How to Develop the Skills to Lead and Succeed

Someone sent me a review about "Enhancing Your Executive Edge" by Kim Zoller and Kerry Preston. I'm not sure it's source but It's worth putting here in total. Some great thoughts about just the behaviors that have been plaguing our system lately.

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It would be wonderful if everyone were nice to each other and had each other's best interest at heart. But the reality is, many people are out for themselves. Sometimes it is a personality issue, and sometimes it is the way the corporate structure is set up.

[Such is the reality of medicine.]

Our goal should be "lead and succeed". To do so you have to see the big picture and realize that a leader is only a leader when there are followers.  You have to be above all the petty behaviors. Although difficult, it is critical for your future to learn how to deal with these kinds of behaviors. 

All these behaviors come from ego. While some ego is important, having an inflated ego can hurt you.

Humility

If you do not have humility, as a leader it is something you must learn. Humility allows you to keep your ego in check and makes you think before you act.

Posturing and extreme one-upmanship

Have you ever worked with people who are obsessed with competing and making themselves look good? This is the definition of posturing in a nutshell. The person is constantly asking, "Who is the better one? Who can run the race the fastest?" Keep in mind that posturing is more than being competitive with others; it is a high level of "oneupping" another person. Posturing comes from a need to win and be known for winning. It may come from insecurity or jealousy of others. This behavior does not bode well for building relationships, nor does it reflect well on the person one-upping.

Sabotage

Unfortunately, there are people who will try to sabotage what we are doing to make themselves look and feel better. Sabotage is really a form of insecurity. There are so many clients who say, "I cannot seem to get my ideas known by anyone around me except my boss." Or "My boss takes credit for everything I do." Not giving or sharing credit is the behavior of a person who is sabotaging another person. The saboteur is trying to make the other person not look as smart as or as effective as he or she really is. What people don't realize is that by making someone look good, we make ourselves look good.

Sarcasm

Some people think sarcasm is funny and do not realize how much it hurts other people's feelings. There is always a hint of truth in sarcasm, which is what makes it hurtful. If you have something to say to someone, say it. Using sarcastic comments will only harm your edge and lessen respect others have for you. Keep in mind that sarcasm may be in your partially blind area. You may know that you use sarcasm, but you may not know the ramifications of it and what other people think and feel because of your sarcasm.

Some things to consider:

• Do not put other people down to make yourself look good.
• Raise your empathy level and always keep others' feelings in mind — increase your emotional intelligence.
• You may say that there are plenty of leaders who exhibit these personality blockers, and, yes, there are. 
• Do people work because of you or in spite of you?

• If you have people who work for you, will they go the extra mile for you?
• Will they stay late?
• Will others take on an extra project just because you asked them to?
• Do not "one-up" people.
• Be collaborative.
• Listen — engagement does not mean having the best idea or best story to tell.
• Do not be the subject-matter expert on every topic.
• Do not try to one-up them — you will never win.
• Do not get off ended; it is their way of feeling important.
• Smile and say things like, "That's great," and keep the conversation going.
• Are you excited for people when they are successful?
• Do you let others take credit for work they produce even when they are not in the room
• Give people credit for their work.
• When someone else's idea is chosen over yours, congratulate him or her.
• Say nice things about other people and their work.
• Realize that when you sabotage other people's work, you will lose all respect from others.
• Take comfort in the fact that people always find out who really did the work.
• Try to include others on e-mails so that they are aware of your work.
• Do not speak badly about saboteurs. That will only hurt you—especially if they have any degree of influence.
• Try to get included in meetings where the work will be discussed.
• Speak up in meetings; do not fade into the background.
• When the saboteur tells about the work that "he" had done during a meeting, use statements like, "Yes, and what I'd like to add was that when I was working on the project, I found . . ."
• If appropriate, go to the saboteur and say, "I respect everything that you are doing. I would really like to be included in the reports so that others know what I am doing at the moment."
• Aren't you just a ray of sunshine.
• Did you take your medication today?
• Do I look like a people person?
• Not the brightest crayon in the box.
• Don't worry. I forgot your name, too!
• Nice perfume. Did you use the bottle?
• When it involves trying to get a laugh at someone else's expense, it is sarcasm — do not take part in it.
• If you have said something sarcastic, immediately apologize.
• When you have said something sarcastic to someone in front of other people, apologize publicly.
• Even if people tell you that your sarcasm is not hurtful, do not believe them. They are not sarcastic and do not want to hurt your feelings.
• Stop doing it and learn some real jokes if you are trying to be funny.
• Do not laugh when they make the joke; your laughter tells them it is all right to keep doing it.
• In private, say to them, "I know you may not realize it, but when you make those sarcastic jokes, they are hurtful. I know you would not want to hurt anyone's feelings, and so I wanted to let you know.  If you are comfortable, say to them, "That's not really funny."

