There are labels, and then there are labels. Good, bad, ugly. Then there’s the one that will absolutely kill your resident, or intern, or medical student. Or colleague.
Let’s be careful when we use that one. Nothing burns like that, nothing sucks like that, nothing taints like that. It will follow that person into the next rotation, then the next, and the next, and over, and over again, just like the commercial. For hair colouring. Or whatever.
It’s hard to wash out, that one. “Unsafe.” Has it happened to you? Have you ever overlooked something? Had a, “geriatric moment”, a hiccup in your mental processes? Just plain dropped the ball? Well, here follows a list. None of these are that uncommon. None rare. All of these are, “errors.” Let’s pull the veneer off, folks. I’ve been in practice 29 years. Here are some goofs. That we may just have done. Possibly. Well, someone else has done.
Do you think some, “colleague,” ever said, behind their hand, “Unsafe…”, when…
How about the person on the ER gurney, no pulse, in EMD they say in retrospect, that you shocked?
The person with past GI bleeding that you just put on NSAIDs?
The kid with penicillin allergy you just gave cephalexin to, and didn’t mention the reaction risk?
The, “clear” chest you didn’t XR?
The urine drug screen you keep meaning to do but don’t?
The depressed person you just couldn’t, no matter how hard you tried, ask if they were suicidal? I mean, you knew them, right?
The kid you gave codeine to?
The well meaning phone call to the spouse, you know, just trying to help, that just … backfired?
Well, clearly you’re unsafe.
I mean, any idiot would have XR’d that guy.
What? Don’t you know college standards? You’re giving out that much?
How about the smaller things? Do you weigh every kid before you prescribe antibiotics? Do you clearly go over ALL substantial risks to your proposed treatment, or, on that day when you haven’t stopped for 4 hours, just aching for a sandwich, just hit the real biggies? Overwhelmed by patient volume, do you give a year of repeats for things that, really, in the perfect world, should be rechecked more often?
Do you work 14 hour days?
When’s the last time you had a vacation?
Do you take calls in the middle of the night, then go in to work the next day?
Do you wear a mask if you have a cold?
Do you purell your hands every time?
Sorry, I’m just trying to shake you up. Because that label of, “unsafe,” is subjective. Yes, the college uses it. We’ve given special powers to some of our colleagues, those that we trust to review patient care, and take care of patient complaints. They need that power. We need to have them use that power, to keep the public safe, and to make it easier for us to work.
Have you thought of that? Because of the college’s teeth, we have it easier. Every day, practice is easier, because of that watch dog.
But do we use it?
Do you use the word, “unsafe?”
Because the word is subjective, and the parameters are subjective. Where does it start, and where does a career end?
Medical educators have a special role in the system. These young people put their careers in our hands. We have a special role also, in protecting the public. Teach compassion, teach an obsessive approach to detail, and follow up. Model integrity, demand integrity.
Teach. That’s our role. Yes, sometimes someone just shouldn’t be in medicine. We’ve got to find those people, and drum them out. Yes.
But. “Unsafe.” That’s for the college. That’s for the Dean, or whatever committee. That’s for the court. Clearly define your concern, and share it clearly with your learner. Define clear parameters of independence, and when the learner must check with you. Review every chart, every line. Read it. Converse with your colleagues, and see if your concerns are overblown, or perhaps too understated.
Let’s get it right; let’s get it precise. Clearly define the problem, the event. Use facts. Share your discomfort, your worry with your learner. That may do more than anything to change behaviour. Facts, collect them: present them clearly with no labelling, hyperbole or colourful language.
Facts. Report these. Judgements are for those higher up the ladder.
“Unsafe.” We’re medical educators. Let’s be precise.
“Unsafe.” Let’s stop using it.