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Don’t Just Sit There Listening –Solicit Input

Posted by capcityspeakers on March 7, 2017

by Suzanne Gordon

Soliciting Not Just Listening                                                questions

Want to be a better physician or nurse leader? Enhance patient safety? Effectively lead teams? One of the current consultant prescriptions is the recommendation that leaders spend more time listening than talking. Whether in the larger management literature or in the articles and books that specifically target health care, listening is portrayed as a key to leadership. Employees want their voices to be heard,” one management guru opined in a Forbes article entitled “6 ways Effective Listening Can Make You a Better Leader,” and to “know that they (their leaders) have their interests at heart because they really listen.”

To emphasize this point psychiatrist Mark Goulston titled his bestselling book Just Listen: Discover the Secret to Getting Through to Absolutely Anyone. Listening 1.1 has, in fact, advanced to listening 2.1 wherein one is exhorted not to “just listen” – i.e. passively and unresponsively — but to engage in “active listening.”

I am all for listening. Of course people have to listen to each other rather than silence, ignore, dismiss, or denigrate one another. When it comes to the implementation of genuine teamwork and patient safety within the hierarchical environment of health care, I don’t think listening is enough. As Amy Edmondson has written in her book Teaming, “Research shows that hierarchy, by its very nature, dramatically reduces speaking up by those lower in the pecking order. We are hard-wired, then socialized, to be acutely sensitive to power, and to work to avoid being seen as deficient in any way by those in power.” Read the rest of this entry »

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Encouraging all members of a medical team to speak up

Posted by capcityspeakers on July 21, 2016

by Suzanne Gordon

The oval, mahogany table dominates the center of the large conference room. A number of chairs circle the table and dot the perimeter of the room. Every week, a group of high level hospital administrators, physician leaders, and leaders of other professional and occupational disciplines—physical therapy, social work, clinical directors of nursing, housekeeping, etc—gather in this room to discuss hospital function. They call themselves a “team” and the gathering a “team meeting.”

Nothing indicates that places at the table are reserved for particular participants. But today, as happens every week, when physicians and hospital administrators enter the room, they immediately occupy the chairs at the table. As nursing and other professional and occupational “leaders” enter the room, they sit around the perimeter, even if seats at the table are empty. The discussion is largely conducted by, and includes mostly, people sitting at the table. Occasionally, someone chips in from the outfield, as it were, but not too often and certainly not with much vigor.

I have been invited to this hospital to consult about teamwork, patient safety, and “professionalism” particularly among the nursing staff. The hospital has sent people to do TeamSTEPPS, a healthcare team training developed by the Department of Defense and the Agency for Healthcare Research and Quality. It has hired consultants to teach people the principles of high reliability organizations (HROs). It is concerned about the fact that non-physician personnel do not speak out about patient safety and, as the Chief Nursing Officer puts it, do not behave in a “professional manner” when at work. Maybe, she muses, nurses would speak up more if they all wore a standard uniform instead of scrubs adorned with flowers or smiley faces. Come and observe us function, and tell us what you think, is my mandate from the executive team.

After the meeting is over, I ask nursing clinical directors and “leaders” in social work and other disciplines, why they do not take a seat at the table when one is empty. They all say they same thing. Read the rest of this entry »

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Does the use of medical titles have an impact on patient safety?

Posted by capcityspeakers on April 14, 2016

by Suzanne Gordon

A couple of months ago, I was invited to speak at an East Coast medical school and hospital. The group of physicians who extended the invitation—a female surgeon, and female and male internist—took me out to dinner the night before my talk. During the dinner conversation, we were all on a first name basis when we addressed each other directly. When, however, one of the three physicians mentioned something one of his or her colleagues had been working on or accomplished, he or she spoke about that physician in the third person i.e. as “Dr Smith has spent a lot of time working on this issue,” or “Dr Jones just published a paper on such and such.” When they referred to my writing or work, I was not Ms Gordon or Professor Gordon, but Suzanne.

I was struck by this mode of address precisely because I was asked to teach medical students and residents about patient safety and interprofessional teamwork. Modes of address are, in fact, central to both. When I asked them about this, they told me that it’s important that physicians be respected because they know so much.

This is by no means the first time I—as a non-physician and non-PhD ( I am a proud graduate school/doctoral program drop-out)—have encountered this particular doctor dilemma. As a patient, and an older one at that, most docs I meet in the exam room call me Suzanne as they introduce themselves as Dr so and so. If I am on a panel with physicians, I am invariably addressed as Suzanne, while the physicians are Dr…

In North America this practice is embedded in institutional culture. In the clinical setting most physicians address or refer to nurses and other professionals and healthcare workers by first name and expect—particularly in front of patients—to be addressed with their last name and title. (Even when they are on a first name basis, they refer to each other as Dr…) Non-MDs almost always introduce physicians to patients or other staff with last name and title (while they introduce themselves with first names only—sometimes even omitting to mention that they are a nurse, PT, or dietician). When they directly address physicians in front of patients, they usually use last name and title even if they are on a first name basis with the physician outside the exam room. When I ask them why this asymmetry of address, they invariably inform me that patients need to know who their physician is and that this physician must be respected. Apparently patients don’t need to respect—or even be able to identify the role of—nurses, PTs, OTs, social workers, or other personnel with whom they are in contact.

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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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