Musings on transfusion medicine: June 2017

Updated: 4 July 2017

June 29, 2007, Steve Jobs introduced a revolutionary gadget

June's blog had a long gestation. Perhaps it's a baby elephant as it's been in the womb for more than a year and a half. Why so long? Likely because I've hesitated to 'give birth to a child' who may be unwelcome. But I'm hoping readers can accept the latest baby-blog in the spirit in which it was created.

BACKGROUND
Bear with me as I explain the experiences that caused me to write the blog before getting to the nitty-gritty content.

In brief, I've been a user of personal computers from the get-go. My first PC was the PC Jr using command-driven MS-DOS software (Aargh!).

Also was an early adopter of the Internet when it came to Canada, mainly because of the exciting potential to communicate with colleagues around the globe. In those prehistoric times terms like archie, ftp, html, telnet, usenet groups, and veronica ruled. Indeed, to create my first website, I learned how to code html from a textbook. Then...DRUM ROLL....

1984: Steve Jobs introduced the first Macintosh with GASP! a graphical user interface (GUI) and mouse;
1986: Eric Thomas invented listserv software for mailing lists and commercialized it as LSOFT in 1994;
1989: Tim Berners-Lee invented the World Wide Web;
1995: Bill Gates' Microsoft introduced its GUI OS, Windows 95.

And, all of a sudden, the Internet was off and rolling, Bigly (as US President Trump might say). A revolution in communication whose evolution is far from over.

Pricing tidbits: After using computers run on MS DOS, I became a 'Macaholic' for years, although Macs were truly expensive in the early years. For example, in 1988 bought a Mac SE with basic software for $5595, 4 MB memory upgrade in 1990 for $660, and 40 MB hard drive in 1989 for $1300. In 1991 got a MaC LC with basic software for a whopping $8111, on a line of credit. Yikes!

Of course, once Windows 95 appeared due to consulting contracts, I ultimately was forced back to the MS dark side.

Over decades of observing how folks communicate on the Internet including running mailing lists for med lab professionals, writing blogs, and corresponding with colleagues around the globe, I'd like to say a few things about e-mail. The blog is not strictly a transfusion-related blog, but I hope transfusion professionals everywhere will be able to relate to its musings on communication.

Executive version: The blog's content offers tidbits for how to communicate more effectively via e-mail, but I'm under no illusion that readers will take them to heart. Perhaps agree in principle to the ideas but, without executing them, ideas are worth nothing. And old habits are hard to break.

The blog may (or may not) be the first in a series of tips involving other communication such as presentations and scientific writing. I'll play it by ear.

Much has been written on e-mail and many valuable resources exist. Hence, I do not intend to re-invent the wheel or to be all inclusive. What follows are just a few musings on things that bug me most.

The blog's title comes from a 1968 Beatles ditty.

IS E-MAIL THE BEST CHOICE OR EVEN NECESSARY?
Most professionals with job-related e-mail accounts know that it's over-used and abused and a major consumer of valuable work time. Indeed, much e-mail is a total waste of time (Further Reading).

Seems obvious, but for each message sent, do you first decide whether e-mail is the most effective way to communicate whatever it is you want to communicate. Before sending a message or responding to one, do you ask if it's truly necessary and the best way to achieve its purpose? Likely not. Today e-mail is an automatic response to communicating.

Yes, e-mail is the easiest way to communicate but may be a poor, even horrid, way for a given objective. Plus e-mail has the dreadful disadvantage of being easy to misinterpret. For one thing we cannot see the sender's facial expression, the smile and twinkle in the eyes. Words said even warmly can come across as blunt and harsh.

FACT: E-mail has run wild with little to no purpose for a long time So many e-mails about so little clog staff in-boxes and take away precious time from the real work of providing patient care, ensuring safe transfusion.

Bet you all know a TM professional (lab technologist, nurse, or physician) whose in-box bulges with 100s of e-mails read once but not yet dealt with. Or on return from vacation, even more in-box clutter?

Abuse like that forces staff to read work e-mail when on holidays, destroying the entire aim of getting away from work pressure. Executives and managers abuse staff this way and get away with it. Ultimately the buck stops with employers who do nothing to stop the practice and may even encourage it.

And you know what? I bet that, if the 100s of e-mails were never read, the universe would still unfold as it should.

TIDBITS: HOW TO WRITE E-MAILS
In this section I concentrate on a few things that bug me most about writing e-mail messages. From experience, I believe that many lab professionals, regardless of age (including those who have known e-mail, social media, the Internet all their lives) do not know how to write and respond to e-mails effectively.

1. ABOVE THE FOLD
Why keep the purpose of an e-mail message a secret, as so many do? For most job-related e-mail and correspondence with colleagues, it's critical to convey the purpose and any action required 'above the fold' (newspaper parlance).

Nothing is worse than wading through an e-mail to find the key bit at the end. It's abusive of the reader's time and reminds me of the typical telemarketing call:

You answer, hear nothing but background noise.
After a few seconds that seem an eternity, someone asks you something like, 'How are you today?'
My response, sometimes said aloud, is 'What the hell do you want? I'm busy.'
Or what a pal typically says forcefully but more politely: 'What do you want?'

Learning point: When writing e-mails, specify the purpose and say what you want recipients to do up front, above the fold. Don't keep it a frigging SECRET.

FACT: Today most professionals are so overwhelmed with e-mail that they typically scan messages with almost none of it being processed in their brains. This makes it critical to get their attention immediately. Also, using all-caps headings can help to focus the mind.

Examples of what to write above the fold include

No response required, for information only. Read now (it's time-sensitive) and file;

Your immediate response to a question is required below. Please do NOT 'reply to all';

Please confirm receipt. It's FYI only but important enough that I need to know that you received the message. Replying 'Got it' suffices.

