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Reigniting the Spirit of Pirates

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Since Talk Like a Pirate Day is upon us, I'm presenting this today.

A little over a year ago, I was invited to give my feedback on a seminar about caring for patients. It is - was, take your pick - an effort to change hospital culture from something out of House to something more... caring. It applies to anybody in any industry, really, but especially to those in healthcare, sales, education, or anywhere in the service industry. Even if you've never heard of this program, I think you can get something useful from this analysis.

What does that have to do with pirates?

You'll see.

(It should go without saying, but I'll say it anyway. These opinions are mine and mine alone. They do not represent the official opinion of my employer, the university I'm enrolled in, the people who created the seminar, or sentient fungi from Pluto. Or anybody else, for that matter. Unless you want to hunt for your own Death Star with me.)

When evaluating any training program, you have to analyze how well does the training prepare its graduates for overcoming the obstacles of the real world? Both aspects of a program are important, but too often as educators we get overwhelmed with the minutiae of how we teach, and forget why we teach.

There are a lot of good stylistic techniques in this seminar. Our expectations were broken from the very beginning, starting with the toys on the tables, the hands-on activities, and dynamic changes in the ways that we sat and addressed each other. The ritualistic nature of the "circle" created a sense of positive - but honest - truth-telling. Finally, there was a structured effort to address all styles of learning and convey the information accurately to all participants.

The program is, however, imperfect

There are elements missing from the program.

  1. The step-by-step HOWTO aspect of implementing changes was often unable to be addressed due to time limitations.

  2. While materials and bibliographies were made available for later review, that was a marked difference from the multiple learning style approach of earlier topics.

  3. There was a large focus on personal improvement, but a lack of looking at structural effects. To avoid the flavor-of-the-month whitewash of management fads, we must ensure that it is a structural change at both the top and bottom of the structure.

Oh - and there was little room for pirates.

Let me explain.

We had to choose a name by consensus. A name that labeled and defined our whole group and the experience we had over those three days. We were split about 2 to 1: the Caring Kindlers versus the Spirit Pirates, Yaaar! While these names seem wildly different, they are complementary and required needs.

During the seminar, we saw a brief clip from the movie Patch Adams. In that sequence, Patch, still a med student, first conned his way into a beef convention, and then snuck into a hospital. Patch - unlike the official doctors and residents - asked a patient's name instead of simply discussing the patient as an affliction. And that's where he was acting like a pirate.

I don't mean a historical pirate, or the hyper violent pirates of modern seas. I mean Veggie Tales pirates. I mean Pie-Rats. I mean, look at Patch Adams.

Does he look like he has more in common with House or an animated cucumber?

Patch Adams broke both formal rules and social expectations in order to do the right thing. And that is the whole point. As we emphasize - in our practice and in our teaching - that we are caring for patients, it is vital that we also remember that the rules are there in service of that goal. And if the rules no longer serve that goal - then we must foster a willingness to hijack the bureaucracy when necessary in order to meet that goal.

This is where the program could flounder. This is a complete culture change in medicine across the United States. Our medical culture is changing from one that centers around rude, hyper efficient, but knowledgeable so-called "professionals" to those who are competent, caring, and patient – and a focus on the patient. But change creates conflict. We can neither treat just one part of a body or just one part of a sick medical culture. The graduates from this seminar - the graduates from your institutions - must not only be able to be fluffy caring people - but also be pirates willing to take risks and break social norms in the service of doing the right thing.

Management - typically risk-avoidant - must become tolerant of people working towards the goal (patient care) instead of working to perpetuate the bureaucracy. We cannot afford to simply let this be a top-down culture anymore. Ideas and improvements come from everyone, everywhere. It doesn't matter what their title is, or how many years in service they have. We have to learn to hear truths from all people with the firm goal of patient care in sight. This is a horribly countercultural idea. The aide or housekeeper might notice something the nurse or doctor does not. In my own department, an aide noticed a safety risk because she happened to be shorter than the people who made the original decision. Without honestly listening to her - and acting quickly to resolve the issue - her input might have been lost forever. We must remember: Good ideas come from everywhere.

The things you and this seminar must impart are not simple scripts to mimic. It is a process of truly understanding and analyzing. We speak of “Treat people the way they want to be treated", but forget how hard it is to do when that person wants something we do not.

It is infeasible to have a massive rollout of these seminars, which again reinforces the need for a caring pirate mentality. As it is, it will be extremely difficult for our original flames to buck the inertia of the system. They are working against a huge amount of peer pressure and inertia. We must give them the tools to withstand that pressure, and then support them as much and as quickly as possible.

Think of it this way. Relationship Based Care means that we must always remember that there is no "that's just the way things are". There is the way you are doing things right now. We must teach ourselves, our students, and our colleagues that each of us holds the choice. Do we focus on social norms and rules - or do we focus on our patients?

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