“Look at every path closely and deliberately, then ask ourselves this crucial question: Does this path have a heart? If it does, then the path is good. If it doesn't, it is of no use.” ~Carlos Castaneda

Wednesday, October 3, 2007

A failure to communicate ....

“To effectively communicate, we must realize that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others.”
~Anthony Robbins

So the other day, I had an anesthesiologist decide a patient I had scheduled was too unstable for transport to the OR and the procedure should be done in the ICU with the ICU team providing sedation. Now, it had been 3 days since the initial injury and the patient had been stable and transported for several studies without event. For some reason, this person thought the the patient was too "unstable." So, I went to the family and discussed the recommendations. I spoke with the ICU attending about it. The ICU attending the proceeded to ask me questions about why it couldn't be done in the OR, yada yada yada. I informed him it was not my decision. He then spoke with this anesthesiologist. In the end, anesthesia came and provided sedation and everything was fine. Days later, another case, same anesthesiologist, I hear that the anesthesiologist is trying to do the same thing. This time it was dealt with without confrontation or actual communication. This person just avoided me and passed it off to someone else. Hmmm, I thought that was strange. The avoidance of communication makes it all better.

Last week, we help out with a procedure with a patient in a halo. My team had explained to me that the patient needed a PEG tube and the person doing it said that the front had to come off. He spoke with my brace person, my chief resident, and the nurse in the OR. I heard the needs, but the kid is in a Halo for a reason. We can only do so much as far as providing space for the PEG tube. They informed me that he was adamant that he needed the whole front of the abdomen free. They actually said he was a bit of an A_ _, but that is hearsay because I did not witness it. So, at the time of placement of the PEG tube, we were all there. I was watching the neck and supervising the adjustments to the Halo. You know he did not say one thing to me. Hmmm, go figure. Yesterday, I was walking down the hall and I see the same physician. As you do, I looked up, we made eye contact, and I say, "morning, how are you?" He keeps walking and says nothing. Now, I was pretty sure that he wouldn't say anything because he never does. But, I keep trying. (With hands up in the air screaming to the sky) We are all on the same team.

Today, I am going to a faculty meeting. I am getting off of the elevator. The door opens, and a team (I assume surgical) is standing 1 foot from the door. I try to get out as the team rushed to get in and a medical student, in his short coat, bumps me. Not a little bump, a full shoulder to shoulder hit. I say, "excuse me." Again, nothing in return. Now, I thought, "OK, I am not in my white coat, but come on this is common courtesy. We don't live in New York City." (No slight to my NYC fans) This got me thinking. Do we create these people believe that they are better than the next person because they may have a little more knowledge? Why is it that in medicine we lose our ability to effectively communicate to one another? Does it have to do with the inherent hierarchy of the medical field or does it have to do with the god complex that some people develop? Why can't we just be civil? Ok, that was way too many questions. Just some thoughts I wanted to put out there to see if anyone else has any answers.

“The single biggest problem in communication is the illusion that it has taken place.”
~George Bernard Shaw


rlbates said...

Damn good post. I don't have the answer, but have often wondered the same. There's a neuro guy here in town who took a patient to the OR from the ER and then consulted me to repair a major ear laceration after the patient got to the ICU. The ICU nurses (bless their hearts) helped me to deal with it there. The family was thrilled. I wanted to scream, rant, and throw a fit about how it could have been down while he was in the OR. It wouldn't have done any good. This guy--oh well. Just don't call him if I need a neuro guy. Thanks

Anonymous said...

That's so funny you said this because I was just thinking about it the other day. I don't know if this is the whole answer but I think part of it has to start in medical school. I feel that I was a pretty "social" person in undergrad. But now that I have started at med school I've noticed that I am not quite as conversationally adept. Not that I have forgotten common courtesy, but I have noticed that I can't keep a conversation going like I used to. The only thing that I have been able to point to is that med school in some ways has taught me to eat, sleep, attend classes, and study. So personally I think that part of it is that many doctors have a two-year span where they have very limited social interactions, at least compared with the average John Smith American. I think what you said is accurate as well, it seems that many med students seem to have the mentality of superiority just because they are better educated.

