feedback abuse
Criticism is a two-headed beast. One head is destructive and utterly useless. The other is constructive and a platform to build upon. Everyone possesses this beast.
Below, which head did the beast’s possessor rear?
The Case:
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A medical department collaborates with a third-party organization for patient services.
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A meeting between the two groups had been designed to offer feedback, to discuss the medical department's role and participation in their agreement.
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The medical director was unable to attend.
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In the director’s stead, the medical group manager attended.
Following the meeting, the director and the manager debrief:
Director: What were their thoughts about what we can do to improve the workflow?
Manager: They said you are high and mighty.
Director: Okay. Anything in particular? Anything else … like … the process, the procedures?
Manager: (pneumatic silence and vacuous staring)
December 2024
truth, perspective, or just an opinion
Speak up or Shut up?
a bit on opinions
an opinion is a judgment.
practical synonyms:
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compliment = judgment
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complaint = judgment
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admiration = judgment
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insult = judgment
liking some judgments over others doesn't make it any less of a judgment.
you committed | pull your weight
You have undergone extensive study and training of one of the highest degrees.
You are offered a paid position to exercise those very high-level cognitive skills.6
Your contract requires your execution of your exceptional cognition … and … your capacity to restock carts as well as refill oxygen tanks and vacuum floors.
On paper, compensation is desirable. In practice, it is insulting.
The Case:
A pediatric/newborn hospitalist had an emergency right at the end of the shift and did not restock the emergency cart. The next doc did not restock the cart either. The doc after that one didn’t restock it. The doc following the last doc didn’t do it. Now, it has been days without a properly stocked emergency cart. Fortunately, there have been days without a proper emergency.
… But what if there had been? …
In the newborn realm, seconds are minutes, physiologically. A mere 5 seconds determines the cerebral fate. In a mere 5 seconds, a cognitively normal newbie can be fated for cerebral palsy or a host of other life-long developmental delays. Hence, during a code, checking the pulse occurs every 30 SECONDS in newborns rather than every 2 MINUTES for adults and older children.
Thus, those 5-7 seconds scrambling about the room or down the hall for the ET tube that should have been on the cart, will make a world of difference for that new life and all those invested in it.
The Truth:
Failure to restock the cart does not hinge largely upon last minute emergencies or an overly busy shift. The most quoted reason is, I don’t think I should have to do it.
And yes, it is beneath you.
But you knew that when you signed the contract.
So yes, you should have to do it, because you are the contracted person to do it.
September 2024
it's just a stethoscope
the thread:
RN: pt has a bunch of ? and keeps me in the room forever
Doc: He has a cath later today. I will see him after 3
RN: wife has a bunch of ? too and keeps bugging me
(Meanwhile, every provider has seen the couple multiple times and answered their questions.)
Doc: I will answer all their questions after the cath so we don’t go back and forth
RN: what if the wife keeps chasing me everywhere because she has more and more ?s
Doc: call security
RN:
( ... nota bene: contemporary professionalism is the fine art of blasé tachygraphy & euphemistic emojis)
May 2024
like the wind consultations
Consultants bear no primary responsibility for patients.
So, is this justified?
Case:
The hospitalist briefs the patient:
Hosp: The pulmonologist seeing you –
Patient: Pulmonologist? Who’s that?
Hosp: The lung specialist.
Patient: The lung specialist? Who’s that?
Hosp: The lung doctor, Dr. Aire.
Patient: The short guy?
Doc nods.
Patient: … He … I don’t even – honestly – he just came and went out before I knew anything. Like, I didn’t know what he was doing and he already left. Like, he just popped in and popped out. I – I – I don’t even want to see that guy again if that’s the doctor.
The stunned hospitalist eyes the patient incredulously then concludes the visit.
***
A few weeks later:
The hospitalist is again stunned. With his own eyes, the astounded hospitalist spies Dr. Aire sweeping into a patient’s room like a freshly fired bullet, speaking loftily without a breath:
“How are you? Good, good. Let me check your lungs out.”
