advocacy in crisis situations

we had a teaching session this week on clinical aggression that primarily focussed on patient-clinician aggression. we have a co-ordinator for the Management of Clinical Aggression whose job it is to oversee protocols, edcuation, management and assessment for any aggression and violence in the workplace.

whenever there is the potential for aggression and/or violence involving a patient Code Grey can be called. this can be planned or unplanned (I think the rate is 60% planned 40% unplanned at the moment).

when you call a Code Grey a small team attend, made up of 4 big security guards, a senior clinician, a nurse, a medical officer (usually from the area calling the code), and an emergency co-ordinator. plus any unit staff that may be involved.

what got me thinking was that there’s no one role that is assigned for someone to be a patient advocate. of course in the majority of cases/situations any health professional can be, and probably should be, an advocate for the patient and this applies to those clinicians involved in code greys. but i think there’s a potential for a specific trained person to attend code grey events and act only as the patient advocate. this could allow situations to descalate quicker than usual, as often the code grey becomes a very oppositional event and ends with what can appear to be punitive measures of restraint (chemical or physical or both).

but if there was one person who could enter the fray and tell the patient, “I’m here for you and want to help you resolve this. I’m not a doctor or nurse. I will advocate for you.” I think there is the potential to shift the oppositional status quite quicky and perhaps have less restrictive outcomes for the patient.

search by calories

i just went to try the new google recipe search, as reported in their blog:

but of course, it’s only available in the US (and Japan… not sure why just Japan got a guernsey) at the moment.

it doesn’t really make sense to me why they don’t just roll it out internationally. they have the experience, the have the capacity, and i’m assuming they’ve done some serious beta testing already.

anyway, i’m quite interested in this from a health perspective. you can specify a maximum number of calories for recipes you’re looking for. as well as defining key ingredients.

with obesity being such an issue in western society perhaps this will help people manage their intake, because in the end the equation is simple. to lose weight make sure calories in is less than calories out.

i look forward to trying it out when australia gets added to the list.

Tags: health google

implicit again

i just read the long rant on obesity by miss g.

earlier i posted about an implicit association test that we were required to do before a lecture on obesity.

it’s an interesting test and i recommend it if you’ve got the time.

in the lecture that followed (part of our ‘social foundations of medicine’ subject) we had a talk given by an obese woman. one of the things she spoke about was the way obesity is perceived in society. how prejudice towards obese people is the last socially sanctioned form of discrimination. and nowhere is it more present than in the doctor patient relationship. some of her personal stories were atrocious – the condescension and judgements made by her doctors (and random non-treating doctors at conference and the like) are so embedded that they weren’t even aware they were being prejudiced. which is the whole point behind the implicit association test – to see what unconscious attitudes and beliefs you maintain.

the focus needs to shift from losing weight to feeling good about your body, your self. to encourage healthy eating and physical activity without judging the patient or setting unrealistic goals. i think miss g is right in how she describes how enmeshed our morals, psyche, body image and foods are. not to mention the impact of marketing and money on sustaining the problems. we need to feel good about ourselves to enable change.

the scary thing about the lecture was that many of the students found it so confronting (their hidden prejudices coming to the fore) that they couldn’t hear the message. some were adamantly denying the advice of our obese lecturer – “what, now we can’t tell people they need to lose weight?” was the sort of response that came out.