2. SUBJECT LINES
Vague Subject Lines that tell the receiver next to nil about the e-mail's content are another gripe.

First, to have any value, Subject Lines of messages to individuals and to mailing lists must be precise and descriptive. As a long time manager of mailing lists, most subscribers have learned to draft useful Subject lines. But I'm always surprised that some continue to use Subject Lines such as 'Question'. Not very informative to readers and makes list archives useless if not revised by the list moderator.

Second, with a series of e-mails on the same topic between even two persons, keeping the original Subject Line for multiple messages in a conversation is not helpful. Multiple messages with identical Subject lines don't give a clue as to which ones contain the specific info people may want to refer to later.

Learning point: Make Subject Lines as useful as possible to the receiver. Think about the TV shows you want to view. Would Sports Contest, Police Drama, or Reality TV be useful listings on your cable TV guide?

3. SHORT PARAGRAPHS
Short paragraphs in e-mails are as important as they are on web pages or in any writing (annual reports, even novels).

But to write in paragraphs, you need to know what they are. Are such basics even taught anymore in the age of texting? (Further Reading)

Learning point: With e-mails I recommend that writers break information into short paragraphs even if they deal with an over-arching theme, but have a discernible sub-topic. When reading long paragraphs, eyes invariably glaze over.

4. PRIVACY
Some colleagues. and administrative assistants in university faculties and hospitals include everyone in the visible Cc field as opposed to the blind carbon copy (Bcc) field.

An easy alternative is to use your address (sender's address) in the To: field and put recipients in the Bcc field. That way privacy is protected, including if any recipient decides to forward the message to others beyond the intended recipients.

Added benefits of the Bcc field:

If someone goofs and replies by hitting 'reply to all', the message will not go to those in the Bcc field;

It's an anti-spam device. Should someone's computer be infected with a virus that harvests e-mail addresses, addresses in the Bcc field are protected.

Learning points: Many people do not want their e-mail address to be distributed to people they do not know. And what folks write to you is for your eyes only. How else can they be honest?

5. HANDLING INFO OVERLOAD
Most experts say to limit reading e-mails to set times of the day, perhaps once in the morning and once in the afternoon. But I know of few who have the insight and guts to do it. There's always the fear that you may miss something, a silly fear because most e-mail is an unimportant waste of time.

Research shows that when you interrupt your work with a distraction such as e-mail, it takes much time to recover and re-focus on important tasks at hand. Yet folks do it constantly throughout the work day. E-mail gobbles up so much staff time it borders on the criminal, meaning it does real harm to an organization's productivity.

Learning point: Why not try being the boss of e-mail versus being its poodle? Breaking free not only involves reading e-mail perhaps twice a day but also dealing with messages at the time of first reading. Reading messages and keeping them so that you need to read them again at a later date is an insane waste of time.

It's similar to quitting smoking. You're the boss - you can choose NOT to smoke. I made the choice 30 years ago after being a nicotine-addicted chain smoker. You can choose to be the boss of your e-mail. It's within your power, albeit not easy. New life-changing habits take much effort.

6. ETIQUETTE
Tips on e-mail and mailing list etiquette are all over the Internet. Many years ago I wrote guidelines for MEDLAB-L (Further Reading). For this blog I'll only offer a few tidbits:

1) As a general rule do not share personal e-mails without the sender's permission. While it's true that once anyone sends an e-mail, they never know where it will end up, But respect the sender's privacy as you would want yours to be respected. Do not share without permission, unless there's a compelling reason to do so, such as you think you are being abused and need to discuss it with others.

2) Never send an e-mail in anger or with a flippant response and especially not after midnight. Give it a day or two to reflect upon.

3) When you e-mail a colleague for help or advice on any topic, once they reply, have the courtesy to say thanks. That way they know you received the reply and, more importantly, appreciated them taking the time and effort to help. I can't count the times I've spent hours assisting folks with a request (some I know but many who are strangers) to never hear from them again. Some experts say to axe the thanks (just more in box clutter) but to me it's common human courtesy and let's folks know you got the reply.

4) Because e-mail is such an impersonal medium and open to misinterpretation, take the time to personalize messages as if you were talking to the recipient in person. Again, some experts recommend cutting the niceties because they're superfluous time wasters. But to me, the personal touch is essential.

5) Keep e-mails short and, as noted earlier, consider using headers to focus the recipient's attention. Involves editing original for brevity (as you would with Twitter's 140 characters), but more importantly, deciding what is fluff that adds nil to the e-mail's key message.

However, do not sacrifice the personal touch for brevity. Connect with colleagues and encourage them to see you as a real person with shared experiences they can relate to.

6) Proofread e-mails as you would scientific papers submitted for publication. E-mail messages reflect on you.

Learning point: See e-mail as a communication medium with an etiquette similar to talking face-to-face. The key point is to respect colleagues as you would want them to respect you.

FOR FUN
The Internet is a revolution that changed everything, which is why I chose Revolution for the blog's title. So many good outcomes and some not so good. On balance, to me life before e-mail was better than life after. Why? Because today time for professionals to reflect is limited. Yep, we can communicate worldwide but at what cost?

Professionals are now slaves to mostly useless e-mail. With multi-tasking 24 hrs a day, no one has time to reflect. It's hours of mindless skimming of e-mail messages that did not exist before. Non-productive, non-efficient wasted time at workplaces, abuses staff time at home and on holidays, and contributes nil to patient safety.

Revolution (The Beatles)

As always, comments are most welcome whether you disagree with me or would like to add more pet e-mail peeves. You can do so anonymously, and include your name or not.