Wednesday, October 30, 2019

I will remember you (Musings on gender in transfusion medicine)

Updated: 2 Nov. 2019

October's blog is short. The idea was initially stimulated by two 'from the archives' papers in TraQ (Further Reading). The topic of the papers was perceived gender discrimination by healthcare professionals. The initial purpose of October's blog was to get readers to assess if they perceived gender discrimination exists in their disciplines and workplaces.

After reflection, I decided to change the focus to highlighting how many great female physicians there are in transfusion medicine, many of whom I've been privileged to know personally. And, sad to report, one recently died. 

The title derives from a ditty sung by Canada's Sara McLachlan.

Historically, medicine has been male dominated, whereas both nursing and medical laboratory technology/science have been female dominated, at least in Canada. That's been my experience in transfusion medicine but it has changed significantly over the years, especially in transfusion medicine.

TIDBITS Since I moved to Edmonton in Nov. 1977 to teach in University of Alberta's Medical Laboratory Science to the present, Oct. 2019 (42 years), top jobs have been held by men: Medical Directors of UAH's Dept. Lab Medicine and Chairs of the Dept. of Lab Med and Pathol (Faculty of Medicine and Dentistry, University of Alberta).

Individual UAH lab specialties have been held by women, including I am especially pleased to say the transfusion service, which is currently headed by one of my Med Lab Sci 'kids', who also holds higher regional positions. Across Canada, many female physicians hold significant transfusion medicine positions.  

Nurses vs physicians remains an ongoing saga and perhaps sometimes it's just about power, not gender. Suspect it gets more dicey when scope of practice is involved, which also adds pharmacists to the mix.

Canada's blood suppliers are a mixed bag. CBS had had a male CEO from the get-go, though many female physicians are CBS medical directors across Canada. Héma-Québec began with a female CEO. Parts of CBS are male top-heavy

Over the years I've seen female transfusion Drs. bullied by what I perceived as pompous male colleagues in rounds and at conferences. As the cliché goes, women must be way better than male colleagues to succeed. Is it still true?

Transfusion medicine is blessed with many exemplary female physicians in top positions. Some examples of ones I've known personally and met F2F (alphabetical order):
Interesting that so many of these Canadian female transfusion medicine docs have held major positions (as above) and won awards. To name a few: 
  • CSTM Ortho award recipients:
    • 2002, Francine Décary (CEO of H-QISBT President 2004-6)
    • 2007, Heather Hume (Executive medical director, CBS)
    • 2010, Susan Nahirniak (Chair of NAC)
    • 2013, Debra Lane, Medical  Director of CBS's only joint transfusion service/ blood supplier in Canada)
    • 2014, Lucinda Whitman (Chair of NAC)
Of course, Canada has many outstanding female transfusion medicine Drs. I've never met F2F but know via social media like Twitter or via e-mail. Ex:
  • Dr. Jeannie Callum (who kindly contributed to CSTM blog on Ana Lima )
  • Dr. Yulia Lin: CSTM Ortho award recipient, 2016; 2019 AABB President's Award, 'In recognition of her role as a master educator in the field of transfusion medicine, particularly through her contributions to the education of junior doctors through the Transfusion Camp program.'
  • Dr. Elianna Saidenberg who died far too young on Oct. 20, 2019 (Further Reading) 
Special note on Elianna Saidenberg, Never met her except via her tweets, and she kindly liked many of mine.Thought she was a wonderful human being as I suspect did all who knew her up close or from afar. Clearly, Dr. Saidenberg made a difference in her all too short time on planet earth. Twitter remembers Elianna

So...what do you think? Does your country have many fabulous female transfusion medicine physicians as Canada does. Is gender an issue in transfusion medicine, whether related to physicians, nurses, medical laboratory technologists?

I've chosen Canadian Sarah McLachlan's song for this blog, one I've used before:

I will remember you 
will remember you, will you remember me? 
Don't let your life pass you by 
Weep not for the memories.
As always, comments are most welcome and there are several below you may enjoy. 

