if that error occurs repeatedly, they’re going to have a very difficult time meeting deadlines.  When this plays out in the workplace it causes both frustration, dissatisfaction, and helplessness especially if a remedy cannot be reached.

Passive aggressive personality disorder. I think we can all recall an instance where we’ve seen passive aggressive behaviors occur. In such cases individuals may not readily start a conflict, but they may position others people to be in conflict with each other.  Know that conflict does not have to be a physical fight.

There you have the abbreviated intro to the various personality types and disorders


Trust your instincts.

Learn to trust your gut instincts.

Ask questions with the intent of rousing an alternative way of thinking.  In the case of Dependent or Obsessive personality disorders who struggle to meet deadlines, one may ask: “Have you considered giving yourself more time to meet your deadlines? That way you’re not feeling all this pressure. Or, for someone with narcissistic tendencies: “Have you ever found that other individuals may have a different way of doing the same type of task versus your way of constantly doing that task?”

Set concrete expectations. You do not want and cannot afford to have any room for interpretation, misinterpretation, or reinterpretation of your instructions.  More importantly, you do not want to be vague.  For example, if you need a report on your desk at 9:00 AM, you make your expectation explicit and assess for barriers to the deadline being met.  Avoid the common practice to say: “Get it to me when you can or as soon as you can.” For a dependent personality disorder, that will be a problem. For an antisocial personality disordered individual,
“You’ll just get it when you get it.” One can readily see how these behaviors can create some conflict for you as a leader in the workplace. I will offer that in my role as a physician, I do my best to instruct my patients to not change your medication dosage without informing me, to take their medications prescribed, and to call if they develop side effects.  So again, I want you to just think of any time you interacted with somebody who had a personality disorder and just write a tip. You know, how did you overcome that or interact with that person in a successful manner?

I am Dr. Ken Richmond. I help corporate leaders pinpoint leadership issues so they can develop thriving workplaces with less turnover, improved workplace morale, and increased organizational performance.  You can follow me on and on all social media platforms @DrKenRichmond.

Dr. Ken Richmond featured on Day Break podcast

Dr. Ken Richmond featured on DayBreak