Dr. Aire listens to the lungs.
“Yeah, you’re good, take care."
That was it.
Patient never said a word.
January 2024
fighting fire with fire
Nurse called doc about a tachycardic (120s-130s) patient.
It was a SIRS admission. The differential diagnoses questioned whether infection was the culprit.
Pt had underlying chronic liver disease treated with spironolactone and furosemide for volume control. Given his history of cirrhotic overload in the past and holding his spironolactone during this admission, a modest amount of IV fluids and albumin had been given.
The doc did not want to infuse more fluids amid preemptive IV antibiotics. Still, the blood pressure was low. Mindful that the underlying issue was unknown and therefore untreated, Doc did not wish to reflexively toss a full-blast beta blocker into such uncertainty.
Decisively, Doc ordered a highly conservative, low dose of metoprolol to mitigate the tachycardia while circumventing decompensation.
Nurse sardonically asked, “So what are the parameters when I call you in 15 minutes because this doesn’t work?”
Doc replied, “To wait an hour. So, yeah, you can call me in 15 minutes if you need to hear that you need to wait another 45.”
Hours later, the heart rate improved with no adverse hypotension.
Nurse never called a second time.
***
Observations:
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First shot fired: Nurse threatened to bully Doc’s pager.
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Second shot fired: Doc curtly mirrored the sarcasm.
Questions:
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Was there a higher road either professional could have taken?
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Or are there unavoidable low roads that must be traversed so that one learns to address another in the way the one would like to be addressed?
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… Or do low roads only add fuel to the fires?
October 2023
blind hire vs. google hire
An oddly named candidate impressed the hiring team seeking a hospitalist coordinator. Despite Mr. Oddly’s resume overflowing with multiple brief stints of employment (anywhere from 2-4months at a time), the hiring team loved Oddly’s resume and phone interview.
Hiring team member C shared the great news about the new hire with one of the hospitalists, to which the hospitalist raised an eyebrow and joked, “Never trust an Oddly.”
A couple days later, team member C relayed the anticipated start of Oddly to another hospitalist, to which that hospitalist questioned, “What kind of name is ‘Oddly’?”, as he immediately Googled the new coordinator. Instantly, Oddly’s social media platforms filled the screen detailing his genitalia and sexual bents, his liberal use of racial expletives, a blurred photographed sexual performance, among other graphic obscenities.
Shocked, hiring team member C consulted the first and second hospitalists about whether this person is suitable representation of the group given such easily accessible, open public information. Another hospitalist within earshot chimed in highly appalled. The docs encouraged member C to inform their site leader and the rest of the hiring team.
Member C timorously broached the topic with next in command, member B. B curtly replied, “What do you want me to do about it?”
Later B notified the boss, hiring team member A, then assembled all three members. A and B declared it unprofessional to Google Oddly. A and B initially considered pawning the matter off to HR then later decided to do nothing at all except harp on the Google search as an unprofessional act.
***
Questions:
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Would Googling Oddly have been unprofessional had Oddly won a Nobel prize that he had omitted resume?
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Or if he were an angel investor on the side?
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Or if he were CEO of a Fortune 500 company?
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Or if he were an anonymously bored multimillionaire in need of menial amusements?
Would that be so unprofessional? Probably not. given that it may become a selling point about the group’s staff and personal character judgment.
Is the real problem embarrassment due to rash / poor judgment?
Or is the real problem that as A and B ignore the matter, they will live with fear-laden hopes that Oddly won’t humiliate them and prove everyone else right?
August 2023
there's no Y-O-U in medicine
New doc, Gordy, requires orientation to the hospital’s electronic workflow. This 4-hour comprehensive training is necessary for any physician hoping to survive any shifts.
The training had been scheduled from 8am to noon since November of the preceding year. Less than 24-hours before the scheduled program in April, Gordy sends a text message stating that he will not be available until 10am and will attend from ten to one. Gordy adds that he already knows the software well.