I hope one or more of my esteemed colleagues reads my blog. But I bet ego won't let them.

FDIC - Frightening Disseminated Intravascular Coagulation

DIC is a paradoxical event in any patient, particularly in pregnancy. Disseminated (everywhere in the body), Intravascular (in the blood vessels), Coagulation (clotting).

 DIC It is one of the most dangerous conditions that we encounter in the mother/baby realm during pregnancy and can threaten both mother and fetus. It is an extremely paradoxical event; A ballet between clotting and bleeding; Between life and death.

 A "trigger" stimulates activation of the clotting cascade and clotting throughout the body. This activation results in widespread thrombosis (clots). All this clotting leads to depletion of the raw materials of the clot...platelets and coagulation factors. The end result of this process is bleeding into many areas and organs and, ultimately, multi organ failure including fetal demise. In most cases in the pregnant patient, this demands emergency c-section with long, exhaustive NICU stays for the babies who survive.

In a word, frightening.

DIC Cascade

I've Nothing Together

"Pride will keep you from growing, because when you pretend that you’ve got it all together, you won’t make an effort to become more spiritually mature. No one has it all together! Humility leads to happiness because it makes you teachable. - Rick Warren

I've been really observant sensitive to the lack of humility in some clinicians that make them unteachable and, worse, dangerous. There is a disturbing trend I've noticed that people are genuinely unhappy in the medical centers I've worked lately. There is so much stress, whirlwind activity and demand of time. I hear so much grumbling through the day (and night) from otherwise nice people.

 The exception to the "nice" rule is the clinician who comes believing that they have it all together and that nobody else does. The lack of teachability, compassion for the team that makes them look good and general sense of untouchability is a dangerous recipe. When those below are unwilling or unable to speak their minds, patient safety suffers tremendously. But more importantly, it unnecessarily creates an environment that nobody feels comfortable in, including the patient.

 Medical education and administration has lost the ability to breed into and maintain a sense of humility in providers. The system is so broken, so lost. There is absolutely no recovery from a system that allows such behaviors to continue and, in many case, flourish. I, on the other hand, become more humbled by witnessing such aberrant behaviors and know for a fact, I don't have anything "together".

Stop the Bullies

"You suck!" That's what he said. I've certainly had good days and off days, but this was a mostly innocuous event in surgery that had no ramification to the success or failure of the procedure. It was a hand movement that provoked it. A totally over the top comment on a minor event. Did he think it would make be better?

I've really become sensitive to bad behavior in medicine today. I'm really tired of how we treat each other in the hospital and the effect it has on morale, work productivity and potentially, patient safety and care. 

"He comes to the operating room late, greets no one, and berates the nurse for not setting up the stepstools the way he likes. He tells the [assistant] he doesn’t know the anatomy and sighs when she adjusts her grip on a surgical tool. He slaps the hand of the [surgical tech] when she reaches for the retractor to pull back skin for a clearer view. The operating room is [quiet and] tense for hours."

