Last week in my personal blog I reflected on humility as defined by James Ryle:
God given self-assurance that eliminates the need to prove to others the worth of who you are and the rightness of what you do.
Ryle suggests, from 1 Peter 5:5-7, that central to humbling ourselves is throwing our cares on to God. Every concern, care and fear being hurled on to God who is faithful and powerful enough to handle them. When we know that we are loved by Him no matter what and that He is in control no matter what, then we remove the need to prove ourselves or protect ourselves. We become humble – secure enough to allow God to be in control and to serve others. Once our eyes are lifted from ourselves we are able to see others to love and serve them.
Just before writing the last post I was reading an article about the report by Robert Francis QC on the appalling treatment of patients at Stafford Hospital. One of the recurring comments made by many different people is that the pressure of targets and incentives increasingly displaces focus on compassion and patient care. When doctors, nurses and managers alike are bombarded with ever increasing and regularly changes hoops to jump through and targets to meet, no wonder their attention and efforts are dragged from patient care.
I’ve seen something of the effects of this in a family member who for many years worked as a Health Visitor. In their decades of service they saw an ever increasing and ever changing string of targets and goals alongside cost cutting moves that stripped resources and personnel. Their desire to be compassionate and offer the best care possible became more and more stressful until it finally proved too much. She recently changed jobs.
Now I’m not trying to attack the NHS and I am well aware that so many people receive great care. But this is not a new concern that is being bandied around with fresh vigour in the light of Stafford Hospital. What struck me is that it demonstrates on an institutional level what also seems true at a personal level. Namely, that when we are forced to operate from a place of insecurity we begin to miss the most important things. NHS services have to meet targets to receive funding to simply keep operating – there will be no patient care if there is no hospital. Oftentimes, especially as a leader, we can live with a sense that, unless we meet expectations or make people like us or recognise our worth, then we’ll have no influence to do any of the things we know we are called to do.
The secret of personal humility is to recognise that we are already loved by our Father before we even move our finger; to recognise that He is control and we can throw every care on Him. A person who can live from that place of security finds, free from the need to prove themselves or their actions, can begin to simply do what they are made and called to do. They are no longer pulled in different directions by a multiplicity of cares. What about an institution?
It strikes me that a similar solution is needed for the NHS. Is there a way to give security for doctors, nurses and caring professionals so that they are able to do what they are called to do without constantly watching their back? Obviously there is a need for accountability for the safety of patients and to ensure a good standard of care, but the constant need to prove worth and achievement cannot be helpful for those who are called to compassionate care.
I’m not a healthcare professional. I don’t know exactly what this would look like. But I recognise in the diagnosis of struggles in the NHS, God’s diagnosis of struggles in many people’s lives. The way He designed us to live with Him is often a good basis to begin to imagine a new way for every level of society to function.
So, my question is this: what would a humble NHS look like? To whom could a National Health Service throw it’s concerns and cares?
An email gone astray can provide fascinating insights for an unintended recipient. Written correspondence has undoubtedly fallen into the wrong hands since homo sapiens first put pigment on bark, but never before has it been so easy to have a personal message go awry.
No longer is it a matter of surreptitiously steaming open sealed letters or snooping around in wastepaper baskets. Finding out another's personal business is now just a click away. Even more conveniently, candid opinions can sometimes make an unscheduled landing in your inbox, making for intriguing reading -- as I discovered.
Some time ago, I'd sent out feelers regarding possible new GP jobs and had emailed a particular practice principal a couple of times, expressing interest. When it looked likely that I was going to pursue a different path, I sent a polite email explaining the situation and telling him I wouldn't be seeking an interview for a job at his practice at present. An email bounced back saying that my not wanting to work for him may be "a relief" as I "sounded a bit intense". It was sans salutation but, based on the rest of the content, was obviously intended for one of his work colleagues. It had no doubt been a simple error of his pressing 'reply' rather than 'forward'.
I was chuffed: I've never been called "intense" before, at least, not to my knowledge. Perhaps there are several references to my intensity bouncing around cyberspace but this is the only one my inbox has ever captured.
I've never considered myself an intense person. To me, the term conjured up the image of a passionate yet very serious type, often committed to worthy causes.
Perhaps I had the definition wrong. I looked it up. The Oxford Dictionary gave me: "having or showing strong feelings or opinions; extremely earnest or serious". Unfortunately, I couldn't reconcile my almost pathologically Pollyanna-ish outlook, enthusiasm, irreverence and light-heartedness to this description -- nor my somewhat ambivalent approach to politics, religion, sport, the environment and other "serious" issues.
