matter what your job is, it’s likely you periodically encounter situations that make you
consider whether you should just look the other way or take ownership. This
might range from a customer service issue with a patient, to an interdepartmental
impasse to a human resource issue.
often we are tempted to take a pass on resolution of the problem because we already
have enough on our plate. We either ignore (or delegate) resolution of what is seen as just a nagging interruption to our already busy day.
not all challenges are created equal. As laboratorians we wag our fingers at
clinicians who constantly over-order or order inappropriately, but we say
nothing using the excuse, “He is the doctor,” or “I am just a tech.” Do we have
a responsibility to voice an opinion? I do not mean delivering a lecture, or outright refusal to perform
the test. But what about a concerted push for the development of a team looking at
utilization and developing algorithms for test ordering? Variation from of the algorithm would require some sort of justification. Pharmacists have developed drug formularies and
ordering guidelines that physicians must adhere to. You never hear, “Well, I am
just the pharmacist, I must dispense whatever the physician ordered.”
Some issues that arise are not merely policy-related or procedural, they have an ethical component as well. How
would you react to the following real-life situations?
supervisor who asks staff to “fix” QC and temperature charts before a survey in
order not to be cited.
lab manager who tweaks quality data like blood stream infection rate or
analytical error rate before the data is submitted to the organization’s Quality
A colleague who accesses the CFO’s medical record because she “heard” he was recently
diagnosed with….. (choose an illness)
MLS who modifies the rules for manual differentials or microscopic urines in
order to end his shift on time.
A colleague, Mary, who falsifies time by asking a colleague, Tom, to clock in
and out for her so she gets credited for more than her actual time worked.
-A phlebotomist who discovers she drew the wrong patient but chose not to correct the error since no one questioned the results.
are all real situations I have encountered in laboratories and the laboratorian
discovering the ethical lapse was reluctant to act. There is always the extra
wrinkle if the policy or ethics violator is a superior, but is that a valid
reason to ignore the issue?
would love to hear from readers who have you faced similar dilemmas in their workplace
and how they reacted.
2006, industry giant, Abbott Diagnostics made a major investment in medical
laboratory science by launching a campaign called Labs Are Vital. They spent
quite a bit of money and expended human resources in setting up a website and trying
to energize the medical laboratory community to help spread the message to the
wider public that labs are, well, vital.
was significant at that time is that no other vendor had made such an
investment or even, frankly, appeared to empathize with laboratory professions
who felt underappreciated, underutilized and even marginalized. Nursing had
their huge Johnson and Johnson advertisement Campaign for Nursing’s Future.
in 2001, that campaign is still going strong, offering several ads on major
cable TV stations, recruiting students to the profession, and help in the way
of scholarships and so on.
intent was always that laboratorians themselves drive the Vital campaign. I
recall a national meeting where Abbott had a booth set up with brightly colored
professional-looking posters of various laboratorians. Lab attendees at the meeting
were encouraged to have their pictures taken with the hope of being featured on
a larger than life poster with an appropriately proud and catchy phrase.
Medical laboratorians were also encouraged and given ideas on how to celebrate
and promote the laboratory not just during Medical Laboratory Professionals Week (MLPW), but all year long.
this year Abbott finally turned over Labs Are Vital to the international laboratory
community. Currently the sponsors are ASCP, IFCC, International Federation of
Biomedical Laboratory Science (IFBLS) and the World Association of Societies of
Pathology and Laboratory Medicine (WASPLM).
Abbott continues to provide financial support, but quite appropriately
the direction is intended to be set by laboratory professional organizations
and their members.
new website www.labsarevital.com is
up and running and features blogs, commentaries, articles, letters and a
schedule of upcoming events. Laboratorians have a chance to weigh in, whether
just to comment on a topical issue or to offer suggestions for a bold new
the website, browse, contribute, get educated, get new ideas, and get energized.
Yes, labs are still vital and with your participation, Labs Are Vital 2.0 has
the potential to be even more influential than it's been in the past.
