Collaborative Centering

I have enjoyed a stimulating month since the Supreme Court decision on the Affordable Care Act.  A number of physicians have asked me for mentoring advice for themselves and their colleagues, feeling that something is about to happen that will transform healthcare delivery. One month ago, I reminded readers that physicians are well suited to be part of the transformative wave because we train to make major decisions despite incomplete data. Often, patient needs do not give us time to obtain perfect information.

Being on call caring for patients is a welcome adjunct to my mentoring, consulting, and speaking activities.  I call it collaborative centering because it reminds me of why I chose a career in healthcare, to make a difference in patients’ and families’ lives. A California psychiatrist counseled me:

Whatever you do, no matter how tiring it gets, you need to continue to provide locum tenens surgical coverage.  There are plenty of retired docs out there, and we don’t listen to them.

A patient whom I was asked to see yesterday represented an example of how surgery consulations embody more than doing procedures.  An elderly woman on blood thinning medication banged her calf a few weeks ago and had a painful orange-sized lump under her skin.  The lump was now solid and no longer liquid.  She displayed no signs of infection. Her medical conditions made general anesthesia life-threatening.  She did not want to be transferred to another hospital. I answered all her questions and told her that I would ask our anesthesiologist to evaluate her ability to tolerate other types of anesthesia, that she did not need an emergent operation, and that we could treat her pain.  I recalled the advice the surgeon Dr. David Habif gave me during medical school:

Inoperable does not mean untreatable.  We can still minister to patients’ basic needs for information, reassurance, and comfort.  In fact, not doing so is an abrogation of the patient-physician contract.

When people ask me how I avoid being overwhelmed caring for patients in different organizations, two lessons come to mind.  First, a cartoon a nurse gave me during residency showed two children playing.  The caption read:

You be the young doctor fresh out of medical school, and I will be the smart nurse who tells you everything that you need to do to keep patients alive.

I recalled in Better Communication for Better Care a conversation with my father, a practicing neurosurgeon, in which he reminded me:

Only those (surgical residents) who are smart enough learn from the nurses.

Second, my recent writing gives me insight into the importance of safety culture research.  In Getting It Done, Gary Yates and Carol Sale from Sentara, suggest using the mnemonic STAR (Stop, Think, Act, and Review) as an error prevention tool to focus attention and decrease errors.  The Stop is a useful reminder to pause, even for a few seconds, rather than to act in ways that cause rework.

The beeper gods have kindly allowed me a few minutes to share my thoughts with my loyal readers.  As always, I welcome your input to improve healthcare collaboration where you work.

Kenneth H. Cohn

© 2012, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

 

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