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How do you prepare for disagreement?

Sometimes you might be asked for something that seems entirely pointless. In healthcare almost every speciality has examples of such challenging situations. In intensive care and oncology such issues are most poignant as patients may end up suffering before death:

In a retrospective review, we identified 100 patients of 331 bioethical consultations who had futile or medically inappropriate therapy. The average age of patients was 73.5 ± 32 years (mean ± 2 SD) with 57% being male. Fifty-seven percent of the patients were admitted to the hospital with a degenerative disorder, 21% with an inflammatory disorder, and 16% with a neoplastic disorder. The family was responsible for futile treatment in 62% of cases, the physician in 37% of cases, and a conservator in one case. Unreasonable expectation for improvement was the most common underlying factor. Family dissent was involved in 7 of 62 cases motivated by family, but never when physicians were primarily responsible. Liability issues motivated physicians in 12 of 37 cases where they were responsible but in only 1 of 62 cases when the family was (χ2 5 degrees of freedom = 26.7, p < 0.001).

Seth et al

This scenario may be avoided if it is anticipated as a ‘set play‘. List all the ways you may be adding to the person’s problems and consider how you might avoid contributing to a bad situation.

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Are you ready yet?

What do you do before you interact with your next customer, client or patient?

Gaze and body orientation communicate levels of engagement with and disengagement from courses of action. As doctors and patients accomplish regular tasks preparatory to dealing with patients’ chief complaints, doctors use gaze and body orientation to communicate that they are preparing but are not yet ready to deal with those complaints. In response, patients wait for their doctors to solicit their chief complaint. These findings have implications for research on nonverbal communication, interactional asymmetry, and power.

JD Robinson

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How do you celebrate?

Do you celebrate with your customers, clients or patients? Why or why not? As a healthcare professional you know at least one date that is very special to them. It presents an opportunity as a teachable moment:

Data from a sample of 2,518 college students suggest that 21st birthday drinking poses an extreme danger: (a) 4 of every 5 participants (83%) reported drinking to celebrate, (b) birthday drinkers indicated high levels of consumption, (c) 12% of birthday drinkers (men and women) reported consuming 21 drinks, and (d) about half of birthday drinkers exceeded their prior maximum number of drinks. Current problematic alcohol involvement and its typical correlates strongly predicted both the occurrence and severity of 21st birthday drinking. It is imperative that investigators consider a variety of potential interventions to minimize the harm associated with this rite of passage.

Rutledge et al

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When did you last have dinner at our place?

We advise people about all sort of things- this is good for you, that will work for you, the other is bad for you…..But can you imagine yourself having a meal at that person’s home? Sitting in their car? Watching television in their sitting room? Shopping in their company? What’s it like walking in their shoes?

Picture by Jeff Kramer

How do you personalise your solution?

We are advised that medications will soon be tailored to our specific genetic profile. Meantime how do you ensure that what you are offering anyone who seeks your help in healthcare is a bespoke solution? What are you recommending? Pills, procedure, diet, exercise or something else? How do you know it will work for this person at this time?

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I am Joe and I get what I want

As I surveyed the new intake of medical students one student found his way to the front of the room.

Are you the associate dean?

When I confirmed he went on:

My name is Joe ( Not his real name- to spare his blushes). You need to know that I get what I want.

Now two years later here was Dr. Joe graduating, resplendent in his academic gown. He has his wish which I hope is for a lifetime of selfless service to people in distress. So when he is called to the patient in bed 9, on the wards tonight and he is told:

I’m Mr. Smith, and you need to know I get what I want. Tell your boss to come to my room at 11am, I’ll be ready for him then and by the way I’m not happy taking those pill, please take them away.

Joe will know he has got his wish.

Picture by KC

How do you frame disappointment?

Things don’t always unfold as you might have hoped. What will you do when that happens next time? How do you plan to live with disappointment? You have two options: accept it or not. But what exactly happened the last time you were sorely disappointed? Did the person you met after getting bad news hear all about it from you? Did you get over it? How? If you are in healthcare did it impact on your work that day? Why or why not?

Picture by Kevin Dooley

What’s the most annoying thing you hear when things go wrong?

Sometimes things don’t go to plan. The package doesn’t arrive, the flight is cancelled, the meal is cold or the documents are lost. The most unhelpful thing you can be told by someone you contact in those circumstances is:

Sorry, it’s not my job. Nothing I can do. We are short staffed, we told the boss that months ago. Call back after the weekend during office hours.

  1. What would you say?
  2. What do you say to your client, customer or patient?

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How do you handle your equipment?

I remember how our science teacher at high school cleaned the blackboard with a duster. It was done methodically and mindfully. It set the scene for the lesson. It’s funny the things you notice. Your customer, client or patient is likely to notice how you handle the equipment in your office, shop or cafe. It may not occur to them immediately what was so remarkable about you but they will notice.  Treating inanimate objects with care adds to the to vibe. It’s part of the choreography as you practice your art.

Picture by tania peguero

Are you aware of your habits?

When the car is stopped at the lights you often put your fingers in your mouth.  Are you aware?

A habit is defined as:

Something that you do often and regularly, sometimes without knowing that you are doing it. Cambridge dictionary

A ritual is defined as:

A set of fixed actions and sometimes words performed regularly, especially as part of a ceremony. Cambridge dictionary

Habits can become a problem. Like doing the same thing for everyone who asks for your help with the ‘same’ issue.There is no thinking in habitual behavior. There are many habits that are unhelpful.

A ritual on the other hand can be chosen and practiced so that they are a part of your repertoire when you are faced with a particular challenge- like hand washing before greeting a patient if you are a healthcare professional. A ritual is performed with mindfulness and awareness. A ritual is deliberate and ceremonial, usually done with reverence and respect. So much better than picking your nose!

  • List your habits, including the nail biting.
  • List the rituals that might make you better at your job.

Picture by Michael W May