I wish I
knew everything, but I don't. On second thought: it would be pretty boring to
have every fact at my finger tips and I never have to learn, to ask, research
or dig for information. In any event, has someone ever asked you a
question and you hesitated before admitting that you don't know the answer?
am the king of trivia, so I have a collection of disjointed facts in my head. I
am the kind of friend to call as your lifeline if you are stuck on "Who
wants to be a millionaire?" I am not cocky, because I honestly don't
even know how and when I stockpiled all that (largely useless) random pieces of
family knows that I am a medical laboratory scientist (not a doctor, pharmacist
or nurse) they also turn to me a lot for medical information and advice. I
happen to know a little about a lot of things, but I am certainly no substitute
for a visit to your physician.
I have long espoused
the philosophy that as medical lab scientists we have a unique body of
knowledge and are the experts on MLS. I strongly support speaking out and
provided current and credible information to physicians, nurses and patients.
But in order to provide such a service credibly, honestly and safely, we have
to make sure we are truly knowledgeable and accurate.
I was in a
medical office recently and overheard a physician explain to a medical
assistant that it doesn't matter how long urine is centrifuged for a
microscopic examination, but "Most people don't spin long enough, I like
mine spun hard for 10 minutes to make sure everything settles."
heard a diabetes educator give blatantly incorrect information to patients
about lipids and hemoglobin A1C. When I am in the presence of healthcare
professionals who do not know my background, I am amazed at not just how they
downplay and "diss" our profession, but how they mischaracterize
important aspects like specimen collection, storage, patient preparation and
interpretation of test results.
We all have
stories about the person in the laboratory who will always give an answer to a
caller, instead of referring them to an individual who is more appropriate or
knowledgeable. Are your phlebotomists and customer service reps trained to say,
"I will let you speak to a MLS about this" or "I am sorry I am
not sure, but I will find out and call you back."
There is no
shame in not knowing. We hurt our credibility and put patients at risk if we
choose to give answers because we want to appear to "know it all."
is a lot of information we can offer; we absolutely should be more aggressive
in giving advice and interpretations; we should wear the mantle of
"expert" more confidently and proudly. But part of being a true
professional who offers real value to those he serves is to know when-and not
be afraid - to say, "I don't know."
In a recent article, Dr. Diane Shannon talked very poignantly of the reason she left the practice of medicine. Shannon said she was burnt out and wanted to be another addition to the statistic that suicide is higher among female physicians than among females in the general population.
That sounds like hyperbole until you hear how much this physician described how she, and other physicians, are often constantly plagued by worry about their patients. Even while away from work, they go down mental checklists and wonder if they ordered the right tests, gave the correct dosage of medications and so on.
Shannon refers to research that indicates that physician burnout might be related to a combination of four factors:
1. Time pressure
2. Degree of control (lack of control) regarding their work
3. Pace of work or level of chaos surrounding work
4. Values alignment between physicians and administration
You will no doubt think, "Those conditions sound familiar." Not very laboratory is characterized by chaos, but the other three factors are certainly pretty typical of Everylab USA, isn't it? So we can certainly relate to all those stressors and recognize them as contributors to the burnout characteristic of our profession; especially among the older crowd.
However, this article made me think of something else. It is a theory I have long espoused. Physicians, stressed, burnt out and inundated with data, would welcome our help in making sense of the information we provide. In fact we can do much more in converting numbers, data, and text into meaningful information. We can offer up ourselves as experts to call or consult for clarification if needed.
Think of a middle aged man presenting to the ED with belly pain, hepatomegaly and is described as icteric. He denies a history of alcoholism, drug abuse and has not traveled outside the country. So the physician starts an IV, orders a hepatic profile and admits the patient.
The result comes back, and all the attending physician sees is an alphabet soup: hepatitis A, B, C; some antibodies and antigens; IgM; surface and core "stuff." It is the unusual physician who will immediately understand what all that means. Wouldn't it make a lot of sense for us to send an interpretive report? Would not the physician and patient be better served if they could immediately see what type of hepatitis the patient has and whether it is likely to be acute or chronic, for starters.
That does not constitute the practice of medicine. It is certainly within our capability and scope of practice. We'd rather roll our eyes and make snide remarks about physicians ordering the wrong tests and misinterpreting the results.
A simple act on our part -generating a legible, clear, interpretive report- would go a far way towards improving and expediting patient care. It might not be an exaggeration to say it might well contribute to saving a patient- and
possibly a physician as well.
