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Quitting work may be the best thing you can do

 

Do you quit work? At least until it’s time to be back in the office, clinic, shop or hospital? Are you constantly taking calls and texts from work even on vacation?

Recreational travel may increase creativity by relieving workers from stress, providing diversifying experiences and increasing positive emotions. Consequently, vacations may boost creativity, apparent in a greater variety (flexibility) and originality of ideas after work resumption. de Bloom  et al

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Do you see how that happened?

You may face may challenges or have an unexpected outcome following your interaction with your customer, client or patient. As a healthcare professional these are opportunities to reflect on how an event unfolded, how you were feeling at the time and how you are feeling afterwards. Consider then how those emotions play out through the course of the day. Given that most  outcomes in healthcare are moderated by an interaction with a health professional it is important to ensure that the health professional is attuned to their inner world. We can’t change many things as providers of health services but we can look within.

Know what causes your negative emotions, and which types of feelings you face most often. When those emotions begin to appear, immediately start your strategy to interrupt the cycle. The longer you wait, the harder it will be to pull yourself away from negative thinking. Mindtools

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Mobile phones aren’t allowed in the operating room.

Before a surgeon gets anywhere near a patient in the operating theatre he must wash his hands, put on a gown and gloves. He then drapes the patient and cleans the skin. As he makes his first incision there is no mobile phone on the table, he banishes all distractions and appreciates that the job isn’t over until he has sutured the wound. Whatever you do for a living how do you approach the job? If you adopted rituals would you perform better? Bacteria can destroy a surgeons work. What contaminates your work and how does that manifest in your results?

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Small details matter

It’s a small detail. If you are accompanying someone down a corridor as a healthcare professional- don’t stride ahead. Ideally walk alongside the person or let them lead the way if they know where you are headed. If they are wheeling a buggy and carrying a bag offer to help by wheeling the buggy.  Just try it. You might like how they respond. Apart from that you can learn so much about the person even before the consultation begins:

So instead of a doctor assessing a patient’s blood pressure, body mass index, chronic conditions, hospitalization and smoking history and use of mobility aids to estimate survival, a lab assistant could simply time the patient walking a few meters and predict just as accurately the person’s likelihood of living five or 10 more years—as well as a median life expectancy. Scientific American

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Is this something for today?

How your customer, client or patient responds to your advice, offer or recommendation will depend on factors that may have nothing to do with how these are presented to them.

Susan sat bolt upright glancing at her watch. Although she had only been waiting for ten minutes she was becoming irritated as she was keen to get away as soon as possible. It would be a long day ahead. The staff meeting was likely to be challenging. There was talk of redundancies. She wasn’t sure if her department would survive the purge. It had been a bad start to the year, the sales figures were down at least thirty percent and the company had appointed an external consultant to determine what should be done urgently. She was interviewed last week and she wasn’t sure if the consultant would recommend keeping her section open. Over the past six months she had been drinking more, the glass of wine with dinner was now two glasses. She was also snacking more during the day and the doughnut on the way home which had been a Friday afternoon treat were a daily habit. She was aware that her weight was becoming a problem but right now she just wanted to get through this nightmare. She didn’t come to the doctor often but she needed a script. She had argued with the pharmacist but he was adamant that he would not supply the steroid inhaler without a prescription. Finally the doctor summoned her through and noted that she was much heavier than he remembered. 

What happened next ……your call.

Picture by Neil Moralee

What stories do you tell?

We all have stories about what we do for a living.  We tell them all the time- even if we don’t recognize that we are telling stories.  They communicate how we feel about our work. Do your stories convey the impression that you are stressed out, bored, bullied, treated unfairly and in general can’t wait to retire? You realise that this is also your self talk and that ultimately you will magnify these experiences. On the other hand if you started telling stories about experiences that energized you, made you feel valued and creative then you might notice more about your job that seems to resonate with what you want and how you want to feel.

At 9 o’clock one bright morning a 32 year of man had been waiting for an hour in a busy clinic. He was called into the doctor’s office. Covered in tattoos, he was a muscular man whose tanned skin suggested a life outdoors. He wore a high vis vest and heavy steel capped boots.

I’ve had a toothache since three o’clock this morning doctor and I need to get to work

He said rubbing his jaw. His doctor was curious, it was odd that a man who seemed very robust in every other way, was getting ready to go to work would wait for an hour in a busy clinic complaining about toothache that started a few hours ago. But of course that wasn’t the whole story. The doctor watched him rubbing his jaw and the side of his neck.

Where did the pain start?

In my chest doctor, it was like someone was sitting on my chest, I felt a bit nauseous and it seems to have settled in my jaw and the side of my neck. I think it’s going into my shoulder now.

Half an hour later the man was in hospital being treated for a heart attack. His decision to get to a doctor might just have saved his life and his doctor’s curiosity paid of.

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What I’m taking is better than anything you can suggest

We don’t know why some people respond to some treatments.  Helen produced a bottle of cough medicine from her handbag.

This stuff is magic. It cures my cough every time.