In Memoriam: Dr Elianna Saidenberg (21 Oct. 2019)

Blau G, Tatum D. Correlates of perceived gender discrimination for female versus male medical technologists. Sex roles 2000 Jul;43(1):105-18. | Related:

Blau G, Tatum DS, Ward-Cook K, Dobria L, McCoy K. Testing for time-based correlates of perceived gender discrimination. J Allied Health. 2005 Fall;34(3):130-7.

Shannon G, Jansen M, Williams K, Cáceres C, Motta A, Odhiambo A, et al. Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet. 2019 Feb 9; 393(10171):560-9.

Tuesday, October 01, 2019

Both sides now (Musings on humans vs technology in transfusion medicine)

Stay tuned: Revisions are sure to occur

There's much transfusion news these days on artificial intelligence (AI), big data, drones, innovations, new technology, precision medicine. In a way this blog is a follow-up to the prior one, 'Get back' (Musings on transfusion medicine's future).

September's blog (albeit published Oct. 1) was stimulated by a weekly feature ('Workplace column') on a local radio program I heard this morning (Further Reading). Also, because as an oldster I want a record of events I've experienced in the hope they will resonate with some and influence others to do similar. Otherwise when we oldsters croak, they're gone forever.

The blog's title derives from a song by Canada's Joni Mitchell.

As you read the blog, regardless of your health profession, please consider the challenges you faced if you have held a management position and, if not, think about the strengths and weaknesses of managers you have had. Also, consider the impact you as a manager have had on colleagues and the influence your managers have had on you and your career. 

Specifically, the radio column was on moving into management, generally viewed as a promotion with a higher salary. The columnist (@sandbaryeg) gave tips on becoming a manager for the first time. Her tips made me recall when I took a giant leap from a long career as a transfusion educator of medical laboratory technologists/biomedical scientists to become a lab manager at CBS ('assman' as the centre's QA department addressed my mail). True, I'd been lab supervisor in my 13-yr job before teaching, but with none of the responsibility the 'assman' position entailed.

Indeed, as I only learned later, although I managed the patient services lab at the blood centre, the position had been downgraded to 'assistant manager' in order for the centre (and perhaps head office?) to retain more control, especially over salaries. Also, I hadn't realized (bit stunned of me) that the person who had been an assistant to the prior manager and perhaps (just a guess) had applied for the job I was recruited for, and was the acting manager when I came. She was a prior student of mine, in fact in the first Med Lab Sci class that I taught all the way through, who I was and still am exceedingly fond and proud of.

My take on the consultant's 5 tips for new managers. How to
1. Run meetings, something many dread;
2. Give effective feedback;
3. Foster a team environment;
4. Attract & recruit the staff you need vs filling an existing job;
5. Manage your own time effectively.

Promotion: First, I'll note that in my experience (historical, I know, dating from 1960s-2000) often the folks who get promoted in the lab are ace technologists. If all factors are considered more or less equal, seniority may play a role. To me, that's not an effective process, but it's likely the easiest.

How often do fabulous footie players (soccer in NA) or hockey players become great managers? Not many. Why? Because the skills needed are quite different.

Needed skills? More recently, not only med lab techs/scientists but also physicians (perhaps nurses?) tend to get Masters of Business Administration (MBAs) as lab medicine and transfusion have become more and more a business. Presumably these degrees help in a new career as a 'suit' whose prime concern is the bottom line, though patient safety is always touted, given first place in communications.

I'll discuss the 5 tips in various ways based on my experience.

Decades ago as an educator I'd experienced many ineffective meetings, including those run by MDs at the departmental (Lab Med & Path) & Faculty of Medicine levels. Some dept. meetings were info-only unneeded sessions. Few required active participation. And often the minutes were totally useless to anyone not attending.
  • My experiences motivated me to write a resource for TraQ in 2009 on running meetings (Meetings as Time Wasters, Further Reading).
On running meetings in my brief career as 'assman' I was fortunate and smart to designate my prior student to run many meetings. She was experienced in the task and did it much better than I ever could. Only time I ran meetings was when it came to getting staff on board with changing almost all pretransfusion testing methods in the lab. That came easy as it was right up my alley as an educator.