There is a lot happening in this country these days. As a medical laboratory scientist, I have been used to change, but it seems like the past few years have been typified by huge changes to many people I know personally and professionally.
One of the questions I get asked a lot as I travel around this country and as I read my emails is , "How can I find a satisfying career in this second half of my life?" or something similar. The professional workforce is aging and as boomers approach retirement, many are burnt out. However the reality is that they might not be able to retire for financial reasons, or they feel healthy and vigorous enough that they are not yet ready to stop working. They are asking, "What else can I do now?" Boomers have become "seekers."
The stock answer to a seeker of any age (or of any background) is to say find your passion, do it for a vocation and you will feel like you are not even working. But how do you find your passion without paying a shrink or life coach? I have a simple method.
Take a piece of paper, grab a pen, sit in a quiet place and answer in writing three simple questions.
What really excites you?For some this is easy to answer, for others it takes some introspection. Think about the things you like to talk about, to watch on TV. What areas are you always following on the Internet? If you go to a bookstore (yes, those still exist) what section do you gravitate to?
What would you do for free? OK, the tendency is to say, "Nothing." But if you were independently wealthy or won the lottery, what would you choose to do to keep yourself busy, to give back, and to feed your mind? This can be something specific or a general area. Writing down these answers tens to crystallize your thoughts and let you see a pattern as you write. So just write freely without censorship.
This may or may something you are especially good at. Do family members and colleagues compliment you in a certain area or constantly volunteer you for a certain type of task that you also like to do?
What really annoys you? This one sounds odd, but if something really annoys you, you generally have some idea of how to change or ameliorate that situation. If it's a process, you might have some alternative suggestions of how you would "run" things better.
These are very simple questions, but I suggest you really think about them. Write down your thoughts and revisit the list three, four, five times. Look for patterns and trends. This technique can be used in any area of your life. For seeking laboratorians it might mean moving out of the laboratory to pursue something else; whether inside or outside of healthcare. But just as likely it might entail pursuing a path within the
laboratory you had not even considered before.
You could be the laboratory liaison to a college, hospital department or the public. Think of adding value by being the laboratory expert or "go to" person in a particular area. It might even mean creating a brand new job. You might well have to sell your boss on changing the status quo; so be prepared to do that. The good thing is I have found that in today's changing, challenging climate, managers all the way up to the C-suite are
very open to any idea that increases productivity, that increases the bottom or line or that makes them look better.
So, open your imagination. Get that piece of paper and start writing.
In healthcare we often talk about quality. In fact we dredge that word up whenever we want to shame someone into doing whatever we want. In healthcare we tend to think of quality as something that somehow improves patient outcome and is often related to some policy, rule or regulation.
We ensure quality control is in range, temperatures are checked and recorded. Blood stream infections, contamination rates and the like are tracked and trended. But these are largely internal measures which are of more importance to us than to the patients. Patients just assume we are competent, qualified (educated, certified, licensed, trained) professionals. To them that's a given. Their idea of quality is related somewhat to outcome, but their daily assessment of quality is based on how they are treated and how we make them feel during daily interactions.
Healthcare is unique in some ways, but in terms of service and quality it is very similar to industry and every other service organization.
A couple weeks ago, my car was hit and after the inconvenience of negotiating with two insurance companies (the other driver's and mine), I took my car into the shop. I picked up my car a few days later, only to find an error code as I drove out of the parking lot. When I took the car back, there was no apology just a defensive promise to "take a look at it , because it was fine when WE checked it earlier." It took them three hours to get a part from the dealer and install it. I had lost about four hours of work before it was all over.
The car was drivable and seemed fine, but I noticed a light out, and a similar error code showed up in less than 24 hours. My calls to the service department went largely addressed. I was given the run around. The front line employees apologized but could do nothing to help. The manager was always unavailable. So, how do you think I feel about that repair shop? What do you think my next interaction with them will be like? A simple "make it right" repair will not be sufficient anymore.
As a laboratory, what do you do when a patient does not receive the service or treatment he/she expects? Many organizations now have Service Recovery policies or even entire programs dedicated to service excellence. Whatever such programs look like, there are a few principles that apply universally-whether dealing with a disgruntled patient or a dissatisfied customer like myself.
