Observations and Reflections

 

In the course of one week, I made these observations and reflections. 

note:  names have been changed, details have been disguised to preserve anonymity

                                                                        Virginia Niebuhr

 

Compassion.

I was leaving the hospital late one evening, eager to get home.  In the hallway of the main building, I passed a woman who looked lost and a bit disheveled.  “Can you tell me how to get to Gynecology.”  It was 8:00 PM, where could she be trying to go?  I asked, “Are you trying to get to where the babies are born?”  “No, I need to get some tests done.”  Tests at 8:00 at night?  I think she’s confused. I explained, “It’s 8:00 and all the clinics are closed.”  The longer I talked to her, the more I realized she was disoriented and probably had chronic mental illness.  Now what was I to do?  The Hospitality desk was closed.  Calling campus security seemed unnecessary – she wasn’t doing anything wrong.  I blabbered some niceties about hoping she figured it out and sorry I couldn’t help her and walked on.  I wanted to get home. I didn’t know what to do for her.  But I found myself thinking of Compassion, and rating myself low on the Compassion Likert scale. 

 

Honesty

This week I pondered the notion that failure to give feedback may be a lapse in professionalism on the Honesty component.. even for something as simple (but also complex) as how to tell a resident that her white coat sleeves are filthy… or the more complicated situation of noticing that one colleague is being very unfair to another colleague.   But all too often it’s so much easier to remain silent than to take a risk. Giving feedback is a gift of honesty; and one on which I sometimes fall very short.

 

Altruism

It seems so many organizations want my money. Indeed they are excellent causes, with important values which I share.  But I find myself often I dilemma trying to decide how much to give and to whom.  And if I don’t do enough, am I falling short in the area of Altruism? 

 

Responsibility

I generally am on time and meet deadlines. But in the past few weeks, I have had more late clinic bills/notes than I should, I have an overdue report, and I have missed some deadlines.  Am I being irresponsible?  Am I not taking my responsibilities seriously enough.  Am I over-committed, or inefficient?  Are personal issues clouding my commitment?  I shall not beat myself up over this, but I do think it wise of me to take notice and consider what steps I need to take to get myself back on course.  Now, that’s being responsible, don’t you think?

 

Aiming for Excellence

The case of the very late patient.  I had a No-Show, sometimes a welcome reprieve during a busy clinic.  The 2:00 patient had not showed up. But at 2:30, I was paged that my patient had indeed arrived.  New patient evaluations are scheduled for one-hour, and I have an evaluation plan that almost always requires this much time.  Now I had less that 30 minutes (the patient still wasn’t registered and that would shave off another 5 minutes.).  I was being given the choice to see or ask the patient to re-schedule (and I knew the next new-patient slot was weeks away).  Quickly I reflected on my recent disdain when I heard that another provider in our system routinely refused to see patients if they were 15 minutes late.  I recall thinking, “Without even knowing why they were late or what they needed that day?”  Well, I did not want to be lumped with this provider into a bucket of what seemed to me to be ‘unprofessional’ decisions.  On the other hand, I was expecting the 3:00 patient to show, and knew it would not be fair to make that family wait. My compromise position was to explain to the family that I would spend 25 minutes with them but surely could not finish the evaluation.  Did they want to get started or re-schedule?   I left the decision to them (giving them some autonomy).  They chose to stay, we got started, and I surprised myself at how very efficient I was and how much I got done.  I was pleased with my decisions and expect so was the family.

 

Confidentiality

I was at a social event with colleagues.  The conversation came to a lull (it is said this happens about every 20 minutes in the midst of social conversation) and across the silence, everyone heard one partygoer say to another “so, did you discharge the Anderson baby  [name changed]?”  Yikes!  I cringed thinking of the HIPAA violations for the mention of the patient name.  “Not yet.  Wow, that mother is something else.  She was such a pain. She told us she didn’t want any resident having anything to do with the care.”  “I know. She told me that, too; and I told her she could go to another hospital, because involving residents in care is what we do here.”  Now I was doubly uncomfortable. The rest of the party guests had not resumed their chatter, so this conversation was dominating the room.  And now, not only was the family named,  now they were being criticized.  I knew there were confidentiality breaches here.  I felt that if I jumped into the conversation, even if to steer it in another direction, I would be participating.  And if I blatantly tried changing the conversation, I knew I couldn’t do so without giving the air of “this is not an appropriate conversation, so let’s change it,” and that would surely embarrass my colleagues.   So I thought of an excuse to leave the room and walked to the kitchen.  And I never did say anything, even in private, about how uncomfortable I was.  This confidentiality issue then spilled back to the Honesty issue I discussed above.

 

Teamwork

This week I had a great teamwork experience.  The team was three – two of us have worked together for years, and one was a newer member.  We had a deadline and we hit a few snags.  Plan A failed for technical reasons, so we had to kick into Plan B.  We each had a job to do and did it.  Because of trust, we knew it would get done. Because of trust, decisions were made quickly - without the need to overdo checking for consensus.  And we trusted each other enough to know that we could interact freely without tripping over each other.  I wonder what makes trust develop in a team, and why some teams never seem to develop trust.  I’m on a mission to learn more about this element of teamwork.

 

Ethics (respect for autonomy, beneficence, maleficence, justice) 

This week I am focusing on Justice. I have many patients with depressed mothers who have access to healthcare for themselves.  My patients already have a neuro-developmental disorder (e.g ADHD, autism, or a mood disorder) and having a depressed mother adds a double insult.  The mothers have no employer-provided health insurance, no capacity to save for insurance premiums or assessed fees, and no access to public healthcare.  Where is the justice in a system that pretends to care for the children but does not provide for healthy parents?  And of course, this issue spills into the issue of

Responsibility, and I know that if I were to be truly responsible, I would enter the social-political realm on this, writing my congressmen and advocating for mental health parity and searching for other solutions to the complexities of mental illness. 

 

Respect.  A colleague sent me what was intended to be a confidential e-mail, expressing disappointment in another colleague’s actions.  Unfortunately, my colleague made the unfortunate mistake of selecting REPLY ALL, instead of REPLY, so the e-mail went to many others, including the targeted colleague. I was pretty sure he was unaware that had happened.  I was embarrassed for all – my colleague who had hit the wrong button, and the colleague who had now been publicly criticized.  The best I could do was point out the error to my friend – in a very respectful way.  He thanked me.

 

 

Overall, what I clearly recognized from this exercise are the following points:

 

-         These categories certainly do overlap

-         I can reflect and find situations where I struggle – but that does not make me ‘unprofessional’

-         I look forward to hearing others’ reflections and observations.

 

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