In a similar vein, I was glad I'd insisted on a whiteboard for my 'assman' office as it was well used when meeting with supervisors in the various sections of the patient services lab.

As an educator I had to give feedback over decades and some was difficult. For example, telling foreign students (English as a second language), whose parents had struggled and worked hard to send them to Canada that they were not going to pass their clinical rotation. For such students it was a total disaster, an incredible loss of face and shame. Frankly, it broke my heart and I know that whatever I said to lesson the blow (e.g., they could have great success in another career) wasn't heard and didn't lesson their reality in any way.

In giving more routine feedback, as a med lab technologist with an MEd, I knew the characteristics of effective feedback. On a personal level I believe that often what shapes us for good and bad in life are 15-60 second interactions with others. For example, I'll never forget the powerful effect of my Dad saying, 'Pat, don't be afraid to be different.'

As a teacher of med lab students I always kept that in mind when giving feedback. Meant I treated struggling students the same as high achievers. And in retrospect I see that many of those who struggled have gone on to be high achievers, leaders in their field. Why? Suspect it's because success depends on many factors, not necessarily getting the highest grades.

A good pal is a standardized patient at the University of Alberta and they have a particular take on feedback, called CORBS (Further Reading):

CLEAR – Give information clearly and concisely
OWNED – Offer feedback as your perception, not the ultimate truth. Talk about how something made you feel. Use terms such as “I find” or “I felt” and not “You are”
REGULAR – Feedback is offered immediately, or as soon as possible after the event
BALANCED – Offer a reasonable balance of negative and positive feedback. DO NOT overload with negative feedback.
SPECIFIC – Feedback should be based on observable behavior and behaviors that can be modified.

Not much to say. Health care teams are similar to politicians kissing babies. Everybody does it as it's the reigning orthodoxy, the cliché of how we love to see ourselves. Again, University of Alberta has a course on it. INT D410 - Interprofessional Health Team Development.

Like to think I've been a member of many teams in health care (my transfusion families over the years) but must admit that many who promote it most publicly do not walk the talk.

Will only speak to my recruitment to be 'assman' 21 years ago. Fact was the job was not quite as advertised. In retrospect I thought they portrayed part of the job almost as if it was what became hospital liaison specialists. I totally dug the part about the centre being the pilot site for a new information system and found it a worthwhile challenge.Our talented team of med lab professionals did a wonderful job in implementing the new IS.

Similarly, I loved the opportunity to change outdated lab methods, though don't think they hired me for that. It was just my 'value added' to the job I held for all of 9 months. When I tendered resignation I explained why in exit interview. They understood more money wouldn't make a difference and admitted they could not change what I thought needed changing most (head office, though it's more complicated than that).

So did CBS recruit the right person for the job? Yes and no. Yes, because I led the talented patient services lab team successfully through a difficult time of incredible change. No, because after years in academia at a university where dissent and free speech are cherished, I didn't fit in a national organization where adhering to head office directives was paramount. That's what made you a valued team member.

The radio consultant pointed out that managers need to prioritize their tasks and serve as role models for staff as they cannot work to 10 pm over the long term. I don't have much to say except that you obviously cannot help others if you're exhausted. See it as a Buddhist concept that you need to love yourself, be okay with who you are, in order to love and help others. Over my entire career I was often the first in and last out daily but that's another story.

Are AI, big data,new technology, precision medicine all important to health care and more crucial than the qualities of people in leadership positions? Perhaps. But not to me. As a human being on plant earth, I'll always value the human condition over technology. See excerpt from 2001, a Space Odyssey (Further Reading).😁

Chose this song because I've lived long enough to see transfusion medicine evolve from being people-focused to technology-focused. As  early adopter of technology (not a Luddite), I doubt we're on the right track (Further Reading). Also, admit that I love the songs of Canada's Joni Mitchell.