Uncategorized – in thriver words

Communication

If you understand the importance of communication and do your best to communicate well, it can be frustrating when co-workers don’t. But the truth is, you can only control your side of the equation.

In this world of abbreviations and emojis, I’ve noticed it’s much easier to say nothing than ever before. This may work fine in some situations. In fact, it can make you appear to be more of a team player than you actually are.

But saying nothing can also be deadly. If you are a pilot, communication with the tower or other aircraft can determine whether or not you make a safe landing. If you are a doctor, clear communication of instructions to your staff and patients can make the difference between complications or smooth recovery. And closing the communication loop builds trust with clients, patients, and colleagues.

Seems like internal communication would be an area of emphasis in policy and training in all industries. And yet, communication is often the most broken system in an organization.

Two men seated. One is masked and gesturing. Blonde female with ponytail and mask leaning toward second man with gloved hands out palms up.

In healthcare systems, this is unimaginable. And yet it is problem repeated day in and day out.

Developing good communication systems is not as complicated as setting criteria for transplant eligibility, developing infection control procedures, or reducing the number of opioid prescriptions. But it can make a huge difference in morbidity and mortality.

So why do health systems focus on external communication and image branding instead of the kind of internal communication that makes patients feel seen and cared for? This would build the brand in a more significant way and get better health outcomes. Better health outcomes will further a positive view of the brand.

This is a rhetorical question. I don’t know why it’s not a priority. I’ve served in multiple advisory positions in a hospital as well as a vendor that worked with hospital marketing departments. Overall communication procedures are something that just never get much traction and, in one instance, direct push back.

In that instance, I feel like there was a desire to avoid transparency. But that’s not always the case. Often, it’s just a lack of thinking the process all the way through and spending the time to write policies.

And there’s currently a weird belief that presenting facts is somehow being confrontational. A lot of people avoid anything that resembles, or that they can imagine might be, confrontation.

Other than quality managers, it’s possible that health system leadership simply doesn’t recognize the importance of communication. Their training may include bedside manner, but most of the focus is scientific.

A pilot study of the effects of more complete communication on medical outcomes in a specific group of patients and/or patients and families could be instructive. If it shows improved medical outcomes in a group that receives more communication, it could help the issue gain legitimacy within the industry.

And all of us can let our health providers know that communication is important to us. Highlight it on every quality survey you receive. Mention it during every doctor visit. Put it in the comments in your patient portal. And express appreciation when the system gets it right.

We can’t control what the system does, but all of us together are a lot of voices. If we keep communicating, at some point, they will hear us.

Add Foods Slooooowly

If you upset your system be sure to add foods slooooowly once you’re feeling better. The mistake I made eating smoked brisket in August, is still affecting me. No, it’s not my imagination. No, it’s not fun. It affects my everyday life, my work life, and my social life.

That’s what ingesting gluten, or triggering an IBS, or MCAS flare can do. It can disrupt everything! The results can make familiar situations so uncomfortable you have to change your routine. And, in the case of me yesterday, they can mean you have to lie down after a meal because if you don’t you feel dizzy or too tired to move.

For the next couple of days, I will eat primarily apples, eggs, potatoes, sweet potatoes, and limited amounts of chicken or turkey. These are things my system tolerates well even during a flare. As time goes on, I’ll add squash and English peas.

The second mistake I made is, once I felt normal for a day, I rushed back to my regular diet and even tempted fate with restaurant food and a few Cheetos. The restaurant is local and uses fresh food, but still may have stretched the limits. Cheetos. I knew better.

Don’t worry, I won’t do that again any time soon. But I haven’t had a flare that lasted this long or put me in this much pain in a decade so I no longer remembered the effects viscerally.

If you try an elimination diet, make note of foods that you tolerate well when you begin adding foods back. This can become your go-to diet for recovering from an accidental ingestion of foods that irritate your system.

Using well-tolerated foods as your base, slooooowly add back foods that typically give you the least issues. For instance, I don’t usually have problems with beef until my system has already been triggered to overreact. In that circumstance, beef may cause a significant detrimental reaction.

It’s best if I don’t rush to eat beef once I feel better. If I do, I risk starting the healing process over to some degree. Not only will that bring physical discomfort, it will bring multiple levels of frustration.

Would I love to eat some chocolate today? Yes, it sounds yummy. But chocolate is an irritant I cannot tolerate in large quantities or often. Instead, I’ve gone back to the dietary basics I started with a month ago.

This is a great opportunity for me to practice patience. I will today and tomorrow, but as I begin to feel better, the temptation to eat something that tastes better will reappear. That’s when my resolve will be tested.

To entice myself to continue to eat safe foods, I can add small bites of relatively safe foods to jazz things up as I continue with the basics. Adding a little honey to my toast, a bit of goat cheese to my eggs, a bowl of rice with a dab of butter and raspberry jam to my breakfast, can introduce enough taste variety to reduce the temptation to eat chocolate or Cheetos.

There’s no set time frame for getting back to a more varied menu after a flare but learning from my mistake and not going back to a full diet immediately after you feel better for a day can prevent a lot of pain. After a flare, it’s better to add back slooooowly.

Good Enough

When is good enough good enough? We often hear the cliche, don’t let perfect be the enemy of good. There’s wisdom in that. None of us will ever reach perfection. Allowing pursuit of perfection to stop us from progress is counterproductive.

But is good enough always sufficient?

Obviously, that’s going to depend on your definition of good enough. In some areas, good enough will depend on your overall goals. But when it comes to adhering to a specific diet plan, your health may dictate whether good enough is sufficient or perfect should be the goal.

