Dr. Damian Roland

What I learnt this week: The importance of listening and language #WILTW

In Uncategorized on April 25, 2015 at 8:00 am

This is the 49th #WILTW

I met an inspirational couple this week who lost their son, Oscar, to a very rare complication of a viral infection. Oscar had come to hospital with a infection in his bone but at some stage during his illness caught rotavirus (a virus which commonly causes diarrhoea and vomiting in children). Unusually the virus spread to his brain and he was not able to recover from this.

During their time in hospital they both eloquently describe how they knew that there was something wrong with Oscar but felt no-one was really appreciating their concern. You hear this story all too often after tragedies, regardless of whether medical error has occurred. I have written previously on engaging parents in the identification of ill children and the great work Cincinnati’s children’s hospital have done on this. Their narrative really hit home as during a clinical shift earlier in the week I had been humbled by a mother’s comments to me, “Thank you for listening“. From my perspective that was the least I had done but for her the ‘medical’ interventions less relevant than the validation of concerns following numerous consultations.

A friend from the ASK SNIFF research group uses the term enacted criticism in the relationship between parents/carers and health care professionals which is described in this video.

Enacted Criticism

One thing that stood out for me in talking to Oscar’s parents was Hannah’s comment, “isn’t there a difference between being unconscious and sleeping?” There certainly is but that difference may only be appreciated by someone who knows their child well or is very experienced. The term ‘lethargy’ is a ill-defined dangerous word. I will always review a child if someone describes them as lethargic. The divide between being tired and obtunded (a medical description of someone who is very unwell) is wide in principle but sometimes not so in practice.

There is then a double dilemma. The ability to listen well, by truly hearing what you are being told, but also have a common language, by using words which are understood by all. In a world of increasingly reliant on technology and protocol their will always remain the need to teach all health care professionals these simple, but vital, communication skills.

What have you learnt this week? #WILTW

Oscar’s parents have set up a charity Thinking of Oscar 

What I learnt this week: Does time make teams? #WILTW

In #WILTW, Medical Education on April 17, 2015 at 4:23 pm

This is the 48th WILTW 

In the most recent edition of the Emergency Medicine Journal there is an article entitled, “How familiar are clinician teammates in the emergency department” by Patterson et al. I think it is a pretty interesting study, even if you are not a health care professional (but I’m a bit of data geek so not everyone will agree!)

The authors looked at the amount of time any given clinician (by this they meant doctor, nurse or support staff) spent with any other clinician over a 22 week period. By averaging out times they calculated something called ‘weekly mean familiarity’ – the average amount of time any two clinicians would spend together. Because of the shift nature of Emergency work and a limit to the amount of shifts you can do there is clearly a maximum time you can spend in contact with a colleague. However some of the weekly mean familiarity figures were surprisingly low. For example, Junior Doctors would only spend 0.4 hours, on average, working with the same Junior Doctor per week. I’ll be honest I still can’t quite get my head around how small this number is but the maths do seem to work out.


This article struck a cord as I attended a lecture this week on Human Factors by Patrick Mitchell, a neurosurgeon from Newscastle. He is particularly focused on casting a wide educational net i.e you must train whole departments if you are to reduce human errors; you can’t just cherry pick the most interested individuals. One his themes was the difference between groups and teams:

Groups and Teams

Table via For Dummies 

Essentially “While all teams are groups of individuals, not all groups are teams [1]” 

These comparison tables are often seen as twee and theoretical rather than  practical. However I’m sure that team spirit being important to effective functioning of the unit is not unique to Emergency Departments. But is a component of team dynamic a function of the time they actually spend together? Given the variety of rotas in many health care organisations I think it’s important we consider how often staff do get a chance to ‘be together’. Many in medicine have complained that working time directives targets have been bad for patient care. I do not completely buy into this. I do believe though the team spirit is vital and that Patterson et al. has given me much to ponder.

What have you learnt this week? #WILTW

1. Source: Boundless. “Differences Between Groups and Teams.” Boundless Management. Boundless, 17 Apr. 2015. Retrieved 17 Apr. 2015 from https://www.boundless.com/management/textbooks/boundless-management-textbook/groups-teams-and-teamwork-6/defining-teams-and-teamwork-51/differences-between-groups-and-teams-261-4011/Teams works differently from groups.

What I learnt this week: Being honest about the trouble with twitter #WILTW

In #WILTW on April 10, 2015 at 1:29 pm

This is the 47th #WILTW

A week of annual leave and moving house (still no broadband!) has significantly reduced the amount of time I spend on Twitter.

While the hierarchy of needs diagram is fun the last fortnight has enabled an honest look at my relationship with Twitter. I am keen to point out in lectures it is a form of social media, not the social media.  I find the use of different social mediums is very specific to the individual. What one person hates about one, is why another person really enjoys it.

Chalk and Cheese

Social Media consists of different beasts, each having their own potential strengths and weaknesses.

I’m focusing on Twitter as it is the medium I chiefly use and taking a step back has highlighted the following:

  • I am guilty of sometimes being more concerned about my absence of involvement in twitter conversations rather than the twitter conversations themselves.
  • I suffer from  ‘I need to say that first’ syndrome.
  • Its real time nature sometimes makes me uncomfortable about responding or interacting for fear of being noticed of being online.

Some difficult truths which say more about me rather than Twitter itself. But what to do about these ‘complaints’? There is an additional paradigm which came to light in some revealing feedback I received which is Twitter users tend to support Twitter users. There is a potential overall inflation of quality, especially of lectures, if twitter is the only vehicle for comment. This partly stems from Twitter being an immersive, generally positive, but intermittently hostile, environment which doesn’t always reflect the real world. It is a bit of escapism, but in which you receive validation not present in other environments. My ‘complaints’ a reflection of my ego acknowledging its own faults perhaps and projecting them onto twitter? An uncomfortable conclusion so while I find Twitter immensely powerful the break has been useful. Commentaries on the adverse affects of social media are not new but as I experiment with #WILTW I am taking a gamble that this acknowledgement will be helpful perhaps not to me but others as well.

What did you learn this week? #WILTW



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