So this is Christmas – you should be writing

you-should-be-writing

This week I wrap up my narrative inquiry course and look ahead to the very last (!!!) class in January. We began the EdD last summer with a doctoral seminar (aka: this is what you are letting yourself in for, and here’s a film about Hannah Arendt smoking on a couch). This January’s class is the second and last doctoral seminar (aka: I hope you were paying attention because this shit is about to get real). In June we have “comps” (aka: stand up there and prove you know what you’re talking about, and we’ll let you do some research for reals). Just in case you thought it was smooth sailing after that, there’s the research proposal next and then the infamous institutional ethics hurdle and then…… we are deemed ready to go off and gather data followed by a long period of writing, crying and dark nights of the soul. Next, that fledgling dissertation runs the gamut of revisions and re-revisions before a final submission. Oh, and then a defense. But yay, last class….

The narrative inquiry course has solidified my thinking about how I want to do my research. I knew that my story would be part of the work, but didn’t have a good idea of whether that was possible. Now I do. I am going to write a series of stories using the data from my participants, and my narrative will be part of that. I’ve also become increasingly interested in poetry. I am thinking I might use it as several placeholders or introductions to sections in the writing.

The research is on “coming out”, I have been reflecting on and reshaping some of my memories – in part to prepare and practice. Here is a gift you didn’t know you wanted – a glimpse into negotiating LGB disclosure with patients having radiation therapy treatments for cancer.

Happy Christmas – see you next year!

 He is one of them and all of them, my next patient

The bluff King of Orangeville, or Orillia, or far away Bobcaygeon

Doesn’t like the traffic, supports the Jays (don’t we all) and this disease

This indignity has caught him, like a poleax, right between the eyes

He’s warming up on day 3, unlike my hands – but you know what they say

We cover the weather (seasonal), the traffic (catastrophic) and his daughter’s wedding

He needs a suit, the wife is asking if he’ll be well enough, will he, will he?

How about that diarrhea, that pain, will he last, will he last, what do I think?

I demur, I support, I encourage. I pat his hand as we leave the room

Not long, keep still, we can see you on the cameras, wave if you need us.

Then we’re back, he smiles – my girls, my girls, you take good care of me.

How lucky your husbands are, to have such kind and clever girls.

I pull up his pants; lift him as he grips me tight, catching his breath

He looks at my bare hand, smiles. I should introduce you to my son.

By the time the words come, he has left the room. Same time tomorrow.

I move the machine back around. Seen and not seen, there and not there.

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Targets, metrics and outcomes: Bah humbug!

UBC snow

As Christmas looms, I have some time to sit and reflect over my festive sherry (while I ignore the paper that’s due January 4th). I realise that as I grow older and grumpier* I get annoyed about things at work that would have previously passed unremarked and/or ranted about. One example is the culture of measurement that stalks our health care system. I confess I raised my voice slightly last week as we discussed whether a 10 point scale was “enough” to gauge satisfaction. My “why don’t we just ask them” did not go down well. Over the last decade or so, we’ve shifted how we work. It seems increasingly that everything is reduced to an outcome, a metric or a target. I am reminded of that famous quote about the dangers of overly “measuring stuff” by William Bruce Cameron:

“It would be nice if all of the data which sociologists require could be enumerated because then we could run them through IBM machines and draw charts as the economists do. However, not everything that can be counted counts, and not everything that counts can be counted”

We’re living in a political environment that increasingly privileges economic competition, and governments are overtly or covertly abandoning the post-WW2 commitments to the welfare state. This “neo-liberalist**” (doctoral word alert!) environment is the sea we swim in but approaching the work we do with the language and values of economic output and quantification is often at odds with our health care professional practice. We know that a person isn’t reducible to a set of numbers – hence the push back with “patient centred care” “patient engagement” and the alarmed attention being paid to the (arguable) lack of empathy in medicine. At a recent patient engagement meeting it was suggested that all health care professionals should listen to patients’ stories, whenever and wherever they chose to tell them. This was immediately followed by a “quality” meeting (a seriously abused word in modern healthcare) – where all the outcomes were either times (less being better) or costs (ditto). Time to listen to patients didn’t make the cut. There is a serious disconnect between meeting 1 and meeting 2, unless Santa brings everyone a real-life Harry Potter time turner and we can increase our working days by magic.

As professionals we are taught to put the patient first, to exercise autonomy and judgement. In a very eye-opening article, the sociologist Julia Evetts examines the conflict between this idea of occupational professionalism and our organisation’s definitions of professionalism (which include standardising work, quality measures, targets and competition…) Evetts calls this “commercialised professionalism” and suggests that our places of work have co-opted the term. So instead of meaning “patients first”, professionalism has become defined and assessed by organisations run like “quasi markets”. The consequences of these organisational techniques on how work is viewed and prioritised “leads to subordinating or neglecting other, less measurable tasks ….time which might arguably be devoted to clients and professional tasks (p.260)” Hmmm, sounds familiar!

So – my grumpiness is vindicated! Social services like health care are increasingly frayed as governments move away from their commitment to the welfare state. The devolving of responsibilities to organisations means economic efficiency so we’re counting a lot of stuff – with our dashboards, performance walls, standard work and quality indicators. Our measurement culture is spinning out of control. But we’re also realising we’re starting to slide on the things that can’t be “enumerated” like a few minutes asking a patient about their daughter’s wedding or some time to read the social history of the new patient coming at 10 o’clock. Basically having the time to treat people like individuals – that’s what we should be asking for Christmas! It’s on my list after a large bottle of gin and the new Stephen King.

time turner

*This is an actual thing…I am now climbing back up from the sad trough of middle aged misery to a new dawn of elderly contentment, apparently

**Political governance emphasising economic efficiency, competition and minimal government interference (think Thatcherism, Regeanonomics)