Acknowledge responsibility. It's important to acknowledge that you screwed up and that the customer is
justified in feeling angry and in expecting more than they received. This step is not about blaming a specific employee or promising the customer that a certain person will be disciplined or terminated. It's accepting responsibility as an organization that has delivered sub-par quality.
Apologize. It's human nature that a simple apology very often diffuses tension. Studies have shown that even in malpractice suits, patients and their families are more likely to settle and go easy on organizations that actually
apologize early on. An apology means simply, "We are sorry we did not meet your expectations."
Correct the problem. As much as possible, do the thing right this time around. Some errors cannot be undone. It's impossible to un-ring a bell. But you can still recover somehow by doing something right. Move towards a solution in some way and don't make excuses for the initial poor service.
It sometimes takes the customer or patient to tell you what they consider reasonable "compensation." It is not always what YOU think. One rule of thumb is that recovery almost always involves added value. If you screwed up, merely doing it right the second time, might not be sufficient to compensate for the "hassle factor."
Another rule of thumb: do not make it difficult for the customer to take advantage of whatever it is you are offering. Owning the problem suggests that you do not compound the customer's inconvenience.
Empower front line staff to act. When a patient or customer has been wronged it does not help (in fact it
might be aggravating) if front line staff has to go up several layers of management to start the recovery process. They should apologize as representatives of the organization and must be empowered to at least start the recovery
If the process is complex, non-routine, or requires authorization from a higher up, front line staff should facilitate that
interaction. They should be empowered to contact management or a decision-maker and make that meeting/call/interaction as expeditiously and seamlessly as possible.
Perception is everything so if a patient feels that they have not been well served, even clinical outcomes are secondary. They don't care about your QC and your trends or even your clinical competence. During human interactions, problems are a given, but it is always possible to recover if you just follow a few principles.
In the last blog we discussed the importance of making a good favorable impression on a prospective employer;
and how to tailor your resume to deliver that oomph factor. Once you have passed that first test and scored an interview, there is another hurdle: how to make a good impression while facing the decision-makers.
Malcolm Gladwell in his best-selling book, Blink, touches on a decision-making technique used by many people, sometimes unconsciously. He talks about "thin-slicing," or "the ability of our unconscious to find patterns in situations and behavior based on very narrow slices of experience." He explains how too much information can cloud an individual's ability to accurately analyze a situation, and how "in good decision making, frugality matters."
Decision makers often just look for clues or familiar patterns to arrive at decisions. One small fact can be used to
extrapolate a much more nuanced conclusion. Inundated with information, many of us use thin-slicing as a heuristic or shortcut to arrive at daily decisions. Gladwell writes that we all do it-and in many cases it serves us well.
Although you never get a second chance to make a first impression, you do get many chances to make the next impression. So the resume is one opportunity to make a good impression, while the interview is another. In both cases, decisions affecting your future can be influenced by some very simple deliberate acts on your part.
Research done at Harvard University suggests that the most successful Superbowl commercials use certain techniques over and over. These commercials strike a chord precisely because of those "secret" hidden elements.
Writer and business consultant Ron Ashkenas, uses Gladwell's thin-slicing as a thesis, and suggests analyzing your favorite Superbowl commercial and incorporating certain simple, but effective, elements from those commercials into your interaction.
Capture your audience's attention. Most commercials "grab" by using emotion, humor or even esthetics. If you don't capture the interviewer's attention within the first five minutes, they have already formed a less than favorable impression which is hard to dispel. So everything from your dress, hair, energy level and eye contact matter more than you probably think.
Convey a clear message. Good commercials have a central theme. They rarely offer more than one message.
Your goal should be to convey your brand very quickly. Answer very early one, something that's in the back of the prospective employer's mind, "Who are you, and why should I hire you?" When you leave, you want this answer to linger in the mind of the prospective employer. You might even want to restate this premise as you shake
hands before exiting the room.
Focus on differentiation. Differentiation is more than a marketing term. It essentially means how is this product/service different than every other product/service/company? So, you are certified MLS, like all the others who have been called for an interview. You may have comparable experience and familiarity with the equipment. But is there something that gives you the edge?
