Wednesday, May 12, 2010

Sometimes it's all in the delivery...

Ah, another grump. Really, all too often things that make one mad could be not a problem at all if the delivery were only different. Think about it - there are so many different ways to say things and you can make almost anything sound better or be less abrasive if you only take a moment to think about it before you say it and try. To quote a couple of old sayings, "My mother told me if I couldn't say anything nice not to say anything at all." and "You catch more flies with honey than vinegar."

That lovely intro to complain about negativity. Honestly, I don't mind receiving constructive criticism and bouncing around ideas on how to do my job better. I'm actually my own worst critic by far. The problem is that people come in and criticize without bothering to find out the whole story and without ever offering a word of praise or considering the situation.

Two stories to illustrate the point. One relates to me, the other to one of my intern mates.

My intern mate is currently on emergency overnights. One of the critical patients in ICU went into respiratory arrest early one morning because it developed a tension pneumothorax (known pneumothorax, had been stable and suddenly deteriorated). He treated the patient and kept it alive allowing it to be rushed to emergency surgery. (The patient, by the way, is doing great.) What do the surgeons do? Do they say anything like, "Hey, good job. We can talk about other things you could do, etc.?" or "Thanks for keeping the dog alive; we know you work under difficult circumstances..." (I'm sure most of you are laughing your heads off at the moment - so my sarcasm is blatantly obvious.) Of course not. Instead, they take the dog to surgery then when he comes back in for his next shift (did I mention he stayed late helping after a 16 hour shift by the way?) they pull him aside to point out all the things he had done wrong and how he could have "treated the case more aggressively."

For me, on my ER shift this weekend, I admitted a cat that escaped the owner's house sometime during the night and got mauled by a dog or coyote or something. On presentation, his temperature was so low it would not read and his veins were so constricted that they looked like a line drawn on paper. We could not gain IV access for quite some time and started warming him aggressively as well as "bolusing" warm SQ fluids. I finally got an IV catheter in him when his temperature reached 89. The owner didn't have a lot of funds so we threw that into therapy rather than diagnostics and managed to have an alive as well as much improved cat the following morning. With what was I greeted? Why didn't you get thoracic radiographs and full bloodwork? Well, first because it took so long to warm him that I didn't want to freeze him again in radiology, not to mention that I did not feel that he was stable enough to go to radiology. Also, the price limit given to me by the owner basically covered stabilization and one 24 hour period in ICU - what good is a thoracic radiograph if you then have to euthanize due to lack of funds? There was (of course) never a "good job on keeping the cat alive, now that he's more stable we should talk to the owner about further diagnostics." (Would have been that simple to make the statement inoffensive - after all, I know that the recommendation is to obtain thoracic radiographs on trauma patients, it's not like it was ignorance factor.)

I don't know; there's always room for improvement but it is just so discouraging when negativity is all that ever spews forth. They also never seem to consider that on ER shifts we are lucky to have one technician on with us;not like the gaggle that they have following them around during the day. Yes, there are students but they cannot be depended upon to have the level of experience needed for an extremely critical case - besides, they aren't technicians and can hardly be expected to have the technical skills needed.

While I'm complaining, I also get really tired of the negativity between technicians. In the ICU here, it seems that they have chosen sides as if in a feud. Monday morning, I'm bombarded by criticism of the tech on over the weekend for not putting in charges, etc. without ever a question of "how was the weekend" because, you never know, there might be a good reason that charges were not put in. In this case, it had to do with the cat previously mentioned that was followed by one of our critical cases (septic abdomen) arresting and receiving CPR for a prolonged period (we got him back twice but failed the third time), etc., etc.

The old adage about walking a mile in my shoes before criticizing is really true but so few people do it. I wish I could just make people pause just for a moment before opening their mouths and consider what they are about to say. If they would, I think they would often either rephrase or just not say it at all.


Fi from Four Paws and Whiskers said...

Just wanted to say - I hear you....
and you are absolutely correct.
People only really see what they want to see and how it relates to themselves.
Keep up the good work :)

Ginger said...

Its all about the money and lost income dear. sorry to hear you had a not tooo good weekend. Keep your head up!