Read on Twitter
THREAD
What's in a name?
Come answer some poll questions and read my mumblings about communication and safety and stuff.
Trigger warning: I have been informed by health care workers that my attitudes to using first names is "disrespectful"
(1/n)
What's in a name?
Come answer some poll questions and read my mumblings about communication and safety and stuff.
Trigger warning: I have been informed by health care workers that my attitudes to using first names is "disrespectful"
(1/n)
Juniors: what do you call your consultants/bosses/attending? (2/n)
Seniors: what do you tell your juniors to call you, or how do you introduce yourself to them? (3/n)
How do you introduce yourself to your patients? (4/n)
What do you call your patients/carers? (5/n)
When I mentioned to my Quality and Safety masters group a few years ago that I called my consultants by their first names, there was UPROAR. Itās disrespectful! How will anybody know who the team leader is?
My surgical consultant when I was an FY1 was keen that I use his (6/n)
My surgical consultant when I was an FY1 was keen that I use his (6/n)
first name. He was also keen that I phone him at the end of each shift and tell him how his patients were doing. I wasnāt as terrified of him as my SHO and registrar, but neither of those things were going to happen, hence lots of 6:30pm phone calls demanding to know the (7/n)
ward situation!
He was Jon Stewart and set up the first local simulation centre. He was very keen on learning lessons from aviation, particularly the use of sim and the importance of seniority gradient.
Yes, I know, youāre rolling your eyes about learning inappropriate (8/n)
He was Jon Stewart and set up the first local simulation centre. He was very keen on learning lessons from aviation, particularly the use of sim and the importance of seniority gradient.
Yes, I know, youāre rolling your eyes about learning inappropriate (8/n)
lessons from other industries. I totally agree that the tools we use to investigate incidents come largely from assembly line manufacture and are not very useful to healthcare environments, which is why Iām a huge proponent of safety-ii and learning from excellence. You can (9/n)
read more about that here: https://bit.ly/2bTOnpJ
However, most of our human factors learning, which most people will agree is A Good Thing, comes from commercial aviation. Letās talk about the Tenerife air disaster.
In 1977, two Boeing 747s collided on a foggy runway (10/n)
However, most of our human factors learning, which most people will agree is A Good Thing, comes from commercial aviation. Letās talk about the Tenerife air disaster.
In 1977, two Boeing 747s collided on a foggy runway (10/n)
in the Canaries. One was approaching take-off speed with another aircraft taxiing towards it on the runway. 583 people died. Itās the deadliest disaster in commercial aviation history.
The investigation found two main root causes. Firstly, use of the ambiguous term 'ok' (11/n)
The investigation found two main root causes. Firstly, use of the ambiguous term 'ok' (11/n)
between air traffic control and the KLM cockpit, which was banned as a consequence.
Secondly, letās consider Captain Veldhuyzen van Zanten. Airline pilots in the 1970s were a big deal, and Cpt van Zanten was the biggest. He headlined KLMās international poster campaign. (12/n)
Secondly, letās consider Captain Veldhuyzen van Zanten. Airline pilots in the 1970s were a big deal, and Cpt van Zanten was the biggest. He headlined KLMās international poster campaign. (12/n)
The crew would line up and salute him when he entered the aircraft.
It had been a stressful day. Gran Canaria airport had been closed by a bomb threat and diverted a lot of international flights to a small provincial airport. There was dense fog, complicating everything. (13/n)
It had been a stressful day. Gran Canaria airport had been closed by a bomb threat and diverted a lot of international flights to a small provincial airport. There was dense fog, complicating everything. (13/n)
Cpt van Zanten wanted to take off. His first officer, on the cockpit voice recorder, didnāt sound sure they had clearance, and tried to reiterate this several times with the control tower (the āokā conversation).
When van Zanten pushed the throttle, the first officer did (14/n)
When van Zanten pushed the throttle, the first officer did (14/n)
not challenge him. He may have been happy with his senior's decision. He may have been intimidated by the seniority gradient. Either way, heād be dead within minutes.
As a result of this and similar incidents, the airline industry created Crew Resource Management; (15/n)
As a result of this and similar incidents, the airline industry created Crew Resource Management; (15/n)
essentially, human factors training for air crews. Although using first names is not a prescribed feature of this, the industry response to Tenerife and other disasters is reported to have informalised cockpit hierarchies: https://bit.ly/2zMNdIY (16/n)
But what about healthcare? Shouldnāt we be using titles to address our seniors as a sign of respect? What if patients discover we have first names?
Iāve worked for three teams in my current organisation. One INSISTS on first-name communication between all grades, and it's (17/n)
Iāve worked for three teams in my current organisation. One INSISTS on first-name communication between all grades, and it's (17/n)
completely normalised in the other two. When I call consultants from most other specialties, they introduce themselves by first name, and can communicate in this fashion.
My experience of using first names elsewhere has been largely positive, but mixed. There are some (18/n)
My experience of using first names elsewhere has been largely positive, but mixed. There are some (18/n)
consultants who seem uncomfortable with it. My own increasing seniority may be influential, particularly when talking to consultants who Iāve worked with previously as registrars. Mostly, thereās some sort of shocked non-verbal reaction from the juniors, but no adverse (19/n)
response from the consultant, as Iām using their name.
What about respect? To badly quote @ian_wac, "if being addressed by your title is the only thing in your team that makes people respect you, you have far bigger problems than what people are calling you to your face" (20/n)
What about respect? To badly quote @ian_wac, "if being addressed by your title is the only thing in your team that makes people respect you, you have far bigger problems than what people are calling you to your face" (20/n)
What effect does it have on team communications? Itās routine here for FY1s to feel comfortable enough to correct consultant-led discussions of patients they know well in large team handovers and meetings if the details are significantly incorrect enough to influence the (21/n)
discussion adversely. Iāve worked in teams where I wouldnāt feel comfortable to do that as a more experienced doctor.
What about with patients? One of my previous bosses uses his first name with all colleagues and his title and surname with patients. He feels it draws an (22/n)
What about with patients? One of my previous bosses uses his first name with all colleagues and his title and surname with patients. He feels it draws an (22/n)
important barrier in a consultation. Personally, I have a surname thatās spelt weirdly and a first name that is short and (unlike in the US) relatively uncommon. I think consultations should be collaborative. Thereās no point me mandating decisions that the patient and (23/n)
carers donāt like, because then compliance is likely to be poor. The patient is the expert in how their condition makes them feel on a day-to-day basis, and the carer is increasingly important to that experience the younger the patient gets. I am the expert (apparently) in (24/n)
managing the problems the condition creates. Together, weāll find a solution.
My usual greeting is something like āIām Sean Monaghan, one of the paediatric doctors. How can I help?ā. I donāt really care what you call me. (25/26)
My usual greeting is something like āIām Sean Monaghan, one of the paediatric doctors. How can I help?ā. I donāt really care what you call me. (25/26)
Whatās in a name? What do your colleagues and patients call you? How do you address your seniors? How does that affect intra- and inter-team communications? (26/26)
