Ask

I recall that as a child I was always fascinated by Kinder Surprise products.  The excitement of having milk chocolate and building my own toy!  I would put the parts together, and then pull them apart to study the design behind it.  Functioning toys despite the limited space and parts! The creative and engineering design behind these creations is amazing.  Even as an adult, I am still curious about what companies and people go through to present a performance, a product or a service.

I come to learn that many Respiratory Therapists have a similar interest in understanding processes.  Perhaps that’s what makes us skilled troubleshooters, innovators, and effective team players in interprofessional settings.

One way to nurture this strength is to ask questions.  As children we were more curious and comfortable asking questions.  We need to revive that sense of curiosity to promote growth.

Here are my 5 personal views and advice on asking questions.

Create a supportive space for learning
I remember on my first day of clinical rotations at my base-site hospital, our Practice Lead said: “You know the saying that there is no such a thing as a stupid question?… Well, that’s wrong”.  I looked around the room and saw that the same expression of shock and surprise on the face of my fellow classmates.  I hope you have a supportive culture at work or school which encourages a safe space for growth and learning.  Allow your students and new hires to ask their “stupid” questions before they resort to “trial and error” on real patients.

 

Asking questions is a not a vulnerability but an indication of caring.

Whether you are a student or experienced RT, put egos and feelings aside and ask questions.  Asking questions is not a sign of weakness but demonstrates a willingness to learn.  There is danger in the mentality of “fake it until you make it”.  Confidence comes with competency.  We should ask questions to learn and to better master the knowledge or skillset.  Learn, incorporate new learning in practice, evaluate with feedback, modify and repeat.

 

Questioning a routine practice is a growth opportunity and not a threat.

When questioned about a routine practice and the answer you come up with is “that’s the way we have always done it”, know that you either need to review the support for that guideline/process or you need to re-evaluate how it is done.

I have had staff RTs express that they used to follow the advice of experienced RTs and that “younger” RTs need to question everything before they do something.  Please don’t view this as a criticism, threat or laziness.  This is a learning framework for younger generations who have a lot more available resources and opportunities to be involved in decision making.

 

Timing of questions

Asking questions, just like any other form of communication, can be impacted by the timing, tone, intent, importance, and perception.  If you are watching your preceptor in the middle of a complicated code and you notice a unique LMA insertion technique, the question about the technique probably can wait until the patient is more stable and/or during the debrief.  If you are asked to put a BIPAP on an unconscious patient and you have valid reasons to be worried about airway protection, then your questions require more urgency.
As always, be kind to others and ask questions to learn something and not to show off your own knowledge or to make a statement.

 

Explore

Talk to people outside of your team, unit, hospital, and even profession.  You will be surprised about the different perspectives on a subject matter.  This is one of the reasons why I enjoy attending conferences that are intended for RTs and those that for various Healthcare professional audiences.

 

“Science is fun. Science is curiosity. We all have a natural curiosity. Science is a process of investigating. It’s posing questions and coming up with a method. It’s delving in.”
-Sally Ride (American astronaut, physicist, and engineer).

These are my personal opinions and views.  Now let me ask you!  What are your thoughts? How have you created a safe learning environment for your students, new hires and experienced staff?  What advice do you have to share with others about asking questions? Do you have a story to share about how an inquiry helped with patient care?  Leave a comment and let me know!

 

Frank

For my latest blog post, I have the privilege and pleasure to share my conversation with Mr. Frank Fiorenza!
His current and past positions include, but are not limited to Clinician, Instructor, product innovator, CEO, and President!

View this video for our conversation:

Recognizing Exemplary Efforts

It is nice to be recognized but I didn’t realize it would be as rewarding to congratulate someone or to write someone a letter of appreciation/recognition!

As the chair of Diagnostic Imaging-Cardiorespiratory Services at work, I have the pleasure of recognizing members for their contributions.

Have you recently taken a step back and looked at your team? Take the time to know your team, and thank those who have made a great contribution.

Dr. Google

As healthcare professionals we have a duty to guide patients in making better decisions based on more current, accurate and proven knowledge.
First we need to be up to date with the latest guidelines and knowledge in our field.
Second, we need to create an open and comfortable space for your patients so they can be open about their thoughts and their choices.
Third, be aware of the latest trends and claims so you can educate your patients on false claims.

Networking

Tired but still showed up.
Didn’t know many people but still made the effort.
Growth and networking is not easy. Requires genuine attempt to listen to others.
But is exciting and rewarding.
Except no outcome but to learn and you get the most out of the interactions.
Make an effort. Meet people in other fields.

Less coffee?? You must be nuts!

 

