Day 878

Gary’s story.
The Last Word.
Work Under Pressure.

These 3 powerful videos appear on the website of Mates in Mind (MiM). Suicide kills far more construction workers than work place accidents.  MiM is a charitable programme to improve and promote positive mental health in construction. It has been co-founded by Health in Construction and British Safety Council.

At present, one in 6 workers in the UK is experiencing depression, anxiety or stress. 6% of the UK work force is made up of construction workers, that is 2.1 million people. Hence at any given time at least 350,000 people in the industry will be dealing with mental ill health and possibly feeling alone. Raising awareness and generating champions through modular training in that community means there will always be someone close by who can help or are dealing with similar feelings.

A recent article in the BMJ states 5 facts about the conditions in anaesthetic training –

Workload – Nearly all had stayed beyond their shift. Nearly two thirds (62%) said that in the previous month they had gone through a shift without a meal, and 75% had done a shift without drinking enough water.

Health – Sixty four per cent of the anaesthetics trainees thought that their job had negatively affected their physical health, and 61% thought it had negatively affected their mental health.

Morale – Poor work-life balance, the burden of assessment, career uncertainty, frequent rotations, and terms and conditions of service sapped their morale.

Patient safety – This had worsened due to lack of available hospital beds, staff morale, and staff shortages.

Burnout risk – 85% of these young doctors were at risk of burnout.

I think Mr Hunt can take credit for some of these issues.

Mate in Mind is a fantastic example for other industries to make a concerted effort to address the well being of their employees in these difficult and uncertain times.

Ref:
https://www.matesinmind.org/employers.html

http://careers.bmj.com/careers/advice/Five_facts_about_conditions_in_anaesthetics_training

Day 875

Why is the length of my mental to-do list directly proportional to my inability to get through it?
Because it encroaches on the functional capacity of my brain.
Our cognitive bandwidth is limited, like our current account. Constantly dipping into it reduces its ability to deal with the jobs at hand.

In Psychology, Zeigarnik effect states that people remember uncompleted or interrupted tasks better than completed tasks. This is a human phenomenon that is becoming more apparent in the present times of perpetual clock chasing.

In a recent article in the British Medical Journal, Tom Nolan, a GP says,
“As I run later and later, rather than completing the task straight away, I add it to my list —my brain’s equivalent of opening up a new tab. The later I run, the more frazzled I get, and the more opening up a new tab becomes the answer to people’s problems. Mrs Jones’s headache becomes a neurology referral instead of finding out what’s really going on in her life. Mr Jones’s headache also becomes a neurology referral. With a few more questions and a bit more headspace, I might have realised that the Jones’s have left their gas on.

The more tabs I open, the greater my sense of impending administrative doom. My system runs slower and slower… The longer they’re open, the less important they seem. That’s when it becomes a real problem and the errors and complaints start piling up.”

He feels that if each of his appointments were 15 minutes long, he could do justice to his patients and the paper work, thus reducing errors and complaints.

Ref:

Freeing up some cognitive bandwidth in General Practice: http://blogs.bmj.com/bmj/2017/02/17/tom-nolan-freeing-up-some-cognitive-bandwidth-in-general-practice/

Mental Bandwidth:
http://blog.handy.com/whats-all-this-about-mental-bandwidth/

15 minute appointments:
https://www.theguardian.com/society/2016/aug/28/doctor-appointments-15-minutes-bma-overweight-population

Day 864

This is a well-known story within medical circles. A few years ago, a patient was in the operating theatre to have his diseased kidney taken out. Everyone believed it to be the left kidney, except a medical student who said in a hesitant, soft and muffled voice that he thought it was the right kidney. No one paid him any attention and went right ahead to take the left kidney out. It turned out, that was the wrong kidney. The only person who was correct was the medical student. The person who suffered the damage was the patient.

Large organisations are hierarchical by nature. Decisions taken by those on top are rarely questioned by juniors. But true leadership means, the ability to challenge the status quo. The culture of an organization is shaped by the worst behavior the leader is willing to tolerate.

During their selection process, Google particularly look out for ‘courage’ in candidates. They prefer to hire people who ask the right questions and are not afraid to be open if they disagree with what is being said, irrespective of who says it.

The only way to improve is to be open. That is how we learn.

When was the last time I kept quiet when in fact I had something to say? When was the last time I didn’t have the patience to listen? What are the dynamics at my work place? Who pays the price for my silence or my inability to listen? Will I have the courage to speak-up the next time? Will I have the courage to listen?

“It is not because things are difficult that we do not dare, it is because we do not dare that they are difficult.” – Seneca

Ref: Just a Routine Operation (A short film about the importance of Human factors , one of them being assertiveness) : https://www.youtube.com/watch?v=JzlvgtPIof4

Day 828

Kimberley Hiatt was 50, a nurse for 24 years, she worked in the Cardiac Intensive Care Unit at Seattle Children’s Hospital. In September 2010 she accidentally overdosed an 8-month-old infant with calcium chloride as a result of a mathematical error. Ms Hiatt, immediately reported the event to colleagues. Unfortunately, the child didn’t survive the error. The hospital put Hiatt on administrative leave and soon dismissed her. It broke her heart when she was dismissed, not just because she lost her job but also because she lost a child. In the following months, she battled to keep her nursing license in the hope of continuing the work she loved. Six months after the event, Ms Hiatt died by suicide.

The suffering of caregivers in the face of a serious medical error has been termed the ‘second victim’ phenomenon.  These individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, seriously doubting their clinical skills and knowledge base. They may suffer from extreme fatigue, sleep disturbances, increased Blood Pressure, muscle tension, frustration, decreased job satisfaction, difficulty concentrating, flashbacks, loss of confidence and grief or remorse.