There is a profound disrespect that abounds in the medical setting, particularly where new or student providers are present. The bullying culture of medicine is well, well known. If you haven't experienced mistreatment, you've seen it regularly. There becomes a subculture of talk about the "crazy" surgeon, who you like and don't like to work with, and the effects of such behavior on colleagues and staff.

"For the most part, I’ve been pleasantly surprised. The majority of doctors, nurses, and other health care professionals I’ve worked with have been courteous and respectful: strong teachers and compassionate caregivers. I have met colleagues whom I would feel honored to work alongside in the future and mentors whom I’d want to treat my own family should they become ill."

 But the mood and atmosphere created by the bellyaching, angry, terse talking surgeon is at least demoralizing to a surgical team. At worst, dangerous to patient care.  The psychological effect of being called out affect our state of mind in "small but cumulative ways. This is the stuff that creates a culture." And I must say that after these many years, I don't like the culture.

So I've learned to deal with the daily mistreatment. It seems to be the way it goes and has to be done. I've done the blow off explanation of that's "how he (or she) is" or "he's having a bad day" or "his mother is in the hospital". I've bonded with other staff over these incidents ('looks like you need a hug") and had conversations of "solidarity" with staff and colleagues about it. Worst, I've trained myself to ignore it, take it, swallow it, and (hopefully) get over it.

I often wonder thought what we aren't doing, what we miss and what we do in error from the effects of the fear and trepidation created in such environments. I think we rush to do things "more" right, more quickly and more expertly when we are chastised and often to the neglect of good procedure that really shouldn't be rushed. Is the environment created by these bullies making people so nervous that they can't really do their job correctly? I think so. And unfortunately I've seen evidence of that recently in the OR.

I can't remember a time in medicine when cooperation, respect, and relationship among colleagues and staff was more important. It takes a team to make medicine happen, particularly in surgery.

"Now, enter the culture of disrespect. Suppose an attending physician makes withering critiques or unreasonable requests. A resident, hoping to avoid such abuse, slowly but surely starts to hold back. She holds back some questions for fear of burdening and, under the constant stress of being scolded, becomes immersed in details of efficiency."

"A substantial body of data attributes medical errors to interactions among hospital workers. Calls for improved patient safety gained traction from the late 1980s through the early ’90s, when Australian researchers reported a shocking find: the vast majority of medical errors, some 70‑80 per cent, are related to interactions within the health care team." If that is the case, then bullies create environments that have the potential to create error.

"The link between harsh words and medical errors was reignited in 2012 when Lucian Leape, professor of health policy at the Harvard School of Pub­lic Health, published a two-part series in Academic Medicine. ‘A substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect,’ Leape and his co-authors asserted. ‘Disrespect is a threat to patient safety because it inhibits collegiality and co-operation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices.’"

"When anger and intimidation flow down, information stops flowing up. The chain of communication becomes clogged."  Some of the most popular reasons for lac of communication in the hospital setting, according to research: Intimidation. Fear of confrontation. Concerns about retaliation.

"When someone is unpleasant or demeaning, something switches in the minds of those on the receiving end: they sacrifice honest communication to save face. I’ve seen it in action so many times that the pattern has become predictable. Preoccupied with fear of appearing incompetent, team members keep uncertainties under wraps."

"Many in medicine actively protect the culture of disrespect because they hold a fundamentally flawed idea: that harshness creates competence". I am experiencing such a shameful experience now. No new competence comes from harsh, disrespectful communication.  "Brutality doesn’t make better doctors; it just makes crankier doctors. And shame doesn’t foster improvement; it fosters more mistakes and more near-misses. We know now that clinicians working in a culture of blame and punishment report their errors less often, pointing to fear of repercussion. Meanwhile, when blame is abolished, reporting of all types of errors increases."

"Bad cultures lead to bad outcomes. Jerks do not make good medicine. They foster a backwards atmosphere that degrades trust, tarnishes open communication, and promotes cover-ups."

I wish I knew how to stop disruptive behavior. But likely if I speak out about it, I'll be dismissed so that the disruptive surgeon bringing in financial benefit to the hospital can continue to rant and rave. Thus facilitating the behavior it hopes to eliminate.

