Variation: Is it poor, or just different, practice that frustrates? #WILTW

This is the 130th #WILTW

Have you ever accidentally left something in a bag or pocket when you went through airport security that you meant to remove?

The alarm either pings as you walk through the frame or the security guard announces to everyone in the room; “whose is this bag…?

It’s a simple mistake, a bottle of water at the bottom of a rucksack, a metallic belt buckle you forgot you were even wearing. Frustrating, but at least it shows the system works. But what if you ‘smuggle’ something through that isn’t picked up?

Toolkit

In a side pocket of my rucksack I have a portable tool kit. I can’t remember when I put it there but it has a spanner attachment for my foldable bike.  I don’t think it could be used as a dangerous weapon (although one of the screw-driver attachments is quite sharp). I must have been through at least 3 airport security checks without realising it was there.

That’s why when the security guard pulled my bag out of the x-ray machine and did the ‘show of shame‘ I had a panicked moment someone may have placed some illicit substances in it. What would make them want to check?

Having pulled all the objects out and hung the bag upside down I eventually saw the pocket at the side. I was relieved when the guard looked at the tool kit and appeared to indicate this was the offending item.

I’m not sure you can take this with you sir.”

[Brief conversation in my head – it’s been through 3 airports and no one else seemed to care – it would actually be really useful should I need it, it’s probably not inexpensive and it was a present – basically I don’t really want to give it up. Can I say I didn’t know it was there? Did I say at check-in that I declared I knew all contents of my bag?]

Errr. Can you check that?”

The guard wonders off to chat to another officer. I have that sense that people are watching me and judging. Similar to when I take my children to the supermarket.

It’s ok, sir. My captain has said you can keep it

Relief was quickly followed by a sense of annoyance. Is there not an international object recognition standard? Were the other airports lax or was this one over the top? What is the point of variability of approach when lives at are risk?

It is easy to get frustrated. But this is probably the frustration experienced everyday by patients, or their carers, when they receive, or perceive they receive, different advice or management about their conditions. Medicine obviously does not operate by algorithm. There are reasons why conditions are treated differently and why patients are not all managed in the same way. But you can see why it might be confusing to take your hot, unwell toddler to one doctor and be given antibiotics and then later, with what is apparently the same problem, to a different doctor to be given nothing at all.

variation of care

Variation is practice is huge but I’d never been on the receiving end of it before.  In the future, if you see your patients or parents face fall when suggesting a management plan, don’t assume it’s because they don’t like your suggestion.  This is maybe the first time they have had an ‘alarm’ and are victims of the system rather than their own health care beliefs.

What have you learnt this week? #WILTW

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  1. Wonderful post! You’ve described the show of shame so perfectly and I love that you used this to empathize with patients’ experiences.

    For me, the absolute worst is when these two worlds collide – airport security and living with a serious illness. I travel a lot and so I get to experience that same show of shame and total lack of privacy when rightfully carrying my liquid medication through security. Every time, they stare at the bottle, then the box, then we do one of a number of “tests” on the bottle, the rules are never the same. Sometimes only I’m allowed to touch the bottle, sometimes they can only touch the bottle, which is fun to watch them struggle with the child proof top. I’ve been on the same medication for 9 years so I’m fairly used to the nonsense and try to have a good sense of humor about it.

    However, I had two extremely uncomfortable experiences flying through London after MedX, on my way to and from Italy. I’ll never fly through there again if I can help it.

    The London Hethrow security guard did the usual tests, verified my passport name closely with my name on bottle, which is not done in the US, but fine… And then he asked what my medication is for… in front of about 10 other weary passengers closely watching while also waiting for their turn to be shamed.

    I looked at the guard and thought, “are you a doctor?” Then my next thought is, “even if he was a doctor, he’d likely know nothing about my disease.” So I said, “it’s for a rare condition you’ve never heard of and I could tell you all about it but I don’t think this is really the time or place and I’m pretty sure you can’t ask me that question.”

    Apparently the medication had failed his “test” for whatever they are looking for when they put it in that strange little microwave looking thing. My blood was boiling. That’s $4,000 in that bottle. Please just give it back so I can catch my damn flight… He took it to the head security guard who put it in the microwave thing AGAIN and then they said it was fine and I could go. Wow, thanks for that extremely unpleasant 45 minutes of my life.

    Anyway, I’ve been meaning to write a blog post on this topic so maybe I will. Sorry for the long crazy comment. 🙂

  2. Thanks for your thoughts Julie – I’d not considered how variability on interpretation of medications would impact on patients at airport security! #alwayslearning

  3. A problem experienced on a daily basis that leads to increasing anxiety in parents and further emotional upset for both them and their children. Another thought provoking post. Thanks Damian