Wednesday, January 17, 2018

Posts from 2016-04-29


Do or do not.  There is no try.

"Fear is the path to the Dark Side.  Fear leads to anger.  Anger leads to hate.  Hate leads to suffering."

                                                                               --Jedi Master Yoda

We're afraid.

It's not something we want to hear as therapists, but it's time for some tough talk about the future of respiratory care.  Fear seems to stalk the background of much of what we do as a profession.  We're afraid of alienating other professions, so we don't fight for stronger license protections.  We're afraid of alienating small pockets of old-school, on-the-job trained therapists, so we drag our feet when it comes to fixing our desperately broken credentialling system.  We certainly seem to be afraid of leaving the shelter of our relative anonymity, and instead are content to lurk in the shadows of healthcare where nobody knows our name.


We know that we improve outcomes and efficiency when our expertise and knowledge are put to use.  So why don't we put that knowledge to use, and toot our own horn more?  

Some of it seems to be rooted in the darker parts of the profession that we don't like to talk about, like those parts where treatments are given because it's too much trouble to go against a nurse or doctor who orders unnecessary aerosols.  It's so much easier to just go with the flow.  Who needs to have their day or night ruined with conflict?  Better to not rock the boat, and just blow some albuterol that (probably) won't hurt.  Unfortunately, while this fear doesn't necessarily lead to anger or hate, it most certainly leads to suffering, because conflict avoidance becomes a part of our professional culture.  If we don't want to make one nurse mad by questioning their suggestion, we sure don't want to make ALL of them mad by declaring certain therapies off-limits, right?

It doesn't take a Jedi master to see how this mindset holds us back.  Many of our licenses are relatively toothless, allowing nurses, EMTs and other disciplines to take jobs away from respiratory therapists and relegating us to afterthought clinicians in when it comes time for "system redesigns" and other cost-cutting measures.  It's also yet another barrier standing in the way of us making bigger strides in the outpatient sector, a place we'll sorely need for expansion over the next decade.

We need to start working right now to cast aside fear and embrace our inner Jedi Knight.  We must stand courageous in the face of adversity, and not shy away from (respectful) conflicts with our fellow clinicians.  Nobody is going to give us the things we want and need to survive as a profession, so let act boldly, and let fortune favor the bold.

Originally published July 27, 2015

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.