"We can’t ignore a system that takes loads of formerly ‘nice’ people and churns out jaded, bitter, and gruff ones" I yearn for a hospital culture that shames bullying making the bully look like the bad guy, rather than making the recipient look weak. 

There is not quick fix, but I for one, am beat up enough for a lifetime. And I don't think I'm a better provider for it. Maybe I just suck.

Time Flies

Time flies when you are having fun or busy putting people back together again. It's no excuse, but writing superflous wordage about next to nothing take back seat to patient care. Now I know how all the King's men felt. It's been a busy time with leaving internship and going to work.

It's been a great learning experience on many fronts. I don't think like a medicine people and being back in surgery is wonderful. Those who can't memorize, operate.

 Quote of the past few months: "Can you imagine what a great surgeon I would be if I could find help who were as good as me?" - Anonymous, M.D.

I continue to strive. Per chance to dream.

Gossip

A man approached Socrates one day to share some gossip. The wise philosopher asked, 'First, are you certain it's true? Second, is it something good? Third, is it something useful?' When the man said, 'Not really,' Socrates replied, 'Well, if it's not true, good or useful, why talk about it?' Gossip can feel like a form of intimacy, but it's actually a false bond motivated by the desire to diminish another person and make yourself look good.

There's WAY too much gossip in the hospital. Much is not useful. But some can be. How do we know?

The following questions can help you decide if it's useful talk:

Are you telling someone who can do something about the problem by helping, or offering discipline or correction?

Are you talking to someone wise enough to help you process your feelings and courageous enough to make you do the right thing by confronting the other person, or confessing where you're at fault?

Is this news approved for sharing?

Are you breaking a confidence, and if so, is it strictly because the person is endangering someone's life, including their own?

Are you willing to divulge your source so it can be checked?

When you say this, does it break your heart?

Would you be comfortable if someone was saying this about you?

Asking...

Bad Behavior

Ilana Yurkiewjcz, a Harvard third-year medical student, writes eloquently about something that has bothered me in medical education for years... Bullying.

She writes about a minority of staff and clinicians across all ranks of staff who are profoundly impactful and are outright bullies.

What is interested me most is her description of those subtle "micro aggressions", subtle putdowns, shaming interactions, sarcasm, passive-aggressive and frankly bad behavior.

There was something very relieving with reading her article. It read like a summary of my resume. Beyond her frank observations is the course reality to what may be wrong, at least in part, with the educational system of physicians and other healthcare clinicians today. Sometimes I'm so ashamed to be associated with this world.

http://aeon.co/magazine/being-human/why-rude-doctors-make-bad-doctors/

How many people does it take

A little while ago I helped deliver twins in an emergency C-section situation. The babies were way early, way small and unfortunately they had to be delivered right away... "Stat", on steroids.

This scene is absolutely chaotic. Or rather sort of an organized chaos. At one point I counted 16 people in the room with various roles and responsibilities. There is the scrub team which includes a surgeon, an assistant, and a surgical tech. There is a respiratory support team for each of the twins. There is an anesthesia team which includes a physician and a nurse anesthetist. Then there is the pediatric and neonatal resuscitation team from pediatrics and neonatal intensive care. Then there is a charge nurse for the operating room and patient care assistants to assist all of the team members.

It truly begins as a rather chaotic scene with all the members of the team scurrying around the room preparing for the delivery. But once the timeout is complete and the scalpel hits the skin it is truly poetry in motion. I don't believe there is any more skilled team in healthcare today then those that deal with high-risk births. It is truly a pleasure and a blessing to be a small part of the effort.

Gross Anatomy is not Gross

139 years ago, Thomas Eakins painted Dr. Samuel Gross, his colleagues and students performing surgery on a live patient with what I suspect is a cowering family member shielding her eyes from the carnage. Dressed in his daily attire, the depiction of his bloody hand wielding a scalpel and his colleagues retracting and cutting on this leg is sobering. Infectious disease experts shudder in horror at the scene.

