Give-away give-away

Here's a news item from CMAJ about US initiatives to free physicians from drug company gifts.

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Warts and all

Dan Walter put a comment on my last post, and it's left me a bit of a dilemma.

He comments that he's "off topic", and, after I did a little homework/surfing, I think he's right. In fact, his post is essentially spam to promote his website/agenda.

And an angry agenda it is!

Dan has left a link to Adventures in Cardiology which is a bitter-voiced (and perhaps rightly so...) personal account of medical misadventures (yes, that's a euphemism!).

So, what should I do with his comment, which had nothing to do with my post about Powerpoint presentations? My first thought was to just delete the comment and have done with it. Obviously, he wants to draw a wide audience to his website to hear his story. How much of the story is accurate? The tone he takes is aggressively negative ("mangled", "ripped to shreds", "bumbling cardiology staff", "Warfarin is commonly used as rat poison") and, frankly, off-putting.

My immediate, visceral impression was to write him off as a crank. He comes across as an angry man who's more interested in trashing, rather than improving, the system.

But, maybe there's some lessons to be learned here (curse you, cooler, contemplative side of my brain!). If medical staff truly made the mistakes Dan chronicles, then the next steps post-error were most critical in moving on: honesty, communication and transparency. Our provincial licensing body repeated tells us that most complaints lodged against physicians are on the basis of poor communication, whether or not there was any medical misadventure. From Dan's story, it sounds like this was a big part of the problem, compounding the actual medical complications.

Even if the medical team weren't "responsible" for any of the misfortune Dan has described, the system has nonetheless failed him and his family. After all, if we want to consider that we practice "Patient/Client and Family-Centred Care" (PFCC), then it is our patients/clients who get to decide whether or not they are satisfied with the results.

Their satisfaction will be based primarily not on the outcome measures favored by the healthcare system (mortality, infection rates, length of stay), but on their experience in the system. Were they treated with respect and dignity? Were they invited to participate in decision-making to the level they wished? Was all pertinent information shared promptly, freely and in a format that the patient and family could understand and use in collaborative decision-making?

And so, Dan's link remains on my blog. If you do check out his site , try this experiment: Read it first from the point of view of a health professional dealing with this "difficult and demanding" family member. Think about how you would cringe, and look for an escape-route, if you saw Dan coming down the hallway of your hospital ward. What a jerk this guy is! He just doesn't understand the complexity of problems we're dealing with every day.

(As I noted above, this circle-the-wagons approach was my first instinct.)

Then try looking through a "customer-service" lens: I want to provide each client with an excellent experience that will reflect well on me personally, my profession and my institution. How can I change the system (yes, I can!) to serve Dan and his family better?

BTW, it's an open-book quiz - the answers are all here.

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A ray of Powerpoint hope

I spent the last week getting hammered by bad Powerpoint.


I was at the annual meeting of the Canadian Urological Association. The speakers were all respected experts in their clinical fields, had excellent command of the scientific evidence supporting their arguments, and rigorously adhered to the Bad Powerpoint code of conduct:

Pack your slides with text. Read directly from the slide. Graphs and charts must be illegible. (If possible, download a pdf of the actual medical journal article and paste it onto the slide.) Comment/apologize using the Powerpoint Phrase of Doom.

The list goes on and on.

There was one bright spot, however. One speaker broke the mold. He talked about an esoteric subject (calcified nanoparticles, if you must know), but was completely engaging. He used plenty of photos and illustrations, rather than bullet points. He told a story, rather than recounting facts and figures. He was excited about the topic, and he let his excitement show. (Almost a cardinal sin at a scientific conference!)

While I'll likely never apply his information in my clinical practice, it was the most memorable lecture I attended.

Medical experts/speakers take note: Tell a story. Use pictures. Get excited!

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Stop talking over patients!

Today, at the hospital, I saw a porter pushing a patient in a wheelchair. She stopped to talk to an acquaintance as they passed in the hallway. Their conversation was loud and of a personal nature.

As they talked, the man in the wheelchair fidgeted, obviously uncomfortable with being ignored. It made me think of a recent article "Talking over patients: sTOP" in CMAJ's Salon.

sTOP is a different take on the "loose lips" problem in hospitals (and healthcare, in general).

Ken Flegel goes beyond pointing out how rude it is to subject patients to our personal conversations, and tells us it's unethical.

"TOP Talk is an unprofessional behaviour not because the topic of conversation is bad, but because the circumstance is an unacceptable time and place for it."

Even if you think that's a little over the top (I don't!), you have to admit that "TOP talk" happens regularly in healthcare settings.

I mentioned the porters in my example, but physicians and nurses are as guilty of this. I don't think Flegel is telling us that we can't have personal conversations at work, but when with our patients, to treat them as special guests.

Like we would want to be treated, if in their shoes.

Or wheelchair.

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Advanced Access updates

You've been keeping up on the latest Advanced Access posts, right?

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Welcome to Strategy readers!

Plain Brown Wrapper is mentioned in this quarter's Strategy, the CMA's financial management magazine. If the Strategy article led you here, thanks for coming. Have a look around the site. I have the most fun with "What's wrong with this picture".

Also, I'm very excited about our office's ongoing Advanced Access project (latest post here), chronicled at Health Quality Council's website. We're trying to reduce patient wait times in our 9-physician urology group.

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What's wrong with this picture? VII - Reloaded

Remember this post about patient confidentiality on a hospital ward?

Well, they fixed the problem!

And so simply and elegantly, too. They just turned the req over before clipping it up. Sure, anyone can still take a look at the req, but they have to make an active effort to do so.

Well done!

I also learned something from this experience. When I had originally noticed this problem, I brought it to the attention of the ward clerk. The response was essentially: "That's the way we do it here, and I don't see a problem with it." That's often the response I get when I point out some of the situations that I gripe about in What's wrong with this picture?

Maybe it's because I don't present the problem in a compelling way. Or maybe there just isn't a strong culture of patient-centredness out there yet. Or maybe I'm telling the wrong people.

Choice number three seemed to be the problem this time. The nurse manager actually found the problem through this blog and then fixed it. She wished that I had brought the problem directly to her attention. She was right.

So, in future, if I'm serious about getting something fixed (rather than just generating material to post here), I'll talk to the person who has the authority to make the changes.

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