Monday, November 20, 2017

Founder's Blog

I Am Not Ancillary

There's an excellent physician blogger out there by the name of Dr. Kevin Pho.  Under the moniker KevinMD, Dr. Pho maintains a website and vast social media presence, dedicated to sharing views on the American healthcare system and the quirks of how our society views medicine.  Many of the entries are written by guest bloggers and experts (including patients), offering a spectrum of opinions on modern practice.

A couple of weeks ago, KevinMD re-published an entry from last year entitled, "Sorry, But I'm Not Part of the Ancillary Staff. I'm a Physician."  This article, written by a cardiology fellow, described a situation in which the fellow was responding to an emergency call for an echocardiogram at night. The fellow responded pushing the echo cart, and was greeted by the patient's nurse saying, "Hooray, the echo tech is here!" The fellow took umbrage at this, and what followed in the article was a discussion about making assumptions about race and/or gender, and how physicians should be properly acknowledged in the hospital setting.  In the course of this discussion, he made it quite clear that the "ancillary" staff of the hospital, while nice to have, was far beneath him, and it was rather offensive to be considered just one of the hospital plebes.

Now, make no mistake, I have no argument with any of these points. Women and minorities absolutely face assumptions, discrimination, and even harassment on a daily basis, and this doc is right on for calling it out. I even agree that physicians deserve a great deal of respect for the work they put into their education and credentialing, and their ongoing commitment to patient care. But the fact of the matter is, even though I might not be a physician, I'm not ancillary, either.

The word ancillary means, "additional, auxiliary, something that functions in a supplementary or supporting role." It originates from a Latin word for "servant, especially female," and connotes something of secondary importance. Personally, as someone who has been in direct patient care for a decade, I can't say I appreciate being told I'm not particularly necessary. Respiratory therapists, physical therapists, occupational therapists, and all the other specialists who get lumped together as "ancillary staff" play critical roles in the hospital.  We, along with the nursing staff, are most often the ones who detect important changes in a patient's status, and are most often the ones who recommend the appropriate course of action. We're the ones who catch inappropriate medication orders by physicians who are too overwhelmed with the rest of the picture to keep up on the latest therapies.  We're the ones who also put our licenses and careers on the line to make sure someone receiving mechanical ventilation is not harmed on our watch, and to make sure our patients are on the path back to wellness.

Many of our physician and other clinical colleagues recognize this, but the level of arrogance and number of assumptions that took place on the Facebook post related to this article was disheartening. All of us RTs know we have a long way to go to really secure our place in healthcare, and one step on that journey is to expect to be treated with respect.  I call upon 'ancillary' providers of all stripes to come together and ask hospital administrators and other decision makers to drop the word ancillary from their vocabulary. We are simply staff; or, if you must make a distinction, 'allied health' conveys the same concepts and even camaraderie without being patronizing. I'm sure our great minds working together could come up with many other suggestions, as well.

Ironically, since that article was published, KevinMD re-published an even older article called, "Stop Calling Nurse Practitioners Mid-Level Providers." It's a statement I agree wholeheartedly with, and a partial acknowledgement that words matter. But they matter at all levels, and it's time to stop pretending some clinical staff members (or really ANY staff members) are less important than others.  Healthcare is a team sport.