I'd like to think that my course in "Gross Anatomy" was named for the man, the surgeon and the teacher who had the audacity to perform such an event absent gown, gloves, mask or other protective equipment. But many of my colleague argue that it's simply a reference to gross or macro anatomy on a large scale as opposed to micro (small) anatomy. Either way, I'm proud to be in the line somewhat of such men who dared to do cutting edge things, albeit without gloves.

We really have come a long way in surgery and the study of Anatomy in the past 140 years. And we don't let family watch surgery from a kneeling position in the corner of the room either. Although, perhaps we should.

Target --> Bladder Catherization

The target was the bladder. Run a catheter made of a rubber like material into the urethral opening, up the urethra into the bladder to allow a conduit for urine from the bladder to a bag hanging on the bed frame.

The procedure is done 1000's of times per day across the U.S. by nurses, medical assistants and other healthcare professionals. There is even a program for patients to "cath" themselves.

It's not rocket science but has some risks of complications including infection. If the procedures are followed correctly, complication are minimized and the procedure is effective and often necessary in the healthcare of the patient. Unless....

Unless of course you fail to understand the anatomy. In the female, the urethral opening is located anterior (toward the front) to the both the vagina opening and the anus.

Earlier this year, I heard a cry for assistance from a nurse in the OR. "I think there is poop coming out of her urethra. does she have a fistula?" I gloved up and made the attempt to assist her as she struggled with the procedure. But very quickly I recognized that she was attempting to place the urinary catheter into the rectum through the anus. A normal place for poop to be located.

It was everything I could to do to laugh out loud, but behind my mask, I had the biggest grin you can imagine.

She thanked me profusely for assisting and pointing out her problem with the very complicated female anatomy.

Nutrition

There has been so much cancer, infection of all kinds, diabetes and GI tract diseases. Seems we are being inundated with it all at the community hospital level. And over the years I've read good discussions about the connection between what we eat and all of these. Isn't it time we made a strong effort to return to a more natural way of eating to at least test the theory?

It would be unheard of to deliberately go to the medicine cabinet and ingest antibiotics and/or hormones for no reason. Yet we ingest foods with both and somehow that seem normal to society when we eat meats. We continue to be an obese people eating too much of the "white" stuff including flour, milk, salts and sugars. More amazing, how much of this stuff we feed to sick patients disguised as "nutrition" during hospital stays and convalescence.

Consider raw fruits and vegetables. They really are our natural diet. They contain all of the essential nutrition we need for life. They are complete foods including fats and proteins. They are composed mostly of water, necessary for good hydration and water balance in the body. They are low in salt, fats without any preservatives, additives, cholesterol, uric acid, adrenaline, hormones, antibiotics or pathologic bacteria in their natural state.

But, the dietician retorts, what about protein? Most plants can biosynthesize all 20 standard amino acids (the building blocks of proteins). Every vegetable and fruit has protein, some more than others. In a diet that contains fruits, vegetables, nuts, seeds, legumes and grains...we will get the protein we need without adding meats to the mix. Each food varies from 4-8% protein with all 8 essential amino acids that we cannot produce ourselves but need. Tomatoes, zucchini, cukes are particularly good sources as are leafy greens, carrots, celery, cashews, chia seed, sunflower seeds, flax seed, mushrooms, sprouted beans, lentils and spirulina. Protein is the essence of "green drinks" in that way. I suggest there is plenty of protein.

It is possible to get protein, needed fats and carbohydrates, nutrients of all kinds and the nutrition the human body needs from this type of eating, so it would seem. What's important now is to test this inexpensive intervention and support individuals through the transition from the old to the new way of eating. It's not a diet, it's a lifestyle change. Including some movement exercise, this is a lifestyle with the potential to reverse the trend of disease in developed countries. It's certainly worth the effort. We have nothing to lose but ill health.

Bruno

I recently met a patient who, when describing her previous illnesses and treatments, mentioned being involved with a group supported by the teachings of Bruno Groening.

