One of the great things about blogging is the permanency of your thoughts. Ideas and thoughts developed on a train journey are often lost forever but if you can encapsulate them in writing they are always available for ongoing reflection. Comments on your work are a functional way for this reflection to be forced upon you but I’d be interested to know how many other bloggers review their material, amend, maybe even comment their now changed views?

With this in mind a while back I posted on the Network site (@thenetwork001) a brief piece on an event that occurred during the Olympics “Was Clare Balding right? Adequacy versus Aspiration”. For those outside the UK Clare is a well respected BBC journalist and presenter. It’s short enough to share below:

“During the Olympics Clare Balding apologised to the nation, “I am sorry we can only offer you a bronze.” her words after Rebecca Adlington’s performance. There was an instant twitter and email response with a prompt, and sincere, apology. In a different event, but with a similar theme, a number of commentators during the games made reference to counterfactual thinking on how actually getting a bronze maybe better than a silver.

The post-Darzi drive for Quality remains a powerful influence in commissioning, service delivery and outcome metrics. Appreciating quality has rarely been defined in terms of Gold, Silver, Bronze and ‘placed’ an exploration of delivery of healthcare find being ‘placed’ a common place event. Take, for example, Medical Education; those despairing at the acquisition of a host of work-place based assessments find the target to achieve a fixed number at a minimum standard. Achieving a gold standard performance is not really an option. How about a service delivery standard? The four hour wait is one part of the Emergency Medicine clinical quality indicators along with unplanned re-attendance and left without being seen amongst others. Trusts stagger towards achieving each of the minimum required standards but it would be more than possible to cluster performance across indicators to enable ‘medals’ to be awarded for going the extra mile. 

How do you rate your own performance? – are you happy that the patient was treated efficiently or effectively? Perhaps just treated? Do you check that your contribution to their care was as evidence based as possible? Do you hope that a percentage of patients thank you specifically for your role in their care. 

Ultimately, as unsustainable as it may feel, are you happy with your bronze performance…”

Reading back now, not sure I would change much, but I did get an e-mail from my educational supervisor (a line manager in a medical training sense) saying it was important I got my facts right. My immediate reaction was concern that I had mis-quoted Clare Balding! However, this was not the case – I had used the term “wait” instead of ‘target”. This may not appear to be a significant error to the casual reader but it is an important principle. The NHS four hour target is well known throughout the world. It is not a ‘wait’ though, the “target” is that the patient spends no more than 4 hours in the department from the moment they register (which includes the consultation, investigations and decision to either discharge or move to a ward). For some in the Emergency Department world the distinction is really important both for public perception and the fact the target is dependant on a number of factors outside of the control of the Emergency Department.

@ShaunLintern remember inflow (no. of pts arriving) and outflow (no. of safely staffed beds available) are independent of what happens in ED

— Damian Roland (@Damian_Roland) January 14, 2013

Ultimately this is a really minor point. However lets say I had said something very  incorrect – does this really matter? I have never had a comment on a blog from a member of my own institution, and one involved in my training. What questions does this raise about blogging (and wider social media) as a means of assessment or professionalism. Obviously stripping naked on a night out isn’t an ideal thing for a line manager to see, but what degree of error is needed in a quasi-professional social media to attract the attention of an educational supervisor? As Social Media closes the boundaries between work and home-life these questions are likely to continue to be asked.