The risk factors for suicide among health professionals, including doctors, are similar to those found in the general population. However, there are some additional risks among doctors such as their unwillingness to seek timely help, access to potent drugs and the skills to self-medicate. Other risk factors include exclusion from work, poor support networks, ongoing investigations, complaints, court cases, inquests and multiple jeopardy from having a complaint considered by a range of bodies including employers and the GMC.

Scott’s 3-tiered interventional model of support for Second Victims is well recognised (Ref: https://www.muhealth.org/app/files/public/1405/Scotts_Three_Tier_Support.pdf)

It’s too late for Kimberly, but her story can serve as a catalyst for a much needed change in healthcare – support for second victims of errors.

“People make errors, which lead to accidents. Accidents lead to deaths. The standard solution is to blame the people involved. If we find out who made the errors and punish them, we solve the problem, right? Wrong. The problem is seldom the fault of an individual; it is the fault of the system. Change the people without changing the system and the problems will continue.”

  • Don Norman Author, the Design of Everyday Things

Dedicated training for all medical students and GPs in suicide prevention must be made mandatory in the NHS and all over the world as prevention of harm means prevention of first and second victims. However, as long as humans are a part of any system, errors will occur. To err is human.

 

 

 

Day 824

What brings you enjoyment?

This was on the list of questions being asked of young doctors at an interview skills practice session for their upcoming promotions.

One of the young women enthusiastically told me not only how much she enjoyed her work but also the stories behind how the interest started and developed and then narrowed itself down to a specialist area, the places her aspirations took her to and the inspiring people she met along the way. Her eyes shone like sparkling diamonds as she spoke and her smile beamed. Towards the end of her answer, there was a brief mention of tennis, friends and cycling.

90% of her answer was her work. Her honesty was clear.

That was me. My work has brought me great joy over the years. I have spent far too many hours at work. It gave me self-esteem. It was something I could hide behind. It gave me meaning and purpose. It made me look and feel successful. It was fulfilling and satisfying and everyday was challenging and exciting. I loved it.

It took away all my energy and I came home spent. It took up a lot of space in my head for many long years. It made me loose my balance. It sucked me in so completely that I couldn’t see the aspects of it that were draining me dry. It deprived me of sleep for years and it drove me crazy. Yet, I loved it.

If I could go back and change what it meant to me, would I?
No.
But I would cut the number of evenings and weekends I spent away from home. I would conserve more energy for home. I would say ‘NO’ more often. I would claim some of my life back.

Day 820

One of the French companies worst affected by suicides has been the telecommunications giant, France Télécom/Orange, where 12 employees took their own life in 2008, nineteen in 2009, 27 in 2010 and 11 in 2011. Despite a new agreement on workplace conditions negotiated with the trade unions, there has been a renewal of suicides in recent years with eleven cases in 2013 and ten suicides in 2014.

Suicides took place at a time when the company was restructuring, including a plan to cut 22,000 jobs in three years. Suicidal individuals shared a similar profile: these were typically skilled male engineers or technicians in their fifties who had been forcibly redeployed into low-skilled roles, often in call-centres.

On 17 January 2014, a 42-year old employee dealing with business customers at a France Télécom/Orange office in Paris, threw himself under a suburban train on his way to work. His sister, who is pursuing a claim against the company, contends that her brother had repeatedly complained to his bosses that he was a victim of bullying by his manager. Occupational doctors had also reported a deterioration of working conditions at the agency where he worked, with a rise of workplace stress as a result of company restructuring. Prior to his suicide, the victim had sent e-mails to family members complaining of an unmanageable workload and of constant surveillance and he referred to “humiliation”, “intimidation” and “bullying”. He held several meetings with senior management where he complained of harassment by his manager. Five days before his suicide, he sent an e-mail to his head of service in which he reiterated his request to change teams. These e-mail exchanges are being used as evidence in the investigation by the public authorities into his suicide.

Whilst in France work place suicides are an urgent public health phenomenon, in the UK, despite severe deterioration in working conditions, workplace suicide is not recognised in legislation and there are no specific official mechanisms for data collection. Even when it takes place in the workplace, suicide is presumed to be an individual and voluntary act and according to Health and Safety Executive (2016) legislation: “All deaths to workers and non-workers, with the exception of suicides, must be reported if they arise from a work-related accident.”

(Source: When work kills : http://www.emeraldinsight.com/doi/abs/10.1108/JPMH-06-2016-0026?mobileUi=0&journalCode=jpmh)

Day 816

Health and social care, care of the elderly, care homes, care in the community, child care, nursing care, residential care, respite care … The word ‘care’ is used everywhere but what does it mean?

The Cambridge Dictionary defines it as ‘the process of protecting someone or something and providing what that person or thing needs’ and ‘serious attention, especially to the details of a situation or thing’.

Synonyms: caution, attentiveness, alertness, vigilance, observance, responsibility, forethought, mindfulness, regard.

Medicine and nursing are caring vocations. Yet, they are jobs like any other. They pay a salary for a service rendered. The care element can potentially become optional as long as all the boxes are ticked.

‘Continuity of care’ is particularly tricky in mental health as relationships are based on trust and every time a new person takes over a caring role, all the facts need to be repeated and trust re-established, starting from scratch.

Now that I belong to a network of mothers and fathers who have lost their children to suicide, one common theme emerges: “It seems that our sons and daughters didn’t need more resources, more GP’s or more psychiatrists or more nurses. They just needed more care…”

Let’s not use the word carelessly.