I'd never heard of him or his claims. Bruno claimed to be a healer and spoke widely on the subject of healing in the early 1900's in seems. He thought no illness incurable with his beliefs or techniques. Around the globe today, there are many "Friends of Bruno" who gather regularly to learn and practice healings.

Apparently the techniques could not heal the colon cancer my patient had or the goiter/thyroid enlargement Bruno had. He died in his early 50's. With any luck of the scalpel, this lady should last longer than Bruno. It's amazing to me what people believe or want to believe as they deal with their own health.

Abroad Tea

Any starts talking to me about magic potions from lands beyond the U.S. border, and I'm all ears. I've seen too many pharmaceutical poisonings over the years and anything that is natural and as effective as the drug company variety is fascinating to me. I smelled it as soon as I entered the doctor's lounge. It was something I'd never smelled before.

"What is that?" I asked my colleague. In broken English my FMG friend told me it was Mate' from his native Argentina made from the dried leaves of yerba mate, also known as llex paraguariensis (Paraguay?) to the science types. I have tasted many strange teas in my life, from many countries, but this one I missed. Before I could say anything more, he vanished to the locker room and brought back a bagged sample of the tea for me to try. I promised to savor it at home. Cute little donkey on the label.

He proceeded to describe the potential benefits of the tea. He said it's a strong stimulant when steeped for longer period of time and acts on the muscles to relax them. He warned of mental clarity without the buzz or addiction of caffeine. He beamed with talks of boosting the immune system and stimulating healing tissue.

I don't know about all that, but I've been buzzing on one cup all day. It was delicious, but I can feel it working on my brain, muscles and nerves. Wonder if I steeped it too long. Now I'm trying to figure out how to fall asleep without countering the effects with something chemical. Wonder how my immune system is doing. Probably to buzzed to notice the bacterial floating around my body. And I don't know how I missed this gem but the scientific community seems to have found it as well and is interested in it's medicinal properties - http://www.ncbi.nlm.nih.gov/m/pubmed/20599603/ .
Thanks for the sample! Now, just need to find a supplier.

Sobering

Emergency C-sections are one of the most sobering events in medicine/surgery. Life is fragile as well as tenacious.

27 weeker babies, fetuses really, are so small and discolored with labored breathing and frantic resuscitation teams doing their best and giving their all to encourage and save life. I forget how much effort they require, how much attention they need at this stage. They just aren't ready for prime time.

I heard one of the nurses say, "this one's not done yet. Put it back in". A bit amusing, but entirely sobering. Off to the NICU for several 100s of thousands of $ of attention and need.

Paraphernalia Stories

Once upon a time there was a baby and his father who lived full time on an ocean going freighter moving "Made in China" tools from Hong Kong harbor to the Port of Los Angeles. One night, the father was strolling with the toddler, just beginning to learn to walk, on the deck of the monstrous ship. All at once a rogue wave swept over the boat and washed the baby and his father off the deck into the cold Pacific....never to be seen again.

I'm not normal. Walking along the beach the other day after a storm that brought up huge waves, I found a pacifier in the seaweed and debris. I don't think about the litter and trash that is polluting our beaches from who knows where. I think about the story behind the pacifier.

I think about the male or female baby in far off lands who somehow lost his or her comforting rubber and plastic binky off some ocean going freighter that his Mom or Dad worked to keep him/her fed and sheltered. Or maybe Tsunami debris from Japan or an eroding dump in the Caribe islands, cascading into the sea.

There must be a story attached to this and other pieces of humanity that wash up on the shores of our beaches. I just try to fill in the blanks.

Healthy Lunch and Dinner

Lunch: Blend smooth and drink...