You recall a recent paper which concluded:

Across Europe, there are large variations in the recommendations made by healthcare professionals for the treatment of acute cough. This has arisen through custom and practice based on the evidence of historical studies performed to standards well short of what would be considered legitimate today. Acute cough is particularly difficult to study in a controlled setting because of the high rate of spontaneous remission and a large placebo effect. Morice and Kardos

What do you say? Whatever you say and however you frame it is worth considering before it happens- because Helen isn’t the only one taking what might be considered a placebo.

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What happens next is up to you

Healthcare more than any other service warrants taking the long view. Supposing a toddler becomes feverish overnight. Mum and dad (assuming they are living together) are likely to fret about that child all night. No one will sleep well. The following day the parents will continue to worry that their baby is ill. Friends or family will be consulted. It is possible but not certain that a grandparent may be able to offer some relief with childcare.

Researchers in the United States have found that a third of children under the age of six receive up to 10 hours of care a week and that 47% of all grandparents with grandchildren (under 13 years) living nearby provide some childcare . Although more grandmothers (54%) provided child care it was found that grandfathers (38%) also made a significant contribution. In the United Kingdom it has been estimated that up to half of working parents rely on grandparent care for their children. It was also found that although grandparents were prepared to provide some child care, and at times even reduced their working hours to provide it, they did not want to give up their jobs. Australian Institute of family studies

The partner who has to go to work the next day will be distracted and anxious. The childcare arrangements, if that’s the norm will be on hold as one parent may take time off to be at home. The parents will visit a pharmacy (drug store) and acquire whatever is recommended in the hope that the child will recover quickly. That is unlikely as even a viral illness can make a child unwell for several days. Eventually they will seek medical advice. Phone calls will be made and appointments requested. Parent or parents and toddler will travel and wait in line to see a doctor. They will eventually wheel the toddler into a health practitioners room. If that person is you what happens next is up to you.  Most likely the child will have a viral illness, be teething or have some other minor illness. But to this family this will have been a stressful and worrying couple of days. How you respond will form their impression of your service and make a bad situation an opportunity to learn about caring for a sick child or add to the  drama.

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The green laces may not be a daft idea

Researchers from Harvard University have just published a study entitled The Red Sneakers Effect. They conclude that:

A series of studies demonstrates that people confer higher status and competence to non- conforming rather than conforming individuals. These positive inferences derived from signals of nonconformity are mediated by perceived autonomy and moderated by individual differences in need for uniqueness in the observers. An investigation of boundary conditions demonstrates that the positive inferences disappear when the observer is unfamiliar with the environment, when the nonconforming behavior is depicted as unintentional, and in the absence of expected norms and shared standards of formal conduct.

It is unlikely that sneakers and torn jeans will impress people when consulting a healthcare professional. However if that practitioner wears green shoe laces or eye catching socks it might not do his or her credibility any harm.

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What is your approach when you know you can’t cure?

The upper respiratory tract infection or common cold is the commonest reason people  see a doctor. There is no ‘cure’. The symptoms last three to ten days and eventually resolve. Some symptoms take longer to resolve than others. Those with a cold have to bear with the discomfort for a few days or even weeks.

Placebo treatment has been reported to improve subjective and objective measures of disease in up to 30–40% of patients with a wide range of clinical conditions. A review of 8 clinical trials on the effects of antitussive medicines on cough associated with acute upper respiratory tract infection shows that 85% of the reduction in cough is related to treatment with placebo, and only 15% attributable to the active ingredient. R Eccles

Twenty-seven patients were randomized to placebo treatment and 27 to the no-treatment group (mean age 22.6 years). The median difference between post- and pretreatment CF was −3 in the no-treatment group and −18 in the placebo group (p = .0003). There was a significant increase in CST in the placebo group compared with no treatment (p = .027). Lee et al

However is it ethical to recommend treatment which is not proven to have any pharmacological effect?

OTC cough medicines do not appear more effective than placebo in relieving symptoms of acute cough. Even if statistically significant, effect sizes were small and of doubtful clinical relevance. The number of trials in each category was small, and the results of this systematic review have to be interpreted with caution. Based on the available evidence from a small number of studies, we cannot recommend OTC cough medicines as a first line treatment for children with acute cough. Schroder and Fahey

Experts are still pondering. Meantime what will you do today when you see that person with a cold who is still coughing a week later?
It has traditionally been assumed that deception is an indispensible component of successful placebo use. Therefore, placebos have been attacked because they are deceptive, and defended on the grounds that the deception is illusory or that the beneficent intentions of the physician justify the deception. However, a proper understanding of the placebo effect shows that deception need play no essential role in eliciting this powerful therapeutic modality; physicians can use nondeceptive means to promote a positive placebo response in their patients. Brody

Although the available evidence is incomplete and confusing at times there can be little doubt that the prevalence of placebo use outside of clinical trials is not negligible and that views and attitudes on placebos use differ considerably among individuals, both health care professionals and patients. Further research is needed to clarify these issues. Fassler et al

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