Healthcare Blog

Archive for December, 2015

Medicine’s F Word—Fail

Posted by capcityspeakers on December 21, 2015

By Suzanne Gordon

“The patient failed” this or that therapy.

I first heard medicine’s F word almost 30 years ago when I was having a casual conversation with an oncologist in a break room on the hematology/oncology unit. The oncologist—an earnest man devoted to his patients—was talking about a man who was dying of cancer. “Well,” he said with grim resignation, “he failed six rounds of chemotherapy and there’s nothing else we can do.”

The last time I heard the F word was at a morbidity and mortality round. A group of physicians were discussing a case that had gone badly. The patient had contracted Guillain-Barré syndrome. As the resident was presenting the case, he reported that the patient “had failed” several rounds of antibiotics and was now completely paralyzed. People in the room nodded sagely. No one but me—who thinks of herself as a potential patient or sometime patient—seemed to think there was anything wrong with this formulation.

And why would they? The F word is everywhere in medicine. It’s used when professionals are talking about patients who are in trouble or are dying, when they describe a treatment that has not worked, or when a patient has experienced a set back. Consider the following examples:

Oncology attending to resident– “I put the patient on Taxol and Adriamycin and the patient failed Taxol/Adria.”

ER physician to hospitalist, “Mr Y is a morbidly obese patient with a terrible infection on his left leg. He failed oral antibiotics and needs to be admitted for IV antibiotics.”

An attendant in the neonatal intensive-care unit (NICU) talking to a NICU nurse—“The baby has a congenital diaphragmatic hernia and has pulmonary hypoplasia. We started nitric oxide and the baby failed the nitric oxide therapy course.”

With variations, notes in charts use the same language, as do reports in research journals.
Many healthcare professionals with whom I’ve spoken about the F word think it is purely descriptive—almost neutral in its content and connotations. They don’t recognize that the verb to “fail,” used with the noun “patient” as a subject always implies blame.

Here, for example is how, Ask Dictionary.com defines the word fail:

“to be or become deficient or lacking; be insufficient or absent; fall short:
to fall short of success or achievement in something expected, attempted, desired, or approved”:

Failure is always an act that is accomplished by an agent. When you fail at something—particularly in competitive Western cultures—you have done something wrong. You have not studied hard enough so you failed the test. You did not run fast enough, so you failed to win the race. When one says that a patient failed a therapy, the patient is, by definition, not doing something right or efficient. They are lacking, absent, falling short or—to follow the dictionary definition—setting him or herself up for the medical equivalent of bankruptcy. When a patient is said to have failed something, the unavoidable implication is that the patient—not the disease process, the limitations of contemporary treatments, or of the state of current scientific knowledge—is responsible for his or her own suffering, deterioration, or demise. Unless the patient actively compromised their own treatment, using the term “the patient failed,” ascribes agency or action to someone who, in most cases had very little ability to influence the outcome. When clinicians use these terms, they are infecting the patient experience with the same burden of shame and blame that they so often shoulder. Only this time, they are transferring part of that burden to suffering patients. As Mardge Cohen, an internist and HIV-AIDS specialist puts it, “It’s almost as if nothing is patient-centered except the patient’s failures.”

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Done is Better Than Perfect

Posted by capcityspeakers on December 14, 2015

by Christine Cashen

Rocks

As the holiday crunch rolls on, I am in full panic mode. Cards to create, teacher gifts still to buy, long distance gifts awaiting shipment, monthly pictures for our family calendars yet to be selected, and every night I sit bolt upright at 1AM, because I’ve forgotten to move the frickin’ Elf on a Shelf. Wait, not only do you have to move the Elf, you also need to find something creative for him to be doing!? Pinterest, anyone?

Hold on…here’s the thing– I waited on our cards because the pictures didn’t look that great and I questioned my card idea (we did a Duck Dynasty take-off– don’t ask). I held off on the calendar because I could’t find the right picture of my sister-in-law for the month of May. I didn’t ship the presents because I wanted a few more useless things for the nephews’ stockings. STOP THE MADNESS!

My engineer “voice of reason” husband calmly tells me that if the calendars don’t arrive until Jan 1st, the family will still love them. Will my nephew notice that he doesn’t have the same amount of plastic crap in his stocking as his brother? Well, maybe, but he’ll get over it. If the Elf isn’t doing something wildly creative, does it make me a bad mom? I think not.

In stressful times, DONE IS BETTER THAN PERFECT. BTW, this does not count for bridge builders and brain surgeons, as well as others who are responsible for wildly important tasks. This is for those of us who put undue pressure on ourselves over trivial matters. The holidays should be a fun time of year. But, every time I see a mom relaxing at Starbucks drinking a latte, and she asks me, “Are you ready for Christmas?” I want to smack that latte out of her hands along with that smug (I handmade my presents this year) smile. Anyone with me on this?

Time for a wake-up call. As a motivational speaker, I know that it doesn’t matter what happens to you; it is how you respond that matters. Clearly, I’m getting sucked into the minutiae. Join me in shifting your perspective. Let’s make time to do truly meaningful things — connect with an old friend, personally deliver a thank you card or buy a gift for someone who is truly needy.

Put the jolly back in the holiday. You’ve heard it before, “Don’t sweat the small stuff” and it’s true! Done is better than perfect. Boxes shipped. Cards out with average pictures. Baked goods for the school party from the grocery. The Elf in a boring pose. It’s all good.

This season, give yourself the gift of not being perfect. You will still end up on the NICE LIST, keep your sanity and make other around you merrier too.

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What Are You Cooking Up At Work?

Posted by capcityspeakers on December 2, 2015

by Vicki Hess

The Big Idea sign with clouds

My son, Josh, and I both love to cook. We also like watching TV shows about cooking. He recently recommended a Netflix documentary called Chef’s Table about chefs who change our perceptions of food and the way we treat the planet and ourselves.

One episode in particular got me thinking about you and work. The chef who was profiled is Dan Barber – the co-owner and executive chef of Blue Hill and Blue Hill at Stone Barns – and the author of the book, The Third Plate.

During the episode, Chef Dan shared that as a young chef a mentor told him, “If you’re not teetering on the edge of the tightrope, you’re not pushing the envelope enough.”

Of course, I immediately thought…”Am I teetering on the edge? Am I pushing the envelope enough?” But this isn’t about me, it’s about you.

“What would a person in your shoes do if he or she wanted to do the BIG thing? If he or she wanted to leave the BIG imprint on the person in front of him or her, then he or she would WHAT??

You might be thinking, “I can’t do the BIG thing, I’m just a (fill in your job). Or “How can I do something so impactful? I don’t have a BIG stage or the ability to make a difference.”

Not so fast my friend…the person you are with today – your coworker, customer, patient, boss, future customer, etc. is counting on YOU to do the BIG thing. That might be listening with empathy, finding a different solution or simply being kind. It’s not rocket science, but it has the power to change the world just like rocket science did.

As you wrap up 2015 and start to look towards 2016, chose to launch yourself, think BIG, stay on the tightrope, have fun, make a difference.

If not you, then who?

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