Thursday, May 27, 2010

Conversation About the Diagnosis

The Dreaded Diagnosis

I sat with the mother and her son when the doctor was about to give his diagnosis following a series of tests. The young adult child’s physical appearance and need for help with small tasks like caring for himself, cutting his food and even walking were becoming more and more apparent. A series of tests and doctor visits became a tradition for this mom and her oldest son.

She requested I attend the follow up visit with the neurologist to be an extra set of ears. I planned to take notes and help think of questions during the conversation and following it. None of us had any warning to what the doctor might say.

He listed many possibilities including Lupus and Multiple Sclerosis. I was quit taken back now picturing a person in a wheelchair or with a walker. I looked at the mothers face for an expression – there was none.

The doctor allowed for time to ask questions, take notes and while the mom had her conversation, I wrote down my questions. I didn’t want to interrupt her train of thought. I was, after all their guest. As the mom searched for words, I wondered to myself how someone is supposed to come prepared with questions after this diagnosis. One can’t prepare themselves.

As the mom searched for time and was thinking of more questions, I asked “may I ask some of my questions now?” She agreed to allow me to ask my list of questions and that gave her time to clear her mind and capture more time with the doctor. When I was done asking, she once again had her list of questions. The first sign that she was ready to resume her conversation, I stopped talking.

She needed to plan for additional tests and follow up appointments. After that there would be additional opportunities to meet with the doctor and do some more planning..

Being alone in the doctors office, especially when you might hear bad news, is never a good idea. But, knowing who the helper might be is just as important.

Thursday, May 20, 2010

The Symphony and Leadership

Learning Leadership Through Music

What can a symphony orchestra teach us about leadership? Plenty, as I learned this week at the NPSF 12th Annual Congress in Orlando Florida. Over 700 attendees sat in the magnificent ballroom amongst many of the instruments to take part in this plenary session ready to kick off this meeting full of patient safety leaders.

As Conductor Roger Nierenberg led the orchestra, The Music Paradigm, through some magical sounds the audience of medical professionals, hospital administrators, patients and families sat amongst many of the players as the symphony shot music through our very soul. There to learn about patient’s safety, as a recent (just 2 days) graduate of the American Hospital Association, National Patient Safety Foundation Patient Safety Leadership Fellowship, I wondered if we were going to learn more, or just be part of this magnificent sound.

Abruptly, the music stopped. As the conductor, wearing a tuxedo with a white bow tie asked us all to choose a member of his orchestra to watch. Watch how they move, see where their eyes go and just pay attention to one. The music started again and I watched one of the violinists.

As the conductor called on audience members, they shared comments like the intensity of some members of the orchestra. As the 90 minutes like this went on, I saw how this was a powerful lesson in leadership, motivation, encouragement, observation and planning.

“Notice the skill of their hands, their movement” he told us. “but still it is one voice”. Teamwork and coordination is what makes this sound as spectacular as it was. As he encouraged members of his orchestra to play their own way, we were listening for how it sounded when each of them got caught up in his or her own “expertise” instead of participating as part of the team.

The conductor asked one musician on the trumpet to play a piece of music. The sound was only one note. “imagine studying music for thirty years” he said “and that’s what you have to do?” The audience laughed, a nervous moment as we all recognized ourselves as often feeling underutilized but still we must keep the spirit. No one here can separate from the team.

He brought some audience members on to the stage so they could hear the sound differently. They could see the whole orchestra as they were scattered throughout the audience. Another time he brought a physician up and held her hand while she conducted. Allowing him to gracefully move her arm, she explained later that she was there only to support. The best leaders are often there only be a supporting role.

Leaders are dedicated. There are many dedicated people who can stand out and lead. Then there are those who are part of the team who will do as little as possible without getting caught. He asked one of each of the instruments to play their best. The rest he suggested would get sloppy. Be lazy but look like you are working hard, he told them. As the cameras scanned the orchestra I could see some were not working as hard. The music still sounded fabulous. He knew the music sounded good. He explained that the goof offs get hidden in the crowd. “dysfunction hides while the best carry it for the others”. It just makes the hard workers work harder.

Thursday, May 13, 2010

The Infectious Disease Doctor

The First Sign of Infection

I gave a presentation yesterday to a group of caregivers for mentally and intellectually challenged children and adults. The presentation was our Family Centered Patient Advocacy Training recognizing that these caregivers, who almost all were social workers, are often the support and / or advocate for the entire family. When they bring a client to the hospital, their skills are perfect for the patient’s needs but what about helping the hospital staff understand their needs and the patient’s safety?

When we discussed the part about infection, I explained that if there is any sign of infection or possible infection, that they need to insist on seeing an infectious disease doctor. Pharmacists, I explained specialize in medication and many doctors have their specialty but an infectious disease doctor specializes in infections.

A nurse in the audience, who was obviously in the business a long time commented. “Infectious disease doctors are always called in if there is an infection” she told us. She explained that it is the policy of hospitals to do that. I reminded her that if policies and procedures were always followed, I wouldn’t be there talking about errors and how to help prevent them. She continued expressing her concern that I may be poisoning the audience (my words not her) with what I was teaching.

Just earlier, a young woman asked how she can find out who the doctor in charge is when her family member was hospitalized. “I kept asking who was in charge and the group of doctors said they are all in charge working together”. I explained that this was probably the resident physicians protecting the attending physician from allowing you to get to him or her. There is an unspoken rule in healthcare that the residents should handle the problems and questions.

Thankfully, a woman with me, who is part of our Patient Safety Advisory Council, just saw last week the
movie about Lewis Blackman who died because of just that reason. Lewis’ mother tried to get the attending physician to look at her son who was declining fast but instead, the new, young doctors, with less experience allowed Lewis to slip away until it was too late. I told the group about the movie and assured her that there is always someone in charge. If one person won’t take responsibility, keep going until you end up in the CEO’s office.

Back to the nurse; I let her know that some hospital staff, maybe the residents trying to protect the valuable time of the infectious disease doctor, may try to handle the problem themselves. With all good intentions, the residents may unknowingly be causing more harm by not getting the “experts” in fast. She was not satisfied and explained further, “Almost always the infectious disease doctor is called in”.

“That almost” I told her, “is why I am here”.

A woman on the other side of the room added to the conversation. Her father went in to the hospital last November for hernia repair, got an infection with all the symptoms, but it took a week to call in the infectious disease doctor. Her father died a short time later.

I rest my case.