Anonymous said...

Because we regress. We progress socially until we graduate college and then we are thrown back into high school while our friends move on to get real jobs and more real responsibilities.

Suddenly we are back to taking classes with everyone in our "grade", even in the same room. We gravitate to sitting in the same seats, near the same people. We have lockers. We even went back to eating in the cafeteria at the same time with our friends. Everyone knows everything about everyone. Cliques develop - people feel excluded. It is bazaar. It is competitive too - from the beginning. It didn't matter to me that my college roommate always slept through his "history of Vietnam" course - in med school that could only help you. Sick isn't it? Everyone knows who the hottest girl is, the best athlete, the worst drinker, etc.

Nothing changes - our cliques get more well defined, separated. Everyone else's idiocy becomes our labor.

I'm 5+ yrs out and think I can identify the problems but am struggling to break the trends. Any advice?

Chrysalis said...

Cool Hand Luke...another good movie.

Sad that people are misguided into thinking anyone is any better than another. Just keep saying hi to that guy you pass and smile to yourself once your past him.;)

Bongi said...

anaesthetist. the basic difference between a shift worker and someone who actually has to live with the problem.
surgeon, even student. the typical godlike complex that is acquired somewhere along the way. unacceptable.

Jeffrey said...

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Jeffrey said...

now that i actually read this article, great observations and thanks for sharing.

i personally think that a contributing element toward a godlike complex in one is the inability to be humble and acknowledge that maybe someone out there knows just that bit more than you, even if he/she does, i'll make sure i know it too. its rather natural in med sch. we don't want to lag behind. or know less.

and perhaps even the competitive nature of society. all who are in a US M.D. cse have certainly excelled and shown they are capable, and now that they are in, they prob want to carry on.

my surg registrar tutor told me, lots of training doctors in india "put their life on hold" till they get into a specialty program. now that is a lil worrying, but i'm kinda mentally preparing to do that.

anyone heard of the ESSENCE model that Dr. Craig Hassed wrote about?

Anonymous said...

Ha! It is unbelievable. I constantly go back and forth in my own mind about these folks - whether they are just evil, or are they actually that oblivious, or did their spouse just get diagnosed with a terminal illness?

One wants to have faith...that people do mean well...that these instances are only due to an underlying dissatisfaction with themselves, some type of countertransference, rather than negative feelings towards others. On the other hand, it sure would feel good to just confront them and say, "Hey pal, what's your problem?" Let's just show our cards, get everything out on the table, and whether we get along or not, at least we'll be on the same page.

On the third hand - what if people think that about me? or you?

Perhaps we should create a website where people can anonymously inform others how they actually come across. Meaningful peer feedback is virtually nonexistent in healthcare - yet all of us have potentially meaningful and helpful perspectives to share.

I agree with other posts - just keep offering the other cheek so to speak.

Midwife with a Knife said...

Totally tangential. I heard about the Chicago marathon on the news. I hope you didn't have too bad a time!

rlbates said...

MWK beat me to it. Same here. Wondering (and worrying) about you and the marathon. Hope you are okay.

Someonect said...

i have been there when something is done in the OR, then that ad hock consult after the fact. it is frustrating. i even had the situation that be had to wait to go to the OR while Plastics (not picking on anyone) sewed up the face.

i agree. people forget what it is like to be human. i remember my wife saying to me that every conversation at every party in residency ended with us discussing the hospital, patient care, or "cool" diseases we saw. all i have to say to that is "chicks dig it." :)

i wish i could help break the trends. it is hard. we all get caught up in it. (yes, myself included. i am human you know) my advice is to be more self aware. i realized that over the last few weeks i have been a little more on edge because of changes at work. the only think i can truly change is my own attitude and outlook. (big smiley face)

i keep pushing forward. smiling and saying hello.

agreed. go springboks.

humility is the key to being a good physician. it helps us keep our mind open. i have not read the Essence model. here is the link. i will also put it in the articles of interest.

hope residency is going well. i would love to see a website like that. and yes, perspective is everything.

MWWAK & rlbates:
thanks. i lived to fight another day. i'm wily.