Radiation therapists, workplace and culture

IMG_1754.jpg

I’m trying to write about radiation therapists. Not the tasks that we do, that’s pretty easy, although most people don’t have much of a clue. I’m trying to explain the relationships we have with each other and what our day-to-day working environment is like. I suspect both are unique. We’re not like our diagnostic radiographer colleagues who can work by themselves. We don’t do that. Our workplace culture is based on tight-knit teams—not only the doctor-physicist-therapist triad but the team that works on the treatment unit.

The closest model I can think of is an operating room. The nurses, anesthetists, surgeons have to work in a kind of dance. This dance relies on what Lorelei Lingard has called collective competence, being able to effectively work and communicate with others. Verbal interaction is key, most errors can be traced back to not talking to each other. It’s similar for radiation therapists. We have innumerable checks and balances, quality assurance steps and protocols, and many of them are verbal. But we also have to, fundamentally, have each other’s backs. It’s a dance of physical movement (moving the patient, moving the treatment couch, moving the equipment) and verbal interaction (I’m doing this now, this next, have you done that?). When we do it well, it flows seamlessly, between ourselves and the patient. When not done well it can cause friction, delays, a lack of patient care and, sometimes, errors.

There may be three of us on a treatment unit, or sometimes more. With breaks and shifts, sometimes just two at a time. If we don’t get on, talk to each other, the work gets harder. We don’t have a choice of who we work with, and we may be working with someone for months at a time. We sit close to them (the treatment consoles are small), check their work (and they check ours), lift and move patients together, and arrange our days (this patient is new, this one is finishing, we need to follow up on this, did you call about the weird noise the machine is making?) We have to trust each other, we have to know the steps.

If you work with someone like this for a few weeks, you often get to know a lot about them. What TV shows they watch, how their commute went, what they have for lunch, what their weekend plans are, their kid’s activities and their upcoming vacation plans. Between patients we chat, we get to know each other, we pass the time, we build our relationship. Our “private” and “professional” lives are not binary – they merge into each other. We need these interpersonal bonds when it gets stressful, when that patient breaks our heart a little, when we have to vent.  They can help sustain us. When we don’t get on, or when we can’t be ourselves at work, it makes what we do harder as well as less safe. The dance slows down, we stumble.

Why am I mulling this over? Because as I write my dissertation I’m remembering times when I was careful what I said at work, the religious co-worker who “didn’t approve of my lifestyle” and an older therapist who ignored my tentative coming out speech and referred to “my husband” (when he talked to me at all). I’ve had recent conversations with gay, bisexual and lesbian (GBL) therapists who have said they “keep themselves to themselves” at work, or “just don’t go there” with some people. There’s ample evidence that having to manage sexual identity at work (to monitor when it’s safe to come out) is common in healthcare, with colleagues as well as patients. GBL workers report more stress and less social support than their heterosexual peers. Covering up who they are is a reality for many, and they are less likely to talk about their partners or life outside work.

Does it matter for radiation therapists? I think it does. We’re not exempt from the same pressures that affect GBL physicians, nurses, pharmacists, other allied health care professionals and our trainees. I might argue that the way we work makes these issues more important. We need to be able to bring our full selves to work, to be able to fully join the dance.

Advertisements