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The aeroplane touches down and your holiday begins. “This time I’ll relax” you promise yourself while nervously pacing around the luggage carousal. You finally check-in to your modestly priced hotel room, and you even open an immodestly priced drink from the minibar. Your partner then fixes you with a familiar stare and delivers THE TALK: “Right you, no work for a week”. Before words have left lips, your phone pings to announce that you now have wifi service. You make an excuse, sneak to the toilet, and feel an endorphin rush as you enter your password. Gosh, this many emails after such a short flight: these must be important, after all they know that you are away…
It’s Monday, but it’s already been a long week for your clinical director. Yet another three page safety notice about that piece of equipment that hasn’t been used since the 1970s. But if others have to read it then so do you. This email has been passed along like the chain letters of old. You feel dumb as soon as you open it. However, this does not stop you forwarding it to a few more folks: you know, just to keep them in the loop.
FYI presumably means “For Your Irritation.” You develop carpel tunnel syndrome by the time you have swiped through this James Joyce novel. You still can’t establish the point of this dirge. Moreover, the contents are copyrighted and yet simultaneously not the responsibility of the sender the novella length signature tells you. The archaeologist in you is compelled to unearth the original missive. “Goodness me” is not the expression you mutter when you discover it concerns maintenance work that started weeks ago, in a building you never visit and can’t even pronounce.
You heart sinks while your mind runs through a rolodex of frustrated patients, angry relatives, and huffy colleagues. What did I do; what didn’t I do? You recall something about someone, but the notes are on your desk and a response is expected pronto. You don’t tell your family, but, for you, the idea of you relaxing on this holiday is now stuffed. You promise not to check your email tomorrow, but who are you kidding. In the meantime, it seems best just to stew.
A 30Mb attachment takes an eternity to download. Finally you can behold all of its colourful Comic Sans glory. Even though you don’t know the people, you now know that mum and baby are doing well. Another person you didn’t know had arrived is apparently leaving, and someone who you thought had never left is now back. You also learn that hand hygiene is less than 70%. You are so distracted you forget to wash your hands on the way out of the toilet.
Subject: Special invitation
Apparently, your glorious work is revered the world over. So much so that all you have to do is click the email link and share your personal details. You and only 5000 others can then pay to present at a conference in a place that may still be under a travel advisory. You ought to send this one tumbling into the spam folder stat, but hey, at least somebody recognizes your genius.
Subject: Let me know your availability
Oh god, the five most dreaded words in the email lexicon have just been typed. There is now no way to escape 50 separate emails whereby everybody feels obligated to cc all. You will soon be informed of such breaking news as “Tuesdays aren’t great for me” and “I’ll try my best to be there but can’t promise”. You wish you could send a pleading email that asks folks only to respond to all if they really must. This presents you with an interesting catch-22, can I really cc all asking people not to cc all?
Now we’re talking: you love cake. Instead, this image of gluten-free diabetic-friendly vegan beetroot surprise sends your finger straight to the trashcan icon. Time to head to the pool before Happy Hour ends. After all, your family appears to be having a great time without you.
You send yourself one last reminder message. After all, you’ve been meaning to talk to the kids about not overusing their smartphones on this trip. You worry where they get such ideas. Maybe you will Google that. In fact, you could even write an article about digital detox; maybe tonight when everyone else is asleep.
Matt Morgan, Honorary Senior Research Fellow at Cardiff University, Consultant in Intensive Care Medicine and Research and Development lead in Critical Care at University Hospital of Wales, and an editor of BMJ OnExamination.
Competing interests: None declared
Peter Brindley, Professor of Critical Care Medicine, Medical Ethics, Anesthesiology at University of Alberta, Canada.
Competing interests: None declared.
The post Please don’t reply all—why we need to learn e-tiquette appeared first on The BMJ.
BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6372 (Published 12 November 2019) Cite this as: BMJ 2019;367:l6372
Follow Matt on Twitter: @dr_mattmorgan
As I walk towards the sound of 1970s music, coloured disco lights spill out from the window. I clutch a quickly wrapped bottle of cold wine, snatched from the fridge as I left the house. But an early start the next day means that the only drinks I’ll be having tonight will contain caffeine rather than the alcohol that sustains the bad dancing.