The thing about differentiation is that it's the seller (in this case, you the job seeker) who has the responsibility to point out differentiation. You may be qualified, but what makes you extra valuable? What value do you bring to the table? Given two finalists, what gives you the edge?
Ashkenas suggests you can use these techniques in just 30 seconds of interaction. Gladwell says most decision makers including employers routinely use thin slicing. I suggest that you incorporate this knowledge into your interactions to create a good first impression and to give yourself the competitive edge.
One reality we have come to recognize is that most people evaluate you, and react to you in a certain way, because of
their impression of you; not necessarily the reality of who you really are or what you can do. The first impression is especially important and you only have one opportunity to make a first impression- for an audience, during a job interview, in a meeting or coaching session with your boss.
Many new grads are looking for jobs right now, and others are looking to change careers or jobs. Even seasoned
professionals are often not experts on writing resumes and interviewing. Since the resume is often your first contact with a prospective employer, it is important that it represents you well; that it creates a good first impression.
There are lots of resources available on how to write a resume. But there are some not so obvious "secrets" that
increase your chances of being selected for an interview. First, employers spend very little time reading interviews. They either "scan" manually or use electronic scanners to select a small select few to be interviewed.
How long do you think employers spend on reading an interview? A recent study indicated that employers report that
they spend an average of four to five minutes on each interview. Some might think that's not a very long time. But using "eye tracking - a technologically advanced assessment of eye movement that records and analyzes where and how long a person focuses when digesting information-shows they actuallyspend only about 6 seconds actually reading a resume.
What are the reviewers looking for? There a few critical elements.
The recruiters spent 80% of this limited time on six key pieces of information:
-Previous position start and end dates
-Current position start and end dates
Beyond those six items the recruiters in the study scanned for keywords to match the position they were seeking to fill.
It is still a great idea to write a simple 1-2 page resume with bolded titles, lots of white space, and easy to read bullets. Customize each submitted resume to include keywords mentioned in the job. For each job/title concentrate on proven abilities and accomplishments over job responsibilities.
In the next blog, I will discussother proven ways to make a good first impression.
Over the years, I have served on many hospital committees including the Pharmacy, Nutrition and Therapeutics (PNT) Committee. This committee is usually chaired by a physician and has tremendous input from an infectious disease (ID) specialist, microbiologist, pharmacist and registered dietitian.
The laboratory has always acted as an ancillary department; providing information, but creating little if any policy. I worked with organizations in recent years in which almost the entire formulary was driven by pharmacy. Sure, physicians had input, but the protocol relating to choices of medication, storage and security of medication in the facility have been set up by pharmacy.
Georgia, like several other states, has had a problem with abuse of narcotics, including the acquisition of drugs through the use of forged prescriptions. It was the state Board of Pharmacy that spearheaded a move to make the prescription process more secure. They drove legislation requiring among other measures that prescriptions for all Schedule II narcotics have to be written on the state board of pharmacy approved paper.
Pharmacists announced they reserved the right to reject any prescriptions not meeting those guidelines- or that were otherwise suspicious in nature.
Can you imagine the laboratory taking such a bold move by developing protocol and dictating standards for physicians to follow; albeit to protect patient safety?
Thinking about this difference in perception of- and expectation from- pharmacy and MLS led me to read again the ASCLS statement on the independent practice of medical laboratory professionals.
It reads, in part:
"It is the position of the American Society for Clinical laboratory Science (ASCLS) that clinical laboratory
testing is the defined practice of qualified medical laboratory professionals and encompass the design, performance, evaluation, reporting, interpreting and clinical correlation of clinical laboratory
testing, and the management of all aspects of these services."
It goes to say that medical lab professionals have the requisite knowledge and skill to perform, correlate, interpret laboratory tests and (with appropriate graduate degrees) direct clinical laboratories.
Functions are firmly grounded in applicable state law and CLIA regulations, according to the document.
Independent practice does not preclude collaboration with others on the health care team. But the profession does have a unique body of knowledge and scope of practice. "Artificial and arbitrary barriers to (independent) practice should not be erected," states the position paper.
Maybe it's time for us as a profession to test those largely unchallenged barriers.
A few years ago I was part of a team appointed by a national hospital company to study and make recommendations for staff retention. The organization had a horrendous record for turnover; in fact in some key areas like nursing assistants the turnover rate was 40 percent!