I know it may seem a bit lofty to explore dietary adherence when we’re spending a lot of time just trying to make sure the eggs, lettuce, sprouts, avocadoes, and blueberries won’t kill us. But let’s assume for this moment that we have resources for locally grown food that is safe.

If you have celiac disease, research indicates strict adherence is necessary to eliminate damage. In that instance, it is not sufficient to avoid cake and donuts most of the time. That isn’t good enough for optimum health.

If you have an anaphylactic response to peanuts or shrimp or any other food (chemical or medication), strict avoidance is necessary to make sure you can continue to breathe. It may not even be good enough to avoid eating shrimp (or whatever you’re allergic to). You may have to avoid areas in which it’s cooked or surfaces it has touched.

When you are following a heart-healthy diet, you may be able to have the occasional problematic food. Discuss with your doctor what level of adherence is good enough for your situation.

For those with MCAS, it can be a bit of a mixed bag. You may be able to tolerate small amounts of certain histamine liberators while others may send you into an intolerable flare. Good enough may be good enough for everything but specific trigger foods, medicines, or personal care products.

Diabetes can also be tricky. You need carbohydrates in the form of fruits and vegetables, but too many carbs can elevate your blood sugar level. And what about the occasional piece of cake at a party? You may be able to tolerate a small piece of cake without a significant spike in blood sugar.

Whether or not you use insulin or a prediabetes management medication will also have an effect. With diabetes, it is important to have a plan and to adhere to it. But your doctor and nutritionist can help you determine if and when good enough is enough to manage your disease. This may change over time.

All of us want to breeze through a day eating when we’re hungry, drinking when we’re thirsty and choosing whatever tastes good in the moment. For some of us, that’s not a luxury that’s available if we want to keep breathing, avoid running to the bathroom, eliminate abdominal pain or cramps, and avoid rashes, kidney disease, heart disease, muscle weakness, peripheral neuropathy, or diabetic coma. For some of us, good enough may not be enough.

It would be great if this weren’t true. But fighting reality can mean prolonging symptoms, development of additional symptoms or complications, shortened life expectancy, and even sudden death from an allergy.

The best tool you have is to understand the parameters in which you can operate and have optimal health. That is the only way to know if good enough is healthy enough.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6647104/

Setting the Stage

A question I asked myself daily when my children were growing up is what am I setting the stage for? That may seem like a less than emotional approach to parenting. It is. But based on my family of origin, thoughtfulness was always better than my initial emotional instinct.

I didn’t sit and study an issue for hours. I just quickly played out the lesson I was teaching to the extreme. Quick example: When my 2-year-old took a Happy Meal toy from another 2-year-old, I suggested he apologize. As I watched his fury and reluctance, I knew he wasn’t sorry. If I pursued pressuring him at that moment, I was teaching him to be disingenuous aka lie.

I’m not discounting that he needed to learn to be polite and kind and function well in society. But that required a more thoughtful and lengthy discussion repeated over time.

If I teach a child to lie at a time in their development that I’m also attempting to teach him to tell the truth about throwing my ring in the trash, feeding the dog chocolate, or breaking his grandmother’s vase, can he differentiate or will he determine he should just ignore me because I make no sense?

You could argue I’m only teaching him to be emotionally disingenuous. Okay, well how will that play out in his adult relationships, especially intimate ones? Will he adopt polite appeasement over the truth? Maybe or maybe not, but the stage has certainly been set for it.

Each decision we make as a parent sets the stage for something. It is worth considering for what. This is also true as business owners or corporate citizens. And it is true of healthcare.

Young man with dark curly hair sitting at white table next to black chair pulling his hair with both hands.

The US healthcare system set the stage for people to seek answers elsewhere. Unfortunately, this has led to doubting science along with healthcare professionals. But dismissing people who run to Dr. Google first is to miss the point of the patient experience.

The aftermath of 2020 led many institutions away from the emphasis they were putting on patient-centered care. This is unfortunate. And even with a movement toward listening to the patient, the system in general needed hearing aids.

Many patients with GI problems suffer through years of no diagnosis, misdiagnosis, ineffective medication, being treated as though they’re crazy. And then years of paying off the invoices generated in getting them no relief. Why wouldn’t they mistrust a system that is not serving them?

A lot of those patients want to be treated by someone who cares to get to the root of the problem even if it means trying something besides medication. I’ve written before about the doctor I had coffee with who said he would never put someone on a gluten-free diet unless they had a positive biopsy. I understand the importance of best practices, but a gluten-free diet does no harm and might give him helpful information toward diagnosis.

Can we get past rigidity of thinking when we know our diagnostic tools are limited? Opting for surgery in an unclear diagnostic situation is considered acceptable. Is that because surgery gins more money through the system?

Why is a non-harmful approach rejected when a potentially dangerous procedure is considered acceptable within the standard of care? The answer may not be simple. Sometimes, it’s just that the physician you rely on is not well-informed on new research or developments. Sometimes, it’s fear of being sued. Often, it’s that huge systems are not nimble and move slowly.

But sometimes a complex answer gets simplified to – we’re following science – and presented to the patient. Great job! Now you’ve set the stage for that patient to distrust science.

And such incidents may come on top of setting the stage for patients to distrust the way medicine is practiced because they haven’t been provided a diagnosis or effective treatment. Further, they may have been treated as if they’re crazy (especially if they’re female).

Posters on Reddit and BlueSky last week asked people to post the most ridiculous thing a doctor had ever said to them with a straight face. These posts received hundreds of replies and thousands of replies and reposts.

We’re reaping the results of distrust in science in things like measles outbreaks. That is bad and dangerous. But until the healthcare system chooses some self-reflection, it will continue to set the stage for distrust.

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”