Contemporary medicine is obsessed with failure. Look anywhere, or everywhere and the word “fail” keeps cropping up. The word is almost always associated with personal blame and thus with personal shame. Physicians, for example, worry that they will “fail” to correctly diagnose an illness and be punished for this failure. Pediatric residents worry that they will “fail” to insert an IV into a baby with tiny veins and thus have to call on surgeons (who will, behind their backs snigger at their “failure” to insert the IV and their need to ask surgery for help) to help. Think of some mistake that physicians – who do not escape the human condition when they graduate medical school — could make and you can bet that the word failure is attached to it. Amazingly (given the fact that there is no reported example of a human being making it out of this life alive) physicians are socialized to consider that they have personally “failed” if a patient dies (not only from a medical mistake but from the inevitable fact that some diseases can’t be cured, or even well managed and that death … Continue reading
I just want to post this article on genuine interprofessional care that just appeared in Academic Medicine. It focuses on what the VA is doing to create new models of real interprofessional care.
From Interprofessionalism Lite to the Real Thing
Guest Author Featured, Guest Perspective January 15th, 2015
By: Jessica Early, a nurse practitioner fellow at the West Haven Veterans Affairs Center of Excellence in Primary Care Education (CoEPCE)
During my time in nursing school, the constant refrain was that interprofessional teamwork is the foundation of patient-centered care. In lectures and seminars, we were told that, as nurse practitioners (NPs), our effectiveness depended on collaboration with all members of the health care team—social workers, RNs, physicians, and specialty providers. Ironically, we were encouraged to develop the communication and teamwork skills needed for this collaboration in a classroom full of nursing students, led by a nurse faculty member, in a building only serving students pursuing a nursing degree.
In my three years of school, I had … Continue reading
I am very happy to announce that I, along with my two co-editors, David L. Feldman M.D. and Michael Leonard, M.D. have just published our edited volume Collaborative Caring: Stories and Reflections on Teamwork in Healthcare. The book is a collection of 50 rubber-hits-the road stories about what it means to implement teamwork, work on teams, or to work in settings in which there is no teamwork. The wonderful people who contributed their essays include physicians, social workers, bedside registered nurses, psychologists,occupational and physical therapists, nurse practitioners, pharmacists, dentists, and hospital administrators. The book also includes essays by healthcare professionals who write as patients who find themselves either the center of a team or exiled to the periphery when healthcare professionals function in siloed isolation. The book begins with an introduction (part of which is included below) and is divided into eight sections, which cover the following topics:
Playing on a Real Team; The Dangers and Damage of Poor Teamwork; Is the Patient on the Team or Not; Psychological Safety; Teaching What We Preach; Patient Advocacy as a Team Sport; Barriers to Teamwork; Taking Teamwork Institution and System-wide. The essays in … Continue reading
On January 7, 2015, a desk clerk in a Veterans Health Affairs clinic in El Paso, Texas, shot and killed a VA psychologist working in the clinic and then shot himself. Although this killing was far overshadowed by the tragic and terrible killings of journalists, cartoonists, staffers, and police officers in France at the satirical paper Charlie Hebdo, this incident should not be forgotten by those interested in the care of veterans in this country. The clerk –Jerry Serrato – was a former veteran who worked at the VA. The person he killed was a psychologist, 63-year-old Timothy Fjordbak. While it is way to early to understand what exactly happened in this clinic, what this case may help us to understand are the dangers that VA employees (and veterans) run when they try to deal with unhappy or disgruntled patients or employees who feel abused (justly or not) by the system. The difficulty of dealing with mental health issues and patient or employee anger in a system that may, in places be understaffed (as this particular clinic was reputed to be) must be taken far more seriously than it is in … Continue reading
Several weeks ago, Pope Francis, who is rapidly becoming my favorite pontiff, delivered a not-so-cheery Christmas message to the hierarchy of the Catholic Church. The Pope’s address was directed at “the Curia.” This church leadership body includes Cardinals and other high-ranking ecclesiastical officials who are definitely not used to being admonished, by their boss, for displaying symptoms of the personal and organizational “diseases” that the Pope described at length.
High on his list of ailments afflicting the Curia is the “sickness of poor coordination [that] develops when the communion between members is lost, and the body loses its harmonious functionality and its temperance, becoming an orchestra of cacophony because the members do not collaborate and do not work with a spirit of communion or as a team”.
He warned about Church officials who “transform themselves into masters and believe themselves superior to others, rather than at their service.” They are prone to “the ailment of rivalry and vainglory: when appearances, the colour of one’s robes, insignia and honours become the most important … Continue reading