Such a high rate was untenable because of its cost to the organization, but also because it directly affected patient experience (customer satisfaction), team coherence and clinical competence. There were always new staff members learning processes, procedures and trying to blend in. Current staff members were resentful of, and tired from, constantly orienting new staff, only to see them leave.
Our first charge as a team was to find out why staff were leaving at such a high rate. Surprising to many of us, the main reason was not low pay, lack of resources or even poor management. While those figured into the
equation, the one message across 60 plus facilities all over the country was that employees were leaving because they felt let down by the orientation process. They felt they were misled; somewhat like being conned by false advertising. Many felt that they were turned loose and expected to function before they felt
Onboarding is the first step in orientation. It consists of a series of steps aimed at integrating new employees into the organization. Although we did not study laboratorians as a separate group, the lessons learned can be applied to any professional group-and was successfully adopted in the organization.
First day orientation was revamped to be more of a "welcome to the family." We removed many of the heavier paper heavy topics and just initiated a conversation, introduced key members of the organizations and
answered questions of concern raised by the employee.
We also made the conscious choice to have employees guide their departmental and technical orientation. Different employees have different needs. While we still had a structure and guideline about what should be covered and for how long, we would meet with employees regularly and seek feedback about progress, areas of concern and their comfort level.
Each employee was assigned a (trained) mentor-buddy whose role was to answer peer questions and facilitate movement through the department and organization. Questions could be as simple as parking, location of the cafeteria, who to contact in HR about a problem and who was the technical expert in the laboratory regarding a particular topic.
For two years we sought feedback from employees who stayed and did exit interviews on those who left. We asked what worked and what didn't. One big lesson learned was that the organizational culture was learned best by example and not by mission and vision statements delivered from on high at orientation, or hung on a wall.
Over 2 years the turnover rate for that organization dropped to 11 percent and employee satisfaction rose to the 95th percentile nationally.
Turnover has tremendous costs to an organization (financially and morale-wise). In my experience, effective onboarding is one proven way to both reduce turnover and improve employee and patient satisfaction in a relatively short time. It's definitely worth the investment and returns a huge return on investment.
Most people realize that many job searches are conducted on the Internet. While most jobs are still obtained through personal networking, it is the odd job which is acquired through a cold call or a serendipitous find in a magazine, journal or newspaper.
One site that is a treasure trove of information and is very underused by the typical medical laboratorian is Linked In. Many see it as just a social media site (it is so much more) or a site used only by the most senior executive types (it is not!).
It is a site to connect and network with old friends and colleagues, develop new networks, join professional groups of like-minded individuals and those in the same profession. Of course, you can also use the Job Search tool to search for jobs, applying filters to narrow jobs based on specialty and location.
Richard Yadon, President and CEO of MMS Group has some very useful tips on how to maximize the use of Linkedin in your job search.
Update your profile.
First create a profile that is accurate and current. Do not lie or embellish because that could come back to bite you. Keep your profile current so that if someone happens to stumble on your profile it represents your most recent experience and the type of opportunities you might be looking for. I suggest you go back just 10 years, unless experience before that time shows diversity and highlights significant achievements that make you more attractive and marketable.
Create references for colleagues.
Peers and bosses, past and present, will appreciate your references of them and their work. This can be brief but give a sense of their value, style and interpersonal skills.
Ask for references.
If you offer references willingly, sometimes without even being asked, those individuals are very likely more than happy to return the favor/ that way you have public accolades associate with your profile. Those references as well as endorsements of your skills can be seen by a desired prospective employer; or even someone just trolling the site. Never underestimate the possibility of being "discovered."
Join and participate in groups.
Look for groups of fellow professionals. Seek out industry (medical lab science for example) groups, including subspecialties. Join those groups and visit them often. If someone starts a threaded discussion, jump in and offer a professional opinion. Craft the response as a professional with valuable experience and something to offer.
Too often we use social networks simply as places to check in periodically and scope out who is there and what's going on. But they offer much more, including viable networking and job hunting options. Make an effort to visit site like LinkedIn often. You don't have to spend hours online, but visit, read threads, participate, expand your network and search for jobs in your area of interest, desired geographical area, or at your dream company
On July 4, 1776 the United States declared independence from Britain and a vigorous new democracy was born. This year we celebrate our 237th birthday and our founding fathers would be both pleased and disappointed at the
state of the country. This experiment in democracy has been unbelievably successful, but we still struggle with issues of basic fairness, parity and human rights in some areas.
