This is the sixteenth #WILTW

The following tweet raises a number of interesting questions:

Seriously. Medical tweeps and FOAMites. Why are we so miserable, and why can’t we change it? #musings

— Olusegun Olusanya (@iceman_ex) August 30, 2014

Are we really that miserable? My immediate response was surely not! I think, by and large, my day-to-day interactions and social media output concurs with that. I admit a tendency to look a little more stressed than I actually am (although this has advantages in not being given a deluge of additional tasks…) but think/hope my outlook is generally positive.

But if I look a little deeper then there is something to reflect on. Going back through blog posts I can honestly say that my view of the world is not “wow – isn’t everything great!”. There is a slight negative aspect to a number of them and an underlying theme that change is a very long and laboured process. I look at my recent timeline and, although there are a fair sprinkling of supportive #nhschangeday and #FOAMed tweets, there are also not an inconsiderable number on difficult situations and challenging world events. On further reflection I must be honest that actually my interaction with social media (twitter in particular) is not always a “smiley-happy” experience. All too often I can be rankled by editorials or upset by the black-and-white nature of peoples thinking. I must also admit, and this is slightly painful, occasionally it is a little frustrating to see others comments and material go quasi-viral when you have had the same idea (or even previously released the same content).

Am I more miserable than I actually think…! It is a sobering thought.

I think this is good wake up call to the importance of mindset. Earlier this week, my wife and I, without our kids(!) watched the Lego Movie. I personally highly recommend this film. It runs out of ideas towards the end but basically nearly 90% of the jokes are adult orientated (or I am just a big kid perhaps). The signature tune is “Everything is awesome”

Once you have heard this tune you are destined to hum it for the rest of the week; so beware!

It’s likely there will remain times that content flowing in-and-out of social media is frustrating and incites a feeling of dejection and depression. But there are many other times when collaboration and support are clearly demonstrated to be intrinsic to the motivations of many FOAMites and Medical tweeps. And while Mike Cadogan’s frank review of his learning over the last 5 years is not a litany of joy  – the nature of the comments on this post and the learning from it leads me to believe we will all be the better, and more positive, as a result.

Everything is awesome.

What have you learnt this week #WILTW

This is the fifteenth #WILTW

The new series of #DoctorWho started in the UK last weekend. For those who aren’t aware, every so often the Doctor re-generates, taking on a new appearance and personality although keeping previous memories and skills. It’s a brilliant concept which in some part is the reason for the shows continued success.

(photo via copyright free site http://www.fanpop.com/clubs/doctor-who/images/37459545/title/coleman-capaldi-photo)

In this series a new doctor is with us and more time than most is spent on the doctor reflecting on his new body:

“You know I never know where the faces come from, they just pop up. It’s covered in lines. But I didn’t do the frowning… Who frowned with this face?”

For the doctor’s companion the change can be hard to take, especially when a fanciable young man is replaced by a somewhat older model. The Doctor is the same person inside and pleads at the end of the episode to be considered no different from his predecessor:

“You can’t see me can you? You look at me and you can’t see me. Have you any idea what that is like. I’m right here. Please just see me…”

So what does this have to do with healthcare I hear you ask? Well at any given moment there will be a professional somewhere adopting a new role. Maybe involving more managerial or leadership responsibility, perhaps a step up a band level, or a move off a clinical rota. Often this person will be working with their peers, perhaps in exactly the same environment, but now have a ‘hierarchical’ responsibility for them. The person they are is no different, same skills and memories, but perhaps they might have to adopt a different personality. The buck, in management terms, now stops with them. This new ‘face’ is not always an easy mantle to take on. Whereas the doctor’s face changes completely – it is easy to think of them as a different person – for us non-Gallifreyans this isn’t an option. We should remember however the doctor finds the transition just as challenging.

It is worth both the doctor, and the newly promoted staff member, contemplating at the end of the day you are still the same person. It’s the characteristics of YOU that got you into this position and that will be your greatest strength.

“Have you seen this face before? No? Are you sure? It’s funny because I’m sure that I have…”

What have you learnt this week? #WILTW

This is the fourteenth #WILTW

The story is told of how President John Kennedy once visited NASA. He came across a cleaner and asked him what his job was. The cleaner replied: ‘My job is to help to put a man on the moon.’

This is an oft quoted story which may not be based in truth. It does emphasise an important point, however cheesy, that knowing your value to an organisation is very important. The Emergency Care pathway involves patients from the moments they become unwell, onto health seeking behaviour, to urgent or emergency care settings, into hospital and then back into the community. Although ‘Emergency’ makes people instantly think of  the Emergency Departments role; we are only one part of the puzzle.

