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How are you today?

4704953402_631194c066_zAustralians do a lot of flying. That’s what comes of  living mainly in coastal cities on the edge of a huge land mass. So we spend a lot of time watching cabin crew run through safety procedures. I’m wondering if that’s something we should do before we consult our patients or clients. Here are three things you might ask yourself during consultations this week:

1. Am I fully with this person in the room just now?

2. What do I know about this person and the impact of their problem?

3. What happens if whatever it is that’s bothering them doesn’t improve or gets worse?

I sometimes wonder if I could be replaced by someone who hasn’t spent 6 years at medical school, four years training and then more years than I care to count ‘practicing’. The answer depends on the extent to which I am able to reach beyond myself on the day the question is posed. On the best days I can pick up on subtle cues. When it’s not so good it’s because I’m not all there.

There are lots of reasons why that might happen. Maslow’s hierarchy of needs explains it succinctly. Hunger, fatigue or boredom are not conducive to caring. Yet we have, and in some cases still expect, our health care staff to function despite those feelings. Roger Neighbour developed a wonderful model for the consultation in primary care. This remains the only guide that specifically includes ‘housekeeping’ as an essential step:

Neighbour acknowledges the need for the practitioner to take care of their own feelings, particularly those brought about by a consultation. If not, the emotions, possibly negative, engendered by one consultation, may spill over into the next.

Perhaps we could take it one step further and determine if someone is fit to work as a health professional on a specific day and especially if they are far too grumpy to care. Many have witnessed objectionable, rude and insensitive behaviour from those who should know better. It was once accepted as the senior doctor’s right to be ill tempered. It may still be. If it is then it should be no longer because anger clouds effective communication. And effective communication is vital to the art of medicine. We aren’t always at our best. Being aware when we aren’t is a first step to ‘safety netting’ as Neighbour put it.

Cancelling the flight because the pilot has a cold isn’t always an option. However replacing the pilot may be wise if she has lost interest in flying the plane. It matters how we look as health practitioners but perhaps it matters even more what we are thinking, and therefore feeling, as the patient enters the room. For those with an interest in innovation, here is the first and perhaps vital focus for improving the quality of the experience for the consumer.

Picture by Ryan Hyde


  1. Lots of useful reading from the links today. Another idea for practice software could be a final pop up window,
    ostensibly to record a guess at patient satisfaction (0-10,) but with the understanding of this as a measure of one’s own performance. Hopefully a couple of consultations with low scores and the penny would drop and the doctor would go out for a bite to eat or a breath of fresh air for a few minutes.

  2. Thanks James,
    I especially recommend Eckart Tolle. It’s often relatively easy to work out that you haven’t had enough sleep, or need a cookie. What’s less easy is to become aware of repetitive and unhelpful thinking patterns, dwelling on the past or living for the future. We don’t encourage our students to become aware of the voice in their heads. Sadly it often limits their ability to support patients.

  3. Adina Abdullah says:

    Another innovation idea could be to reenact something similar to the safety procedures to patients waiting to see their doctors. It could go something like, “ding,ding, dong, dong…Please pay attention to Nurse Minah. She has very important safety announcement for you today”. Nurse Minah” Good Morning, ladies and gentlemen, it is important for your safety and to ensure that you make the most of your visit to our clinic today that you should adhere to the medications given by your doctor, perform all the lifestyle changes and come to see us again on time as schedule for your follow-up appointment. Thank you..ding,ding,dong,dong”.

    The fact that airlines safety briefing are repeated again and again without the industry ever saying, “I think we could stop now, cause I think everybody on earth had heard it”. Yet we, in the healthcare industry, forgets to remind patient of the basic rules of safety when using our services. I guess we think everybody knows them already. Now, let me look for that stewardess outfit that I may have laying around in my cupboard!

  4. You make a good point Adina. For me the issue is what would nurse Minah say to the others. ‘ ding dong, important safety message doctors. If you don’t feel you are at your best today please ensure you take the time to make sure you listen very carefully to what your patients need today.’

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