My Husband Burned the Pot and Patient Safety
The other evening, as we were having company for dinner, my husband burned the roasting pan. Completely and irremediably. I was cooking a roast and asked him to keep an eye on it while I went out to get a haircut. “Make sure you don’t let it get burned,” I instructed. I gave him a quick how-to on basting and left the stock near the stove. When I got back an hour later, he was sitting in the kitchen working on his laptop. As soon as I walked in the door I could smell the burnt odor. “What’s burning?” I asked. “Not the roast,” he assured me. That was true. It was the pan the roast was in that was burnt. I had a fit. He was furious. “Look the roast isn’t at all burnt,” he said defensively, as I pulled it out of the pan and stuck the latter, crusted in black in the sink. I continued to fume, he to feel injured. He felt he had done his job. I had mentioned nothing about the pan. The roast wasn’t burnt, and he was being ill used. He scraped off the charred remains, injuring the pan permanently. (It was an old one, coated with Teflon, that I liked but probably shouldn’t have been using. But now, scratched, with Teflon surely flaking off, I would have to get rid of it.) We continued cooking the roast in another pan. My sauce — which was to be made with the pan drippings — would have to be done some other way. I pulled it off. We had a nice dinner with friends, and the next I tried to do a debrief about the whole mess. Ordinarily, I wouldn’t be writing about such domestic trivia on a blog largely devoted to healthcare but what I found out about and reflected on does have something to do with our current health care dilemmas.My husband, after 33 years of living with a kitchen control freak –me — doesn’t know much about cooking. (His job is the cleaning up — which he has perfected.) So when I instruct him about watching a roast, or a stew or soup bubbling away, he is very concrete. He does exactly what you tell him. First of all, his heart may not be in it because truth be told he doesn’t like cooking. But second of all, he doesn’t know why he’s doing what he’s been asked to do. Nurses would call this the “critical thinking” part. In other words, he has no idea that I have marinated the roast in orange and pomegranate juices, which contain sugar and are thus more apt to char if not constantly basted. Nor does he know that you make the sauce out of the carmelized bits –not charred bits — that are produced by the long, slow, careful roasting. He doesn’t really understand that you have to carefully monitor the state of the roast just to make absolutely sure it doesn’t begin to burn. He doesn’t realize that all of this care will result in a decent sauce. Nor does he know that the pan is Teflon and that scrapping off an entire layer of crusted and burned remains will undoubtedly scratch it and dislodge Teflon flakes which are bad for your health. When I say “please make sure it doesn’t burn,” I am envisioning a universe of implications — both promising and problematic. When he hears, “don’t let the roast burn,” he is envisioning a very narrow task with few implications and complexities. He is a novice and I am an expert and our different visions are produced by our education and experience.
When he complained that he did what he was told and I thought, with great frustration– and probably said — but “use your commonsense — couldn’t you smell something burning?” And then thought, “what’s wrong with you, don’t you have any common sense?”(which, thankfully, I didn’t say). But think it I did, which of course, To utterly neglected the fact that common sense is not something you are born with but actually something you acquire through experience.
This kind of scenario happens all the time in the domestic setting, where it results in constant wrangles and probably more than one divorce. It also happens constantly in healthcare, where the consequences may be far more dire. Indeed, many contemporary attempts to save money in a system with escalating costs depend on laying off experienced and educated staff with less expensive, experienced and educated replacements (the healthcare equivalent of replacing me with my husband in the kitchen.) Many of those in leadership positions in our healthcare system seem to be unmindful of the kinds of problems people have when they lack on-the-job experience. Instruction manuals, clearly delineated protocols, and well articulated scripts are no substitute for what people learn in a well thought out program of education, which is supplemented by recurrent on the job training and learning. These replacements may seem to be cheaper and effective in the short term, but like my husband, with the best intentions in the world, they may burn the pot, destroy the dinner — and in healthcare, do irrepairable damage to the patient.