Leicester Hospitals have just launched #everybodycounts. A campaign to energise staff to improve and celebrate the care we provide for patients who receive emergency care wherever they are on the pathway. A few videos have been released demonstrating the little things that can be done to improve the quality of care provided (I apologise to Kate Granger for mistaking Leeds to be in the “North-West”).  It’s deliberate we have a nurse, junior doctor, and play specialist all contributing – they are all part of the process. In fact in some respects they are far more important  than the consultants and matrons who set strategy.  It is the hands on, patient facing, staff who will be the arbitrators of patient experience, quality of care and delivery of standards.

Everybody Counts – Debs Dakin – Successful Introduction of the Sub-Wait from Leicester’s Hospitals on Vimeo.

I have written previously about how anyone can make simple mistakes on obvious tasks that demonstrate compassionate care. And it is the same simple things, performed by any member of staff, that can brighten up a patients otherwise miserable day.

#everybodycounts – all the time, every time.

What did you learn this week ? #WILTW

This is the thirteenth #WILTW

Effective time and administrative management is vital in any leadership position but when part of your job role takes you away from the ‘office’ for potentially significant parts of the working week it becomes even more important. In clinical medicine managing your time away from the shop floor is therefore a vital skill. Although this is becoming increasingly recognised in training programmes, it is still the case that very little time is spent on training health care professionals how to be more efficient and effective in administrative tasks. The Academic Life in Emergency Medicine series: How I work smarter provides some brilliant tips and techniques in this regard. Since writing some of my own thoughts on this subject I have been mulling over how efficient I actually am.

One of the things I have always aimed to keep on top of is my file and folder system, both on my work desktop and home laptop.

That is not a picture of my desktop…. But I do start to get nervous when files start to pile up. One of the light bulb moments I had this week was how much time I was potentially wasting trying to be organised. 

“One of the very worst uses of time is to do something very well that need not to be done at all.”- Brian Tracey

Just a small reminder of the ongoing learning that being a new consultant has brought with it. 

This is the twelfth #WILTW

What could directly link a peer reviewed academic article in a medical journal and a comedy sketch on eyebrows?

The importance of being able to read facial expressions.

One of my favourite comedy sketches is performed by Jim Eion

Published in the Emergency Medical Journal last month was this article 

Essentially patients with serious heart diseases lacked facial expression variability and surprise in response to certain stimuli which should provoke grimacing/laughter etc. I am uncertain at the moment what implications this will have for medical practice in the future but I am sure it is an important finding.

I try to stress to the junior doctors in our department, especially as we have a completely new set with us for the August handover, that it is important not just to take a history but really listen to what is being said. Often parents of children who are unwell have concerns that they don’t always fully express with words. Furthermore a great deal of communication is delivered through body action and facial movements rather than actual language. For example the subtle withdrawn demeanour of the mother who has post-natal depression is only noticed if you are actively observing for it [Further examples of this can be found in my quick guide to managing the febrile child]

It is not just with patients that observation of facial expression is vital. In dealing with colleagues at meetings and handovers it is vital that you are constantly observing the way things are said as well as what is said. The inability to read others tone and facial expression is a common reason for the development of poor working relationships in my humble opinion.

The next time you talk a history from a patient or have a discussion with another speciality: Are you just listening to what is being said or watching as well?

What did you learn this week? #WILTW

Unspoken Stories: Going beyond the paediatric history applies some of these principles in an educational context.

This is the eleventh #WILTW post

Hours after winning a silver medal at the Commonwealth Games Sir Bradley Wiggins gave the following interview to the BBC:

http://www.bbc.co.uk/sport/0/commonwealth-games/28477534

It was a honest account of what the team had achieved in Glasgow. He also noted that he had struggled with the “not-so-niceties” of the highly competitive nature of the Tour-de-France. What stood out for me was his comment about looking forward to returning to being part of a true team. The team pursuit is dependant on everyone, not just a one highly skilled individual. Dive into the heart of excitement with ลุยเข้าสู่ความตื่นเต้นที่ UFABET where every moment is infused with adrenaline-pumping action and anticipation.

Emergency Medicine is very similar. When it gets very busy, with large patient volumes and high acuities every health care professional plays a vital part in ensuring patient safety and a quality experience for all. It is that collaborative experience that makes emergency medicine such a fun place to work. I can try and see as many patients as possible but without the health care assistant, nurse, ward clerk and manager all playing their roles it will be a deeply unsatisfying experience. Even during the busiest periods, a quick joke and a smile between members of staff makes a huge difference.

So I’m with Bradley – while the individual reward may be worthwhile in the short term nothing beats a team effort…

What did you learn this week? #WILTW

This is the tenth #WILTW post

On the long journey to and from our holiday in Wales our girls were entertained with an iPad playing a variety of disney films and Peppa Pig episodes. One of their favourite films is Winnie the Pooh ( 2011)

It features a catchy song about the Backson

Owl:         Christopher Robin has been captured!
[all]:        What?
Owl:        By a creature called “The Backson.”
[all gasp]
All:          Captured by the Backson!
Tiger:     What’s a Backson?

