HSBC airport ads - Love 'em!

Having schlepped through more than my usual number of airports this month, I've noticed, and enjoyed, HSBC's ads displayed in various walkways.
The ads feature beautifully-photographed images alternately labelled with antonyms, that, well... Check them out for yourself and you'll get the point.

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Wonder words

Long time, no blog. No excuses, just life.

I was reviewing a patient's chart this morning, and several phrases in nursing/physician notes caught my attention: Patient refused breakfast. Patient denies shortness of breath.

If you're a hospital caregiver, you've seen similar stuff written on charts. Wording notes this way makes it sound like patients are our adversaries. Like we're suspicious of what they say and do. Like the little sneaks can't be trusted. (Oh, he denied shortness of breath, but I think we know better. Refused breakfast, did he? Well, we'll just see about that!)

I've also seen people refer to themselves in progress notes as "The writer" rather than saying "I", as in "The writer observed the patient performing self-care", instead of "I watched Mr. Jones perform self-care." What's the reason for that? Is "the writer" somehow more professional and credible? I also wonder why people write "Patient stated" or "Patient verbalized" rather than "Patient said".

And, if you're a patient, don't ever dare to leave the hospital "Against Medical Advice". If that gets written on your chart, you're branded as an uncooperative jerk.

Which you may be.

But, you may also have needed to deal with an urgent personal matter, and your doctor didn't see fit to make ward rounds and write your discharge order at a reasonable time. "Uncooperative jerk" cuts both ways. " Discharged self AMA" sounds like we're running prisons rather than hospitals.

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Welcome SORN attendees!

Thanks for coming to my presentation of BOMB! How a (failed) career in standup comedy made me a better surgeon. I look forward to receiving your feedback. Please click here to take the survey. You'll need the password from your souvenir postcard!

This survey closes on Saturday, September 20.

P.S. Got time on your hands? Check out "What's wrong with this picture?"

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Tom Peters takes on Health Care

Tom Peters (Re-Imagine) is just a little hot about Health Care. Check out his proposed hospital org chart.

He gets it.

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Healthy skepticism

Latest Adventures in Improved Access post.

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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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