At least the slip-up was minor. Several years ago, I unintentionally managed to proposition one of my young, shy GP registrars by way of a wayward text message. He had the same first name as my then-husband.
Scrolling through my phone contacts late one night, alone in a hotel room at an interstate medical conference, I pressed one button too many. Hence this innocent fellow received not only declarations of love but a risqué suggestion to go with it. Not the usual information imparted from medical educator to registrar!
It took me several days to realise my error, but despite my profuse apologies, the poor guy couldn't look me in the eye for the rest of the term.
If I was "intense", I would conclude on a ponderous note -- with a moral message that would resonate with the intellectually elite. Alas, I'm a far less serious kind of girl and, as a result, the best I can up with is: Senders of emails and texts beware -- you are but one click away from being bitten on the bottom.
(This blog post has been adapted from a column first published in Australian Doctor).
Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work here.
Imagine a world where procrastination became a productive pastime…
Procrastination, as it stands, is a core feature of the ‘human condition’ and most would argue that it is here to stay. However, what if we could hijack the time we spend playing Candy Crush saga and trick ourselves into contributing towards something tangible. Today, I wish to explore this possibility with you.
The phrase ‘gamification’ is not a new or made up word (I promise) although I agree it does sound jarring and I certainly wouldn’t recommend trying to use it in a game of scrabble (yet). The phrase itself refers to the process of applying game thinking and game mechanics to non-game contexts to engage users in solving problems. For our purposes and for the purposes of this blog ‘problems’ will equate to promoting healthy living for our patients and maintaining our own medical education.
For one reason or another, most people show addictive behaviour towards games especially when they incorporate persistent elements of progression, achievement and competition with others. The underlying psychology won’t be discussed here; call it escapism, call it procrastination, call it whatever you will. What I want you to realise is that every day millions of people spend hours tending to virtual farms and cyber families whilst competing vigorously with ‘online’ friends. If we can take the addictive aspects of these popular games and incorporate them in to the non-game contexts I indicated to above, we could potentially trick ourselves, and even perhaps our patients, into a better way of life.
The first time I heard the phrase ‘gamification’ was only last year. I was in Paris attending the Doctors 2.0 conference listening to talks on how cutting edge technologies and the Internet had been (or were going to be) incorporated into healthcare. One example that stood out to me was a gaming app that intended to engage people with diabetes to record their blood sugars more regularly and also compete with themselves to achieve better sugar control.
People who have the condition of Diabetes Mellitus are continuously reminded of their diet and their blood sugar levels. I am not diabetic myself, but it is not hard to realise that diet and sugar control is going to be an absolute nightmare for people with diabetes both from a practical and psychological standpoint. Cue the mySugr Compainion, an FDA approved mobile application that was created to incorporate the achievement and progression aspects of game design to help encourage people with diabetes to achieve better sugar control. The app was a novel concept that struck a chord with me due to its potential to appeal to the part in everyone’s brain that makes them sit down and play ‘just one more level’ of their favorite game or app.
There are several other apps on the market that are games designed to encourage self testing of blood sugar levels in people with diabetes. There is even a paediatric example titled; “Monster Manor,” which was launched by the popular Sanofi UK (who previously released the FDA / CE approved iBGStar iPhone blood glucose monitor).
So applying aspects of game design into disease management apps has anecdotally been shown to benefit young people with Diabetes. However, disease management is just one area where game-health apps have emerged. We are taught throughout medical school and beyond that disease prevention is obviously beneficial to both our patients and the health economy. Unsurprisingly, one of the best ways to prevent disease is to maintain health (either through exercise and / or healthy eating). A prominent example of an app that helps to engage users in exercising is ‘RunKeeper,’ a mobile app that enables people to track and publish their latest jog-around-the-park. The elements of game design are a little more subtle in this example but the ability to track your own progress and compete with others via social media share buttons certainly reminds me of similar features seen in most of today’s online games. Other examples of ‘healthy living apps’ are rife amongst the respective ‘app stores,’ and there seems to be ample opportunity for the appliance of gamification in this field. An example might be to incorporate aspects of game design into a smoking cessation app or weight loss helper. Perhaps the addictive quality of a well designed game-app could overpower the urge for confectionary or that ‘last cigarette’…
The last area where I think ‘gamification’ could have a huge benefit is in (medical) education. Learning and revising are particularly susceptible to the rot of procrastination, so it goes without saying that many educational vendors have already attempted to incorporate fresh ways in which they can engage their users to put down the TV remote and pick up some knowledge for the exams. Meducation itself already has an area on its website entitled ‘Exam Room,’ where you can test yourself, track your progress and provide feedback on the questions you are given. I have always found this a far more addictive way to revise than sitting down with pen and paper to revise from a book. However, I feel there could be a far greater incorporation of game design in the field of medical education. Perhaps the absolute dream for like-minded gamers out there would be a super-gritty medical simulator that exposes you to common medical emergencies from the comfort of your own computer screen. I mean, my shiny new gaming console lets me pretend to be an elite solider deep behind enemy lines so why not let me pretend and practice to be a doctor too? You could even have feedback functionality to indicate where your management might have deviated from the optimum.