Arthur, the physician network’s lead conducting the training, clarifies that familiarity with the software will only get Gordy through the log-in. Arthur remains firm: the time cannot change.
Dissatisfied, Gordy protests to his hospitalist site leader.
An hour later, Arthur receives a text from the site leader stating that Gordy will arrive at 9:30am. Unflinchingly, Arthur directly informs the two that training will conclude promptly at noon. Whatever Gordy misses, the site leader will be wholly responsible. Gordy hurriedly replies that he will now be available at 9am.
Gordy arrives unapologetically. Arthur begins the session at nine. Gordy is thoroughly confused and somehow forgets basic software functions he knew so well before. Arthur concludes the session at noon. Gordy is cluelessly primed for disaster.
***
So, Gordy cavalierly shifted his availability from 10 to 9:30 to 9.
Did he try to consider Arthur’s schedule?
Clearly Gordy couldn’t care less.
However, if he could care just a bit, Gordy would have learned that 8am was an equally taxing start for Arthur who completed a swing shift past midnight and needed to promptly return home to sleep in preparation for his 24-hour overnight shift beginning at 10pm.
May 2023
smacked around in specialists' ping-pong
Good morning,
I contacted Spec-A at 0710 8/15/18 for a consult for mr#1234567, whom I had admitted during night shift.
She asked me to contact the on-call Spec, stating that the shift from the night before ended at 0800.
I then contacted Spec-B at 0717, who asked me to contact Spec-A. I informed him that she had referred me to him. He referred me back to her at 0728.
At this point, I notified the oncoming daytime hospitalist of the situation at 0733 and advised that the hospitalist pursue a Spec consult after 0800AM.
Regards,
Hospitalist Ball
… turns out, Spec-A and Spec-B divorced one another some time ago … mmhmm … coincidence?
January 2023
why does the cable guy get a pass?
Pt: “Been waiting on you all day!”
Doc entered the room at 10 am.
Pt: When is cardiology coming?
Doc: I can’t say for sure. But he has been notified.
Pt: So, you can’t give me a time?!
Doc: Just as you couldn’t predict you’d be here in the hospital, I can’t predict when the cardiologist will have heart attacks and emergency catheterizations prior to seeing you.
Meanwhile the person hooking up some entertainment has at least a 4-hour window before irate interrogations.
October 2022
was the point made well?
A habitually disgruntled ortho doc openly despises consults. He loathes coming into the hospital, but he will operate.
A patient presented with joint pain compounded with SIRS. The knees swelled with skyrocketing WBCs.
The hospitalist reports his observations. The ortho doc ridicules the lack of ortho details in the internal medicine exam. Ortho schools IM that septic knee is the concern. Insulted, IM clarifies that septic knee is the purpose of the consult.
Ortho barks, “Well, I have already left for the day.” (He’s on call.)
He storms in.
He operates.
He makes a point.
He leaves.
IM checks on the post-op patient. There are drains in both knees, both ankles, and a wrist.
The patient appears calm, tethered, drained and confused.
June 2022
doctor over doctor ...?
Case:
Agitated schizophrenic was found undressing in a stranger’s backyard. Psychiatry determined inpatient psych to be the appropriate disposition. The patient has been off meds for a while. Psych instructs to start low dose Clozaril then titrate up over 5 days plus Zyprexa.
In the ICU, however, the patient is on the highest dose of Clozaril Hospitalist Ross has ever seen. Once the patient transitions to the floor, Dr. Ross changes the dose to the low dosage and additional med Psych determined. Dr. Ross discontinued all other preemptive prn antipsychotics from the ICU.
Hours later, PharmD Joe calls Dr. Ross quoting Intensivist Dr. Cody’s note that patient should remain on the previous medications. Dr. Ross underscores that Dr. Cody is not a psychiatrist.
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Dr. Ross: I’m following the psychiatrist’s recommendations.
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PharmD Joe: But, Dr. Cody said –
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Dr. Ross: Once again, Dr. Cody is not a psychiatrist. I’m going by what the psychiatrist said.
