Friday, October 19, 2007

Relationships Critical in Effective Leading

This month's issue of Center for Creative Leadership says "the ability to build and maintain relationships and work well with others is in big demand - and in short supply."

While I might think a leader is the one on point setting the pace, it's the manager who collaborates amongst departments to share resources, develop programs, and train personnel while simultaneously integrating direct reports' career and family desires with senior management edicts. So who really adds more value to an organization?

CCL says "Organizations are increasingly operating in ways that involve interdependent, boundary-spanning work - creating a greater demand for leaders who are skilled at participative management, building and mending relationships and change management."

Today's Navy Nurse manager [Division Officer] usually cannot offer choice job assignments although senior management does try to match career desires with billet openings. I have found that giving an expected timeframe for this transfer to a coveted position helps as well as exploiting opportunities for cross-training when workload is light. It also helps that nurse develop relationships with nurses already working in that department so this person is not only getting the benefit of me "pushing" this person to that department, but the department is "pulling" that person to come work with them in staffing meetings.

We cannot pay someone more for working the off-shift, weekend or holiday. This past summer, when staff members were working 18-20 twelve-hour shifts and on-call for more, the Nursing Middle Management Council wanted to reward those staff members with----a pizza party. I rolled my eyes. "Why not reward them with something that REALLY matters?" I asked. "Why not submit a nomination for a Navy Achievement Award---something that would appear on a fitness report and be presented in front of peers by the commanding officer?"

The response? "I'm really busy. I don't have time to write up a nomination." So, calling Pizza Hut or Dominoes is the ineffective leader's gift to direct reports. And it gives me a very good insight as to this manager's relationship abilities.

Thursday, October 18, 2007

"Health" Magazine Writer, Suz Redfearn, Advocates Deceptive Practices

The teaser arrived in my email box---Nine Secrets Health Insurers Don’t Want You to Know---and I clicked. Suz Redfearn, a freelance writer, says that

To get tested, talk up your symptoms.Your insurer doesn’t want to pay for a colonoscopy if it’s not necessary. But if your best friend is diagnosed with colon cancer and you want the $675 test to put your mind at ease, here’s how to get one covered: Mention to your doctor that you’ve had some blood in your stool and a lot of gas lately—or simply that your bowel habits have changed.

First, this is obviously not a colonoscopy but a flexible sigmoidoscopy. It costs a lot more for the more extensive procedure that checks the right side of the large bowel in addition to the transvers and descending colon. And sedation typically is not given for the flexible sigmoidoscopy. Most patients do not require colorectal cancer screenings before the age of 50. These exceptions include those with a history of familial adenomatous polyposis, obvious changes in bowel habits (bleeding, changes in diameter of stools, and unexplained anemia), and first-degree relatives diagnosed with colorectal cancer.

The National Cancer Institute has a wonderful site that explains the various options available for colorectal cancer screening. I would encourage all patients to discuss their risks with their providers and not resort to subterfuge or lying in order to obtain a test that may not be necessary.

I sent a letter to Health stating my disappointment with their decision to publish an article that advocates lying and deception in the patient-provider relationship. Healthcare providers already manage patients who claim they take all their medications as prescribed, who exercise as recommended, and who avoid dangerous health practices. Let's add another nail of skepticism to the communication coffin.

Other blogs about this article include:
California Medicine Man
Kevin MD Medical Blog

Sunday, October 7, 2007

October is National Breast Cancer Awareness Month

In the summer of 1994, our neighbor wore a turban and we learned she had breast cancer. I remember being invited over to their apartment with walls lined with books from floor to ceiling. She and her husband had three children who were crammed into this little apartment.

One day we came home to find her crying in the hallway. "Are you okay?" we asked, concerned. She shook her head no. "It's in my bones," she said.

I've thought about her off and on over the years. The five-year survival rate for breast cancer with metastasis to the bones is 21%. I hope she is still alive; her husband and children deserve that much.

Breast cancer is the leading cause of death in women ages 20-59 while lung cancer is the leading cause of death in women ages 60 and older. Breast cancer diagnosed in the early stage, that is, while it is still localized to the breast has a 96% chance of survival. This is why mammography is so important. There are no early signs or symptoms of breast cancer; even the monthly breast self-exam (BSE) detects cancers at much later stages than radiology.

My annual mammogram is scheduled for this month and I am not looking forward to it. However, the inconvenience and pain of being diagnosed with breast cancer far outweighs the inconvenience and pain of this diagnostic exam.

For more information, please check

Thursday, October 4, 2007

Too Sick to Take Meds

From the Chicago Tribune:

"In a new study published Thursday, a group of University of Chicago doctors found many diabetics believe that the inconvenience and discomfort of their treatments, especially multiple daily insulin injections, were as bad as the complications that can result from not treating their disease.

"Some patients, 10 percent to 18 percent of the total, said their treatments were so arduous that they would be willing to die sooner -- some said up to 10 years earlier -- if they could stop their medications.

""Some of this might be lack of education and people not understanding the disease process," said Dr. Holly Mattix-Kramer, a specialist in preventive medicine and kidney disease at Loyola University Chicago Stritch School of Medicine. "We need to do a better job educating our patients about what preventive care means and how it may affect their life span.""

I wonder if the providers evaluated these patients for depression.

There is a lot of support given to patients who are diagnosed with cancer. We have cancer support groups, we hold fund-raisers, and we generally don't fault these people for getting cancer (well, maybe we think smokers have it coming....).

In any case, there is no support for diabetics. Many diabetics have made lifestyle choices that have predisposed them to diabetes and, for some, lifestyle choices may have delayed but did not prevent the onset of diabetes. So others look at these people and "should" all over them. "You should have watched your diet. You should have lost weight. You should have..."

You cannot be dumb when you have a chronic illness. You have to track all sorts of medications, the timing, the changes in your diet and lifestyle (to include exercise and stress management as well as checking your feet every night) and then tweak your dosages when the next evidence-based practices are published. This means multiple visits to your provider and pharmacy and maybe visits to the emergency department when you take too much or too little of a medication. Think about all the time spent on managing this illness...

A multitude of factors comes into play here---psychological costs as well as very real physical costs. My only hope, as an adult nurse practitioner and clinical nurse specialist in adult health, is that these patients make INFORMED decisions---that is, they understand the full ramifications of the radical steps they are about to make and understand they may not be able to change their minds once they start down that path.

If they are honestly able to make this decision (and not just overwhelmed with the sheer agony of it all), then we as fellow humans have an obligation to support them in their decision and to allow them to die with dignity and grace.