Perhaps more sensibly, the potential also exists to build on the existing banks of online medical questions to incorporate further aspects of social media interaction, achievement unlocks and inter-player competition (because in case you hadn’t noticed, medics are a competitive breed).
I have given a couple of very basic examples on how aspects of game design have emerged in recent health-related apps. I feel this phenomenon is in its infancy. The technology exists for so much more than the above, we just need to use our imagination… and learn how to code.
a person who provides expert advice professionally:
he acted as campaign consultant to the president
[OFTEN AS MODIFIER] British a hospital doctor of senior rank within a specific field: a consultant paediatrician
forming names of inflammatory diseases: cystitis, hepatitis
(Origin - from Greek feminine form of adjectives ending in -it?s (combined with nosos 'disease' implied) )
You may not be surprised to hear that the way in which I recently heard the term 'consultantitis' used cannot be understood to mean 'inflammation of the senior hospital doctor'. Although, I wish it was.
Professionalism, compassion, transparency, teamwork and communication - all terms that appear to be used with an increasing regularity within the NHS. These are concepts that are not merely taught but preached to medical students today. Why? Well it is nit merely the work of a heavily publicised inquiry into a foundation trust, neither is it the upshot of the medical profession's own Voldemort - he who must not be named (except I will name him - Harold Shipman).
Is it then an attempt to heal the wounds within our national health service from within? I hope so. Yet, there are countless more 'isms' and other terms being muttered under the breath of healthcare professionals all over the country. 'Consultantitis' is one that fills me with sadness for one reason in particular: it suggests that those at the top are at the core of some of the problems.
Ponder over that for a while, I intend to explain myself further in my next blog post.
To be continued****.
“You want to be a medical leader? … Gone to the Dark side have you?”
For years medical leadership has been the place to retire to once you’ve done your hard work on the wards. The image of a doctor hanging up their stethoscope, picking up a clipboard and joining the managers “dark side” is all too familiar.
Medical leadership, Healthcare management, Clinical lead, Quality lead – these are all ways of describing someone (a healthcare professional) who wants to make a difference, who wants to help not just one patient but every patient in that service.
Medical leadership is the zeitgeist! It is a growing field. It is a discipline of the young and dynamic. It is something that is relevant to you all. It is something that you will be expected to show in years to come.
As an individual student you can join the Faculty of Medical Leadership and Management (FMLM), do some reading, do a quality improvement project (QIP) and write that you have an interested in medical leadership on your CV.
What if you want to do more than just improve your CV?
Be an agent for change, found a student’s medical leadership and management society at your medical school!
It’s easy! First, find 10 student colleagues – the driven, the politically aware, the idealists, the power-mad and the ones that really care. Step 2 – give yourself a suitably pompous name. Step 3 – register your New “University of X Leaders of Tomorrow” society with you MedSoc or Students Union. Step 4 – Contact the FMLM to let them know you exist and want to join their revolution. Step 5 – Collaborate with the other student Medical Leadership Societies (MLS) around the UK. Step 6 – Hold a social. Step 7 – Find a local doctor who would love to talk about their career and recent success. Step 8 – Invite us all along. Step 9 – Write it on your CV. Step 10 – Leave a legacy.
At the present The University of Birmingham Students Medical Leadership Society is in contact with the FMLM and other similar groups at the Universities of Bristol, Barts and Oxford. We are looking to get in contact with every other society in the country. If you are a new or old MLS then please do get in touch, we would love to hear from you and are happy to help your societies in any way we can – we would also love to attend your events so please do send us an invite and we will do our best to attend and advertise it.
