Start of a Journey #AnotherWay

It’s a little over three decades since I joined medical school and I find myself starting a new journey – exploring deep compassion in clinical practice.

I will be doing so through a Masters program “Human Factors in Patient Safety” offered by the Royal College of Surgeons of Ireland from this September. A little nervous, and very excited.

Human factors” can mean different things to different people. For me, it is about exploring how compassion influences the interdependence between human beings and clinical systems. Anyone who has experienced genuine compassion knows the effect it can have on clinical outcomes – how might it be possible to reproduce this at a “system” level ? And if we did, what kind of effect might it have ? In short – could there be #AnotherWay to how we deliver care ?

I hope to share what I discover over the coming months through this blog …

IMG_4061

 

 

 

 

A Three Breath Traffic Light

 

traffic-lightsAs I prepare a resilience workshop, I would like to offer you a simple tool called the three breath Traffic Light.

In essence, you keep an image of a traffic light somewhere easy to find – like your phone or on your desk. Have an alarm prompt you every so often to look at this image.

The Red Light – is to remind you to just stop and breathe.

The Orange Light – to breathe and be aware you are breathing.

The Green Light – to breathe and then go.

While this may sound childishly simple, it’s power can be immense. Neurophysiologically speaking, “stopping” interrupts fear and flight or fight circuits from continuing to spread beyond their origin in the amydala. Becoming aware of the feeling of our breath, strengthens the links between the right and left sides of the brain. Finally when we breathe mindfully and “go” it restores brain function and control to the executive centres in the pre frontal cortex.

Or put simply, it gives us the power to choose how to respond, rather than be driven by subconscious lower brain impulses.

Faced with the breaking point pressures in the NHS as we have been for 3 years, it is worth remembering tools similar to this have helped rebuild inner strength and resilience in children exposed to much worse – the devastating trauma of 9/11. If it can work for them, it can work for us. Will you give it a try ?

Inner Resilience Program

Social and Emotional Learning

IMG_1396

Breakfast Rounds

img_0117

 

Which comes first – my role as a doctor or my role as a human being ?

Recently, with clinical need exceeding inpatient bed availability, patients have been forced to spend the night boarded in their local Emergency Departments. Which brings me to my dilemma.

Imagine I come in at 8 am. I start with a “ward” round on these overnight patients. I come to patient number two and find a frail 81 year old lady who has been in ED for hours with very little to eat or drink. I look for a health care assistant or hospital volunteer who could bring my patient some breakfast. There isn’t anyone. I look for my patient’s nurse and find she is stretched between several other patients, about to start antibiotics on someone septic while simultaneously organising the urgent transfer of a patient she needs to take down to CT. (gone for another 30-40 minutes at least). So it comes down to me –  do I  stop the round and make tea and toast for this lady and other overnight stay patients myself ? Or do I delegate the task –  knowing it may be an hour or more before it gets done – and instead check whether the remaining boarded patients have serious medical problems to sort ?

I honestly don’t know. Like Australian Lieutenant General David Morrison, I believe the standard you walk past is the standard you accept. And this is a standard I can not accept.

My friend and colleague Damian Roland wrote about being the kind of consultant who answers the telephone.

Another friend (and fellow ED consultant) routinely pushes patients on trolleys to the CT scanner when a hospital porter isn’t available.

While noble and good for the individual patient concerned, I wonder if such actions might weaken the system further, putting future patients (and staff) at greater risk. (“We don’t need more reception staff / porters / health care assistants – the doctor can answer the phone / push the trolley / get breakfast…”)

I guess some of it depends on how we as doctors communicate these issues to hospital managers, and how hospital managers in turn respond.

Till then however, my dilemma remains …

 

img_0716

 

Reflections on ‘firefighting’

A thought came to me while watching the trailer for Deepwater Horizon at our local cinema recently. We use the term “firefighting” in the Emergency Department almost daily – as a way of explaining our focus on immediate shop floor crises, often at the cost of proper planning for the future. But what exactly does “fire fighting” involve ?

Certainly a team of people – we generally don’t expect a single fireman to deal with a burning house on his/her own.

It needs specialist training, and constant updates in best practice.

Finally, firefighters are inherently heroic, aware they may be called upon to sacrifice their lives every time they get called out.

Looking at EDs across the UK, and at our own, how often do we send a multidisciplinary  team of both emergency and in-hospital specialists (doctors and nurses) to deal with episodes of shop floor overcrowding and severe clinical risk  ? How often are those of us leading the response really trained in managing critical imbalances between emergency demand and available resources ? (good article by Damian Roland on unconscious incompetence at scale). How far are we ready to go in sacrificing career progression, even job security by speaking out when the situation calls ?

There are reasons why even with our best intentions, the fire in UK Emergency Departments continues to burn …

img_0428