I’ve been reading Brene Browns book ‘Rising Strong’ in which she explores this idea. I’m not entirely sure why but for the first time it actually hit home. I’ve heard it said a hundred times but generally dismissed it.
‘Sure I know they’re trying but are they…? Really?’
I even found myself saying it at work to be told it wasn’t good enough. That can be hard especially when you’re being held to account for things that are out with your control. I know I’m not the only one who has experienced this from what I see discussed on social media (Professor David Oliver’s tweets from the weekend are a good starting point @mancunianmedic)
Medicine sometimes feels like a giant mechanical beast to be dissected and analysed. We’re very good at coming up with diagnoses, tests and management plans. We’re great at refining ‘process’ when things don’t go well. We also have a complaints department whose job it is to write letters with our findings. It’s all very…. clinical.
Where is the feeling?
I’ve been a supporter of Patient Opinion (@patientopinion) for years. I love its simple concept of real time feedback. I have become increasingly frustrated and disillusioned with the clunky, time consuming/wasting complaints process on offer to patients and families. Patient Opinion allows people to share stories – good and bad. It allows us not only to be transparent and honest but also lets us share with the whole team. It opens up the possibility of real time change in a way that the current system doesn’t.
This ability to effect change in real time I think is crucial in maintaining the trust of patients and their families. I also think however it has a role in protecting the emotional well being of the team.
A colleague on twitter Dr James Fisher (@JimboFish) introduced me to Schwartz rounds (@PointofCareFdn). The idea is again a simple one. While we can do a significant event analysis we rarely focus on its impact on the team from an emotional perspective. We don’t talk about the frustration of dealing with an agitated delirious person who we wish would just sit down in case they fall and break a bone. Or how we felt being shouted at by angry relatives in the middle of the ward. I understand their stress and worry but does that mean they can call me all the names under the sun and twist my words….?
I tried to introduce this to the post take ward round debrief when I was on call this weekend. After going through the job list I asked Tania, my FY1, was there anything else we should or wanted to talk about. It turned into a discussion about the non pharmacological management of delirium. We spoke about trying to change perspectives to see through the eyes of the person we are trying to help. What was amazing was the realisation that actually the most helpful things are often the most simple and easy. Feeling empowered she went off to put into practice what we had spoken about. All with a renewed sense of confidence.
Having tried a modified version of it on call I’m thinking of making it part of our weekly multi disciplinary team meetings. I think emotional vulnerability is hard especially in an organisation such as the NHS. However if we are entrusted with the care of the most physically and mentally vulnerable – sharing our own emotional vulnerability can only be a good thing.
Resources
http://www.patientopinion.org.uk
Then Wednesday arrives and it’s a bit of a jolt to the system. Suddenly the team is brand new and not only do they not know the patients they don’t know how things are done. Its kind of like when a plane hits turbulence. Its all a bit unpleasant but no one is in any kind of real danger. That’s how I feel manning the ward on changeover day. I’m the pilot of the plane trying to get us through the worst as quickly and safely as possible. I consider our senior charge nurse to be my co pilot. We make for a pretty awesome team having been through it many many times!
Sparklystar55 