Email us at firstname.lastname@example.org
Follow us on Twitter @UoBMedLeaders
Find us on Facebook @ https://www.facebook.com/groups/676838225676202/
Come along to our up coming events…
Thursday 5th December LT3 Medical School, 6pm
‘Why should doctors get involved in management’
By Dr Mark Newbold, CEO of BHH NHS Trust
Wednesday 22nd January 2014 LT3 Medical School, 6pm
‘Has the NHS lost the ability to care?’ – responding to the Mid Staffs inquiry’
By Prof Jon Glasby, Director of the Health Services Management Centre , UoB
Thursday 20th February LT3 Medical School, 6pm
‘Creating a Major Trauma Unit at the UHB Trust’
By Sir Prof Keith Porter, Professor of Traumatology, UHB
Saturday 8th March LT3 Medical School, 1pm
‘Applying the Theory of Constraints to Healthcare
By Mr A Dinham and J Nieboer ,QFI Consulting
This anecdote happened many years ago when I was a brand new (read: inexperienced) physician doing my stint in the Colonial Health Service of the former Belgian Congo. I was assigned to a small hospital in the interior of the Maniema province.
Soft tissue infections and abscesses were rather common in this tropical climate, but at one time there seemed to be virtual epidemic of abscesses on the buttocks or upper arms. It seemed that patients with these abscesses were all coming from one area of the territory. That seemed rather odd and we started investigating. By way of background let me say that the hospital was also serving several outlying clinics or dispensaries in the territory. Health aides were assigned to a specific dispensary on a periodic basis. Patients would know his schedule and come to the dispensary for their treatments. Now this was the era of “penicillin.”
The natives were convinced that this wonder drug would cure all their ailments, from malaria and dysentery, to headaches, infertility, and impotence. You name it and penicillin was thought to be the cure-all. No wonder they would like to get an injection of penicillin for whatever their ailment was.
As our investigation demonstrated, the particular health aide assigned to the dispensary from where most of the abscesses came, would swipe a vial of penicillin and a bottle of saline from the hospital’s pharmacy on his way out to his assigned dispensary. When he arrived at his dispensary there was usually already a long line of patients waiting with various ailments. He would get out his vial of the “magic” penicillin, show the label to the crowd and pour it in the liter bottle of saline; shake it up and then proceed to give anyone, who paid five Belgian Francs (at that time equivalent to .10 US $), which he pocketed, an injection of the penicillin, now much diluted in the large bottle of physiologic solution. To make matters worse, he used only one syringe and one needle. No wonder there were so many abscesses in the area of injection. Of course we quickly put a stop to that.
Anyone interested in reading more about my experience in Africa and many other areas can download a free e book via Smashwords at: http://www.smashwords.com/books/view/161522 . The title of the book is "Crosscultural Doctoring. On and Off the Beaten Path"
A 37-year-old man presented with acute inferior ST-segment–elevation myocardial infarction (MI). His only risk factor for
coronary artery disease was smoking. He underwent urgent x-ray coronary angiography, which showed a chronically occluded left
anterior descending artery and recannulized right coronary artery. A bedside echocardiogram was performed to assess left ventricular
function and any postinfarct complications. It demonstrated severely impaired left ventricular systolic function and an aneurysmal
apex with a mobile intracavity mass (Figure 1A and 1B, online-only Data Supplement Movies I and II). Further views demonstrated hemopericardium suggesting concealed free-wall
rupture (Figure 1B, purple arrow). An intramyocardial tear at the level of the midinferior wall (Figure 1B, red arrow) was suspected.
Carew’s world took this drastic turn Sept. 20, when he suffered a heart attack while playing golf. A battle with heart failure ensued, spiraling to the point where he needed a new heart – but his body was too sick to handle a transplant.
Study Highlights Adults with congenital heart defects have considerably higher rates of stroke compared to the general population. Heart failure, diabetes and recent heart attacks were the strongest predictors of stroke caused by a blocked...
Background and Purpose—Bilingualism has been associated with slower cognitive aging and a later onset of dementia. In this study, we aimed to determine
whether bilingualism also influences cognitive outcome after stroke.
In a presentation at the 2015 AHA Fall Conference, Daniel E. Singer, MD, spoke about identifying patients with an increased bleeding risk with the long-term use of oral anticoagulants and whether or not there is a benefit in those cases.