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November 2005 - Comfort Zones

As I sit in my study pondering this column, the sun is streaming in the window and there is a gentle breeze blowing in off the river providing relief from the heat. This certainly is a comfort zone. The fact that the muses have deserted me and I don't yet know the direction these musings will take is not enough to spoil the tranquillity.

The same cannot be said as I sit at my desk at work with the sun bathing my back and with the pen poised over yet another chapter of our manual - the last one, I hasten to add. Yes, it will likely be hot off the press on December 31st!! Why the difference I wonder? I enjoy my work. I enjoy the challenges that get thrown at me. I enjoy meeting these challenges. I eagerly await the implementation of all we have learnt along the way. Aye, there be the rub.

As we have journeyed down the Accreditation Road, we in the lab have learned a great deal about just about every aspect of what we do - from infection control, to the appropriateness of test requests, from performing the tests to teaching the junior docs how to interpret them. There has not been a single aspect of what we do that hasn't benefited from our scrutiny. This aspect of the process has been very rewarding. Why then do I feel less than inspired as I continue working on the manual?

I have a sneaky feeling that writing the manual is the easy part. The real challenge lies in implementing the changes we have highlighted along the journey. We have all be doing so many things almost by rote eg 5 puffs of Ventolin to test for reversibility while the latest guidelines indicate 4 puffs is the way to go. Instead of simply giving Ventolin we have to retrain ourselves to give only 4. This means thinking about what we are doing instead of doing it by rote - which is probably good!

Why is it so hard to change? It is a case of habit and being in a comfort zone where the art of thinking is diminished. How many labs have the philosophy imposed on them that the volume of tests done in a day is the primary outcome? How often do we avoid phoning a GP or consultant team when an inappropriate test request comes in? It is easier to simply do it. I believe, however, we have a responsibility to ensure that the tests we do are appropriate to the clinical situation and to the question being asked. For instance what do we do with a request that explicitly states the test is needed to determine safety to dive but which is for a histamine challenge when saline or exercise is available? It is far easier to simply do the test isn't it? But is it ethically appropriate to do so??

We all need comfort zones where challenges can be put aside for a period. Without them we could not survive. However, as Professionals, we must be prepared to get out of them to ensure that everything we do carries the hallmark of a professional service - the highest possible quality demonstrated by pride in our work. Nice as it is to say "These are the changes we need to make, lets do them next year when the manual is out of the way" we are being untrue to ourselves and doing nobody a service if we do that. Once we know something could be done better or more consistently, we are suddenly in a position that we cannot afford not to make the change.

Writing the manual is the easy part, getting out of our comfort zones to implement that manual is a whole new and far tougher ballgame.

To all those who in the same boat as us, good luck and make sure you have one helluva party organised for January!

K

November, 2005

kevin.gain@health.wa.gov.au

 

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