Photo by Christian Joudrey

As I sit down with patients and discuss smoking cessation, I actively try to stay open and to hold back any judgment. I hope for an honest discussion on their part as well. I share with my patients that everyone’s journey is different and there is validity in their struggle. Smoking has a physical, social and psychological aspect to it.
I am not a smoker and have never been addicted to nicotine. Could I truly be empathetic to a smoker? Sure! I believe we all can be more empathetic without going through the same experience by listening to people.
Coffee is my addiction.
I have been drinking coffee since my first year of undergrad. It began as a necessity to allow me to read through pages of Kinesiology and Psychology notes at York University. Drinking coffee continued even post-graduation. Again, it became my crutch while studying respiratory therapy at school, during my clinical rotations and while working as a staff RT at an acute care hospital. Even when I stopped working in the acute care setting, every day I drank a total of two medium Tim Horton’s cups of coffee.
As a self-awareness and reflective process, I decided to limit my caffeine.
For the past three weeks, my caffeine intake has been limited to decaffeinated coffee. Even within the first three days, I experienced some expected changes. I felt more tired in the afternoons. My heart rate was lower and didn’t have the sensation of beating at the “top” of my chest. My ongoing general and social anxiety has reduced to almost non-existent, and I urinate less frequently.
I have also experienced two elements that I did not predict or expect. First, I expected to have some irritability or withdrawals but experienced none. This may be due to my daily consumption of decaffeinated coffee as it contains a small amount of caffeine.
Second and unanticipated to me, I began to have more dreams! In the past, I would wake up once or maybe twice a week knowing that I had dreamt. Now I wake up every morning, knowing that I have! It is my guesstimate that with a medium size coffee in the morning and one in the afternoon, caffeine’s six-hour half-life never had a chance to clear my system in time to allow me a restful sleep.
Literature and studies go back and forth on the benefits of coffee, and this post will not attempt to cover that information. The goal of this post is not to change your drinking habits (unless you experience general anxiety associated with an increase in heart rate and have a pattern of low quality sleep).
What did I learn from this “experiment”? In this self-awareness exercise, I had the assumption that greatly reducing my caffeine after 15 years would be very difficult. Also, that it would lead to severe withdrawals over the first few days. Luckily that was not the case.
I did not decide to suddenly stop drinking coffee and instead, settled for decaf because I really enjoy the smell and taste of coffee! Sometimes it is hard to change the social, lifestyle and behavioural patterns and routines.
Did this experience lead to a groundbreaking insight and further deepen my empathy with my patients who smoke? The truthful answer is not really. I felt that I already had a supportive mindset toward my patients. While this exercise did not necessarily make me a better clinician, I do enjoy the personal benefits of limited caffeine consumption. I still occasionally drink regular coffee but almost all my coffee and tea is decaffeinated. The reduced heart rate and associated lower anxiety symptoms and increased dreams are great benefits.
I encourage you to identify and challenge some of your held beliefs and routines. If you are on the right path, then it will re-confirm your choices. If not, you can explore new possibilities.
Through self-development, hurdles, struggles, and victories you can be more aware of the processes involved in change. Sometimes awareness itself can make one more empathetic.

RTweek18

It is becoming an annual tradition for me in the RT Week to write a quick note to express my gratitude to those who have made a difference in my career and professional life over the past year.

Thank you to (in no particular order):

Nancy Garvey and Dilshad Moosa who continue to support my growth with RTSO. Thank you RTSO for allowing me to be part of the family.
Dr. Mika Nonoyama, who gave me a unique opportunity to teach on a topic that I am passionate about.
The CSRT team who continue to motivate and support me in my drive to help the RT community. One of my first supporters and I will be forever grateful!
Eric Cheng, one of the founders RTWB, for introducing me to Annette who shared her amazing perspective on working in Kenya.
Tom Piraino, Tony Kajnar, Carolyn Greer, Shawna MacDonald, and Annette Lievaart for taking the time to answer my questions for my recent blog posts.
Bernie Ho, Tony Kajnar and Dr. Shukla for always being willing to answer my clinical questions.
Christina Sperling, Kathleen Olden-Powell, Kathleen Frame and Carolyn McCoy for being open to hear my thoughts and to guide me with their wisdom.
Novus Medial Inc team for always being open to my technical questions. Also, awesome T-shirts at the Vancouver CSRT2018 conference!
John Meloche and MeloTel for giving me the online space to operate and run my website! One of my first supporters!
Christiane Menard, Noel Pendergast, Rachel Allen, Shawna MacDonald, Mieke Fraser and Katherine Tran for their ongoing support of my online presence.
And of course, the ongoing support of my girlfriend and family.

ASBESTOS

Canadian government is taking steps to limit the use of Asbestos. While this is not a complete ban, and some exceptions exists, it is still a step toward the right direction.

Occasionally at the PFT lab we have individuals who have been exposed to Asbestos, and we perform the testing to rule out interstitial lung disease.

CBC has a piece on this which you can check out at:https://www.cbc.ca/news/politics/trudeau-asbestos-cancer-regulations-1.4867684

RA

At the Pulmonary Function Testing lab we assess and monitor patients who have Rheumatoid Arthritis (RA).
“Interstitial lung disease may be a manifestation of RA or may be a complication of RA therapies, such as methotrexate and leflunomide.” -Daniel Aletaha, MD and Josef S. Smolen, MD.
If you want to learn more about RA, check out:
Diagnosis and Management of Rheumatoid Arthritis-A Review. Oct 2 2018
https://jamanetwork.com/journals/jama/fullarticle/2705192?guestAccessKey=4054e5dc-45b4-4fd7-bec5-e6a9a4c14a87

Cannabis

Recreational marijuana use is becoming legal in Canada in just few days. With the political, legal and financial debates aside, there are health concerns that the public, users and healthcare providers need to be aware of. I have attended few talks on this topic and have read few articles that cover this issue in details. While I did not become an expert, I have noticed a common message:

Inhalation of marijuana can lead to temporary and permanent damage of respiratory system.

  • Review and share this collection of Questions and Answers by CBC: ok https://www.cbc.ca/amp/1.4856021
  • Avoid and limit your inhalation of airway irritants.
  • Please do not drive under the influence!