Tuesday, July 2, 2019

This is f'd up in too many ways to count


This is f'd up in too many ways to count, but we can boil it down to:

Physician culture is perverted by power and privilege.
Nursing culture is perverted by powerlessness and passivity.

Also, too: the chase - Nursology and Nursing own the word "care" and its related "caring." 

This issue is not up for discussion.

Back story...

I got an email from my nursing professional organization, the Hospice and Palliative NURSES Association - HPNA. It was a joint digital celebration between them and the American Academy of Hospice and Palliative MEDICINE - AAHPM.

They're all excited because they've apparently devoted substantial talk and energy to a bold new plan, well, I'll let them tell it...   

tl:dr The hashtag #hpm for 'hospice and palliative medicine' was felt exclusive to non-physicians, so a bunch of docs came up with the idea of stealing the word 'care' from nursing for a new improved hashtag #hpac for 'hospice and palliative care.'

"A diverse group of AAHPM and HPNA Twitter leaders met earlier this year to discuss the 2020 Annual Assembly hashtag. 

The leaders concluded that a change in the hashtag was necessary - #hapc was more representative of the growing and evolving field. 

Participants in the discussion were 

Amy Davis MD
Ashley Deringer MD
Kyle Edmonds MD 
Allison Jordan MD 
Christian Sinclair MD 
Holly Yang MD 
Allison Lundberg not a doc, marcom
Laura Davis not a doc, mktgconsult

Harry Crytzer not a nurse, marcom
Len Mafrica not a nurse, assoc exec

A "diverse group?" 

No, there were eight reps from the physician's org, and two from the nursing.

Six of the eight from the physician's group are physicians. One's a marcom staffer, the other's a marketing consultant.

Both of the reps from the nursing org were men (nursing is 90%+ women), and neither of them are nurses.One does marcom, the other runs the biz side of the org.


First, to the docs: 

What is wrong with you? Is this what you learned and practiced through pre-med, med school, residency, and since - when you want something, just take it. 

You get no credit for disguising your attempted theft with a bogus "diverse group." 

Your actions are even more shameless than when I first read about the silly hashtag nonsense and assumed you docs just rolled over the relatively numerically matched nurses in your usual ways - brute force, slowly whittling away, whining how "everybody cares, I care, we all care," and/or bribing them with food.

But holy crap - you didn't even let any actual nurses into the room! Just two flunky dudes. Was the HPNA accountant unavailable?

It stops here and now. If that bothers you, tough. 

This is about patients and families, not you. For once.

The only way to begin addressing the gross imbalance of power between medicine and nursing (and every other freaking clinical discipline on the team you like talking about) is for doctors to give it up and/or for nurses and allies to take it.

Don't worry, you'll be fine. Doctors will always be fine.

Here's a quick lesson in language, clinical disciplines, why our industry is such a mess, and what you need to do about it.

Medicine uses science to explore and identify illness in the organs or systems of someone's body, which is seen as a problem to be dealt with through various ways, mostly involving some form of burning, cutting, or poisoning.

Doctors diagnose and treat. Science never stops, and neither does the ability to identify illness and develop treatments. Battle metaphors abound, and people like winning. In this context, you personify the intersection of science and skill at its best. Success beats failure. Nice work, but remember it's still baseball - the season is long, and Ted Williams didn't get a hit roughly six times out of ten in his best season, and he was the greatest hitter who ever lived.

You play an important role, physician friends, but it's only one of the many roles and contributions in our system that benefit patients and families. Somehow lots of people, including you all, decided doctors were pretty much the only folks who mattered, or at least who mattered much more than anyone else.

If you don't think you're the most important player, think again and harder. If you still say you're an outlier physician in a culture perverted by power and privilege, why'd you do this? How do you explain a doc/nursing discussion stacked 8/2 and with no actual freaking nurses?

If you now say, "Damn, you're right. This is f'd up. That hashtag is gone." I say, excellent. Be an outlier, then change the culture.

Part of being an outlier physician in its perverted culture also means you have to stop talking and give up your seat to someone who hasn't been to the table. You invite that person to take your seat, and you stand by them not over them. That person should probably be a nurse, but they could also be a pharmacist, chaplain, social worker, volunteer, formal caregiver, informal caregiver, family member - you get the idea.

Being an outlier physician in a perverted physician culture means you do this again and again, you call out your physician colleagues when you see them flaunting their privilege and abusing their power no matter who they are in your pecking order, especially when they're higher, and you hold the door open and keep it open for all of those who haven't been able to get in.

As for "everybody cares, I care, we all care." Of course you do, it's a human capability. Your human caring is evident in your choice to use science in ways that benefit patients and families.

But you don't get to steal the word "care," dilute its meaning by including everybody on the clinical team within its definition, you no longer get to do all of the talking, or make every decision.

Care is the philosophical foundation of knowledge (nursology) and the science basis of practice (nursing). 

Care is why and how nursing exists. Caring is what nurses do. 

Medicine is science for diagnosis and treatment.
Nursing is political action and intelligent care.

I'll stop here for now, except to say that I'm even more troubled by my nursing colleagues who either don't see the problem, go along with it because, or worst of all think they somehow benefit by it.

Also too: Maybe more important than a hashtag - Previous Post