As I enter the social club, a line of hungry people talk about the weather, football, and Brexit while balancing beige, pastry based snacks on unstable cardboard plates. A silver banner, too small for the huge white wall it’s stuck on, exclaims the reason for tonight’s celebrations: “HAPPY RETIREMENT!”
For the doctor retiring, it’s been 30 years of sick patients, grateful families, and endless mandatory training—interspersed with times that made you smile, times that made you cry, times that you will remember forever, and times that you would rather forget.
The hospital’s medical director shuffles on to the dance floor, tapping the microphone to try to be heard above the sounds of “Dancing Queen.” The speech contains all of the right words: commitment, treasure, grateful, missed, dedication, thanks. The big moment arrives when an oversized card, signed by hundreds of people, is carried in from the sidelines, and they present you with that special gift that will soon feature on your mantelpiece. You deserve it, and we all applaud loudly.
Other people, other places
While the private sector embraces frequent moves, job shuffles, and the multi-hyphen method of people’s portfolio careers, healthcare still celebrates staff who show dedication, through long service awards. But, although this is only right and proper, we should celebrate short service too.
By reducing the number of geographical rotations that doctors experience to just a small cluster of hospitals—and by implementing more prescriptive, inflexible local guidelines, which are often based on politics as much as their worth—we risk losing the learning and experience that come from working with other people, in other places. “This is how we do it here” is fine, as long as you also experience “how they do it there.”
Run-through training schemes, based around a small number of hospitals—in one country, one county, even one city—can put the breadth of medicine at risk. A narrow focus can be powerful in healthcare, as long as you gaze at the horizon now and then. To help doctors obtain such long-sightedness, the process of moving between hospitals and experiencing different environments should be easy, seamless, and even encouraged.
So, perhaps we need short service awards as well as long service ones.
A massive thanks to Ger Gilroy and Stuart Lancaster for inviting me onto Episode Three of the second season of Leader’s Questions.
I still remember the first time I said those three little words. Growing up in a loving Welsh family, I’d heard them said many times. But the first time they roll off your tongue will always be different. You try to choose your moment, but sometimes the words take you, and the listener, by surprise.
If “I love you” are the three most important words in life, then “I don’t know” are the three most important in medicine. They’re also the most underused. Their power comes from admitting that doctors don’t, and can’t, know everything.
For me, the first time I admitted to a patient’s family that I didn’t know the answer was after caring for a young man who died from sepsis. I was a doctor on the intensive care unit, surrounded by fancy blood tests and scans. Yet I couldn’t answer his family’s most basic, most important question. Trying to comprehend what had just happened, his mum asked, “Why him? Why has he died?”
All medical encounters revolve around things we don’t know. Patients and families often challenge us to predict the future, asking, “Will she survive?” or, “When can I go home?” Like the best meteorologists we must integrate science, history, and our gut instinct to make a stab at an elusive possibility that we hope clings to a truth.
Consider a weather forecast of a 90% chance of rain. If the sky stays blue the prediction wasn’t wrong—truth just happened to be found in that smaller 10%. Openness about uncertainty can lead to more understanding: a 90% chance of rain may tell you to take an umbrella, but “I don’t know” is the start of longer, more nuanced conversations.
Looking a patient or relative in the eye while saying “I don’t know” is hard. They’re difficult words to say. It’s hard to admit the limits of our knowledge, and sometimes it means hinting at the boundaries of medical understanding. Patients and families often expect doctors to have solid answers, or they assume that modern medicine can cure them. It can come as a surprise when we don’t and can’t.
They’re also risky words. When you’re standing on the solid ice of reason it can easily get slippery when that ice begins to melt. You can fall, become unsteady, and have little to grip on to. It’s a disorientating and unnerving experience for doctors to say, “I don’t know,” and once you admit the limits of your knowledge it can make you question more and more.
Yet these words also carry immense power: the power of hope, because there may be that chance to recover. They also carry the power to inspire people to strive for a better understanding of what’s not yet known. Even when these things don’t follow and hope is lost, perhaps honesty with yourself and those you care for is good in itself—although I’m not sure about that either. I don’t know.
It was a pleasure to speka with Dr Andrew Davies on his podcast Mastering Intensive Care. Have a listen here https://masteringintensivecare.libsyn.com/episode-47-matt-morgan-mixing-science-history-emotion-and-humanity-in-telling-critical-stories