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PharmD Joe: The patient wasn’t seen by the psychiatrist. I only see Dr. Cody’s note.
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Dr. Ross: The patient was seen by a psychiatrist. Look.
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PharmD Joe: Well, in Dr. Cody’s note, she quoted the psychiatrist.
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Dr. Ross: Really? Show me.
PharmD Joe opens Dr. Cody’s note which said, “per psychiatrist, patient should be titrated on Clozaril.” Dr. Cody failed to start low then titrate. The note planned to continue Geodon and other prn meds ordered routinely by the ICU.
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Dr. Ross: That’s not the psychiatrist’s note. Look at the psychiatrist’s note.
PharmD Joe opens the note, hurriedly accedes, then sprints off the phone.
PharmD Joe calls again an hour later, stating the patient refuses the other med Zyprexa, claiming that he has never been on that.
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PharmD Joe: Is that a new medicine?
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Dr. Ross: The psychiatrist recommended that medication. The patient is acutely psychotic. He is on a 5150, which is involuntary hold for an inpatient psych transfer.
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PharmD Joe: Well, there is a lot of confusion about what is written in the note.
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Dr. Ross: Dr. Cody’s note is not the psychiatrist.
PharmD Joe eventually gets off the phone.
Issue:
Wherein lies the communication muddle?
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The Dr’s challenged ego?
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The PharmD’s insulting vie for power pitting doc over doc?
April 2022
bossy or leadership skills
There is an unspoken perception of pecking order in the hospital. Here are a few permutations:
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Surgeon then ER physician then hospitalist
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Cardiologist then ER physician then hospitalist
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ER physician then hospitalist
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Nurse Supervisor then hospitalist
Case 1:
ER doc calls hospitalist for urgent assessment of a patient. Hospitalist notes that the patient belongs to another physician network and directs ER doc to the responsible team.
ER doc towers over the hospitalist and clarifies, “You will do what I say!”
Case 2:
Same ER doc hounds the hospitalist for not taking an admission. Hospitalist explains that several admissions in the queue are ahead of this one. ER doc orders the hospitalist to call in back-up. There are no available hospitalists for back-up. Instead, hospitalists ask ER doc to “bear with me.”
ER doc lords over the sitting hospitalist and replies, “You need to figure something out! We already did our job! You need to go address this now!”
The hospitalist stands squarely and towers over the ER doc. “I will get to them when I can.”
ER doc backs off then away.
From the ER to the floor, patient care works like an assembly line. If one part of the line backs up, then the entire system is disrupted. Sometimes it takes line part A to regroup itself or assist line part B if B is the back-up. Now, what does a leader do in this case? Does the leader bark orders that further delay line part B?
Specialties operate like line parts: discretely yet interdependently. In theory, different specialties are designed to work in parallel unison. In theory, parallel entities lack a top and a bottom. So, in theory, one specialty cannot boss another, right?
January 2022
off the clock
It is the third of infinite meetings among hospitalists across the region.
The fiery topic: Tests after Discharge
Enter mid debate. …
Hospitalist I: It’s not fair to have to follow up on tests after I’ve discharged the patient when I’m not working or on vacation.
Silently, Hospitalist Y: Kind of like taking a poo then expecting someone else to wipe.
Hospitalist U: I think the admitting doc should be responsible for following pending tests.
Silently, Hospitalist Y: You mean the person who saw your patient once, seven days before you discharged him.
In the corner (inconspicuously on the wall) observing, a mindful cricket pondered the universal law of responsibility.
Beside him, a watchful fly concluded: Well, just don’t order the test.
Could it be as simple as that?
July 2021
sex in the hospital
Why is sexuality an everyday conversation?
As far as the everyday is concerned, sex needs minding when dealing in STIs, pregnancy, and reproductive cancers. Unless one is bedding someone, it doesn’t matter.
Personally, I don’t want to think about your genitals and what you do with them.
Perhaps we can chat about something else – work, maybe?
June 2021