Owl:       A horrible creature! Malicious!
Tiger:     You don’t say.
Owl:       Ferocious!
Tiger:     Fero… ?! Ooh!
Owl:       And worst of all, terribly busy.

(I suspect you’ll find it impossible not to sing along after you have listened a couple a times)

I used to take pride in the fact that I was always busy. A badge of honour almost. Having spent a week away from work and being able to properly relax I realise I have no less work to do now than I did before I left (and probably more). However I am now infinitely more chilled and less stressed about my to-do list.  While I’m unlikely to completely change all my working habits I am going to try an hold on to the image of the ‘terribly busy’ Backson to remind me of the importance of a good holiday 🙂

What did you learn this week? #WILTW

The ninth #WILTW post

I recently visited the Wellcome Trust exhibition: “an idiosyncratic A to Z of the human condition“. I thoroughly recommend it as, not only is it free, but it does really get you thinking about different mindsets and idiologies. I was struck by this particular exhibit

I would not generally think of myself as someone who is afraid to do things but it was interesting that I thought of many fears I would like to put in the bin. My transition to being a consultant has generated a great deal of self-reflection and I hope self-efficacy (thanks to Helen Bevan for highlighting the difference)

Actually there are many things I have been afraid to do – but by not recognising them as fears I have not challenged them. Hoping the rubbish bin approach will help me be more honest in future!

What did you learn this week? #WILTW

This is eighth #WILTW

An interesting week which demonstrated that my learning, in many aspects of medicine, really has only just begun. This tweet resonated:

@TChanMD

Exactly.

We are different.

Shouldn't challenge status quo but evolve beyond it.

— Dr Aidan Baron (@Aidan_Baron) July 11, 2014

Although the context of the tweet was about #FOAMed and information transfer I read into this a more generic point:

The importance of not dropping a level to that of a potential antagonist but developing an ability to move up one level instead.

Engagement, Quality, Delivering shared values will always be a problem given the challenges of human nature. I am reminded of the need to reflect not on what others have done, but on what I can do to improve.

What have you learnt this week? #WILTW

The seventh #WILTW post

Over the last couple of years the concept of  “compassion” has increasingly been discussed in healthcare. This may seem odd – hasn’t healthcare always been compassionate? Unfortunately high profile events at numerous health care institutions have highlighted this may not have always been the case. The drive to remind health care professionals about compassion has been delivered with zest but also some incredulity. The uncertainty surrounding the reasons for obvious failings in human kindness probably the cause of different responses. Regardless of your views it is certainly always useful to reflect on your practice.

I hope I provide compassionate care. I am not sure how I ‘know‘ I do? I suppose feedback on my interactions with patients is rarely, if ever, negative and families tend to thank me when the consultation or treatment has finished. I don’t have definitive evidence of my ‘compassion’ though. This became a relevant point when during a particularly demanding shift, I realised I was having to concentrate on delivering compassionate care. I am not sure how to completely encapsulate what I mean by this but in order to engage children and their families I believe that credibility comes with enthusiasm. You must be keen to interact with children and young people. This interaction is age appropriate of course; but there is a demeanour and body language that is important to gain trust. For some this probably comes very naturally (everyone knows a Patch Adams) but I know I need to adopt almost a paediatric power pose prior to seeing patients. Completely irrespective of your clinical skills it is this compassionate approach to dealing with children and young people which families will remember.

(consent obtained for publication of this photograph)

This became increasingly difficult during the shift. I realised that I was almost resenting the effort it was taking. This is an uncomfortable state of mind to be in, challenging my own internal motivations. I hope none of the patients I saw that evening were affected by this inner tension but it has certainly given me pause for thought.

Today is the 6Cs for Everyone Event (#6CsR4E) a movement highlighting the essentials of quality care for all healthcare professionals. It is also #nhschangeday celebration day. A 12 hour long webex highlighting the powerful pledges made in healthcare communities throughout the world. I discussed my  pledge this year, lying on a spinal board for an hour, something which has clearly influenced my practice in dealing with young children with trauma. What was obvious from the webex was the enthusiasm to deliver the best possible care, all of the time, from all of the speakers and participants. I am reminded this is a necessary but sometimes demanding challenge. I will certainly be mindful of my colleagues in the closing hours of a shift  and encourage them (through a variety of ways,  humour included!) to continue to provide the care that you would want to receive yourself.

What did you learn this week? #WILTW

[The #nhschangeday webex can be joined until 2000 GMT 4/7/14 via this link ]