Isn't that sort of where we are as a profession? We have certainly come along way, but we are remarkably
retrograde in areas of respect, parity, professional independence and professional licensure.
I wrote in a previous blog, "When American patriots chose to defy King, Crown, a powerful power structure, and
even history itself, the conventional wisdom was that the fledgling movement could not survive. There was little more than a deep desire to be free, a belief in the power of determination and the shared aspiration to be
Independence is a scary thought. Whether it is a country, a profession, an organization or an individual, the status quo can be safe because it represents a known quantity. One learns how to cope with the expected; it is the
unexpected that presents the greatest challenges.
But as a country we have coped with challenges in a uniquely resilient way. We have tremendous resources and
an indomitable spirit. As professionals it is easy to give up and say there is no hope for change. We can wait for "others" to make us feel better. We can coast towards retirement and leave the "problem" to new professionals. But as Americans we also know that anything is possible.
We can each live out our creed of a strong, proud profession with knowledge, gifts and talents. Wherever we are
we can still make a difference, independent of everyone and everything else around us. Sure, it's a challenge, but we do not as a people shrink from challenges. We turn them into opportunities. Happy Independence to you!
I am just not a morning person. I decided a long time ago that my ideal job would be that of a stage actor, working at night, relaxing leisurely after work, going to bed way after midnight and then sleeping in the following morning.
Most of us do not have that luxury, however, and we struggle with getting enough hours in a day. It is a constant battle for many people to get enough sleep, rise early and get "stuff" done before they start their long, hectic day.
I just completed reading a book called "What the Most Successful People Do Before Breakfast," by Laura Vanderkam, a self-described time-management guru. She is a huge advocate of rising early and deliberately
accomplishing certain tasks before breakfast in order to better manage our entire day.
Citing several busy executives and other successful people who have re-engineered their schedule to take advantage of early morning hours, Vanderkam explains the seeming magic of those early morning hours. You are less likely to get distracted in the morning. A busy person's day fills up fast. If you wait until the afternoon or evening to do something meaningful for yourself such as exercising or reading, you're likely to bump it off the to-do list altogether. "There are going to be lots of reasons why you can't tackle a personal priority at 4 p.m.
Things have a lot less likelihood of coming up at 6 a.m.," says Vanderkam.
You have more willpower early in the day. Even if you aren't a morning person, you may have more willpower in the early hours than later in the day. "Willpower is like a muscle that becomes fatigued with over-use," says Vanderkam. During the course of the day as you're dealing with difficult people, making decisions and battling traffic, you use up your willpower, leaving you feeling depleted toward the end of the day.
Mornings give you the opportunity to set a positive tone for the day. If you've ever slept through your alarm, been late for an important early morning meeting or even had a minor disagreement with a colleague you know that starting off the day with a "failure" can bring down your mood and affect your productivity at work all day.
Vanderkam says waking up earlier allows you to start the day with accomplishing something you want to do (a victory) and sets the tone for a happier and more productive day.
So how do you make that difficult decision to rise earlier than your current time? Vanderkam has suggestions for that as well.
1. Keep a time journal. Vanderkam says one of the reasons people say they don't like mornings is that
they stay up too late. She recommends keeping a time journal for a week to show where you may be using your time inefficiently. She suggests that when many self-professed night owls look at their time journals, they are often surprised to find they aren't spending their evening hours productively or doing anything particularly enjoyable when they stay up late.
2. Imagine your perfect morning. Imagine what you would do if you had an extra hour in the day. Would you exercise? Make a healthy breakfast? Pack lunch? Meditate? Getting up earlier isn't about punishing yourself
or even making a sacrifice. It is about accomplishing something. But you will not get out of bed if you don't have a good, specific reason to do it," says Vanderkam.
3. Plan your morning. Once you have decided what you want to do with your extra time, plan how to execute it, and set as much up as possible the night before. For example, if you want to exercise in the morning, lay out your clothes the night before, or gather the ingredients for your breakfast.