1/2 for lunch (250 calories), 

1/2 for dinner (250 calories)

Orange Carrot Green Machine

3 apples

1 orange

2 1/3 carrots

1/2 banana

1/3 kiwi

3/4 mango

1/3 cup pineapple juice

2 tbs lemon juice

1300 mg spirulina

400 mg chlorella

100 mg broccoli

100 mg spinach

50 mg blue green algae

50 mg garlic

75 mg wheat grass

50 mg ginger

50 mg parsley

16,000 u vitamin A

94 mg vitamin C

836 mg potassium

Or just go buy two bottles of Naked and mix together. 

Way easier! 

Even if it's a Pepsi product and they have been sued for false advertising of contents.

Creating Takes Time

I watched a turtle the other early morning. Such is the byproduct of being on call. Up in the middle of the night when only nocturnals are also out and about. But I was there for a reason. So I watched.

Slowly, deliberately and with extreme labor, I watched the several hundred pound beast pull itself out of the water and up the hard packed sand. Then into the soft sand, with less tractable footing. For over an hour she pulled and seemingly huffed and puffed to get ashore to her "spot". Then she dug for another hour and then laid her eggs in the bottom of a pit created by her own urine. And then, the march back to the sea for another hour. Truly an amazing thing to watch and experience.

Things worth doing, that create life and abundance, are worth doing slowly and deliberately. And perhaps, in the middle of the night.

Bright Side

In medicine, we have a habit of "eating our young." And this mentality seem to extend from clinical leadership for the most part; Searching extensively for the negative qualities, deficits in people instead of their value(s).

Leadership guru Balconi encourages wise leaders to look at what an employee can do rather than what he cannot do. This subtle perspective change is extremely valuable in this age of "team" medical care and not something trained in medical school.

The glass 1/2 full attitude in medical leadership would go a long way and I've been lucky to experience such leadership in my tenure. Talent of our colleagues in medicine should be about identify core skills a person can do, and helping each other in those areas that are holding us back from achieving individually or for the team, or patient.

As Balconi says, "Talent is not a commodity. It is the lifeblood of the enterprise and those leaders who look for it, nurture it, and seek to capitalize on it are ones who achieve their objectives." We can only hope for more enlightened leaders in medicine who can make such a reality.

Higher Selves

As long as we are in touch with our higher selves our egos are not a threat, rather a tool in service of the spirit.

It's a rare thing in medicine, but when I find true professional, willing to talk openly about approach to problems in patient care...it can be magical. But it supposes for even an instant that all parties open their minds beyond "what's done here" and their own prejudices. I've learned so much that way. There are MANY ways to do almost everything in medicine. I can watch 5 people sew up the same wound 5 different ways. The knee has at least 8 approaches (if not more) for arthrocentesis.

Having such discussion usually happen late at night, in corners of intensive care units with like minded providers. They are insightful glimpses into the genius that is in most of us when others truly listen and open their minds to the possibilities. It's also about deferring such discussions from the presence of the patient and others so we don't feel the need to prove ourselves.

I am so surrounded by ego, and it's "my way or the highway" mentality that we often miss the point, and allow the patient to suffer in the process. But even during long, long days engulfed in 90 hour work weeks, there is still some possibility of finding our higher selves in spite of the attack of ego of others. It's better for the practitioner, better for the practice of medicine and better for the patient.

Bullshit Rules

I know the rules. The rule in surgery, your hands should never slip below your waist. Everything below the table level is considered "unsterile". Once your hands enter that area, they should never be brought back into the sterile field.

So when I lowered my hands to adjust my lead apron, hands at belly button level, technically I was in violation. I was careful to keep my hands in front and not below table level or my waist. One of my esteemed anal retentive, subversive, passive-aggressive colleagues (an oxymoron) pointed out to the entire OR my faux pas.

But in our world, it's a moot point, filled with inaccuracies and frank bullshit. We sit and stand regularly in the OR bringing our entire torsos to nipple level below the table and pop back up again...regularly, with impunity.

Some things are just bullshit. In this case, not sure if it's the rule without evidence or the colleague without discretion or sense. It's likely a commentary on more broad issues in the world of medicine, pseudo teamwork, inexplainable rule without evidence and ego than contamination.

I changed my gown and gloves without saying a word.