4. Build the habit slowly. Vanderkam says you will likely hit the snooze button and sleep in if you try to switch your habits drastically. So instead of setting your alarm for 5 a.m. when you normally get up at 7: 30 a.m. set the alarm for 10 minutes earlier each day. To make sure you don't lose sleep, go to bed 10 minutes earlier each night. If you have trouble hitting the sack on time, set a bedtime alarm.
This last suggestion of setting a "time to go to sleep" alarm is something I have do for myself and have recommended to coaching clients for a while. It works!
I am not nearly where I want to be in terms of going to bed at a decent hour, waking early and using those morning hours more productively and beneficially. But I am better than I used to be. Try it; you might be pleasantly surprised.
Two of the most bandied-around concepts in healthcare are those of privacy and confidentiality. Even before HIPAA mandated measures to ensure that health information be
safeguarded, medical professionals felt ethically bound not to disclose medical information to those who were not authorized or had a distinct "need to know."
The Health Insurance Portability and Acountability Act of 1996 (HIPAA) just codified those practices, laying down specific guidelines for implementation, and spelling out the adverse consequences of violating those principles.
Most of us feel our information is pretty safe. As recently as last week I received notification of lab results on my smart phone and I often log in to my medical record through a "secure" portal using my cell phone or iPad. That is all part of the convenience and immediacy provided by technology. Each site is password protected and I am typically reassured by the hypertext transfer protocol secure ( https://) designation that pops up on "secure" sites.
Recently we all heard through a whistleblower insider that the government has in effect being spying on us. The subsequent information coming from providers like Google, Facebook, AOL, Yahoo, Verizon and others indicate the extent of the information routinely accessed by the government's National Security Agency (NSA) and its civilian contractors.
Under a classified program called PRISM, the NSA surveys the communication that flows through the servers of these American-based companies on the pretext that some of that information to and from overseas might indicate a national security threat.
So if you have emailed "confidential" information, shared "private" information electronically with friends, conducted business, accessed "secure" sites, there is the possibility that the government was looking over your shoulder. How does that make you feel?
The feeling that as a law abiding citizen you have nothing to hide might be true but naïve. The current claim that information is gathered and aggregated but not necessarily analyzed might be little comfort. How much of your information has been gathered and stored? What might this information be used for in the future? How comfortable are you with the idea that even your medical information you'd rather keep private might in fact be no longer private?
The debate about the serpentine, complicated Affordable Care Act (so called Obamacare) continues. Aspects of the bill phase in over time, we know. It is also commonly accepted that many more individuals will be insurable and insured; creating a greater potential pool of consumers of medical laboratory tests.
Most people will continue to receive healthcare through employer-subsidized plans through their place of employment. Others will be eligible for Medicare and Medicaid. Not much will change for those people. The people who will be most affected are those who are unemployed or some other reason do not fall into one of the "covered" categories. Just to put it in perspective, actuarial studies indicate that in 2014 just over 7 million individuals, representing 2.5 percent of the population will need to buy health insurance.
Insurance will be available commercially from private companies, or individuals can take advantage of the economies of scale afforded by group purchasing at discounted prices through so called health exchanges or marketplaces run by states or by the federal government if the state elects not to set up its own exchange. As the population grows, this insurance consumer group is expected to grow as well. For example by 2023, the pool of folks needing to purchase their
own health insurance will be around 24 million or 8 percent of the population. Depending on the point you wish to make, you can argue that is a huge number or simply a fraction of the population.
The debate over the cost of the Affordable Care act is so tinged with political bias that it is often difficult to know what to believe. As medical laboratory scientist we are not experts on every aspect of healthcare. However if your friends and family are like mine, they do expect you to be able to speak intelligently about many issues including healthcare
An article in the Wall Street Journal uses the simplest analogy to cut through the clutter and demystify the entire concept of the cost of health insurance acquired through insurance exchanges. It also debunks the knee jerk reaction that says "it must cost more."
It is a little bit of an oversimplification and does not consider nuances like private commercial insurance and tax penalties for not buying insurance, but it does cover the majority of the marketplace. It does use real data from one of the more mature insurance exchange markets, so there is no "guesstimate" involved. It is worth a read.