Baa-ram-ewe! Baa-ram-ewe! To your breed, your fleece, your clan be true

Who earns your loyalty and why?

It's a tough question because we rarely think about who or what gains our loyalty. The sheep in Babe give their hierarchy in the title of this post, but for clinicians the distinctions are not always clear.

Is it your practice or department which comes first? Is it your speciality? Is it your health community?

It is too trite to say that you are loyal to your patients, especially since all too often it is they who remain loyal to the practitioner who has failed them in the past.

This loyalty issue has a nasty inverse consequence. I recently met someone who worked for a specialist trust. She described consultants from that speciality who worked in nearby DGHs as having failed to attain the standards required to work in her organisation, and in effect, not fit to treat her dog.

When loyalties are put in conflict, such as organisational mergers we are likely to see reactions which are unpredictable, possibly aligned to loyalties not apparent to those outside the group. These conflicts will be increasingly common as the commissioning agenda develops.

Go with the Flow

It's interesting looking at how other professionals work to see if there's something we can adopt in medicine. This last month or so I've been interested in Flow. It all started with the golf, a young player nails the first round, leads the board but next time around he's hopeless- the yips have struck.

Equally in snooker, darts, chess, whatever there are moments when the players are so "in the moment" that for them the game is over in seconds, their performance is faultless, the result dramatic.

This state of "Flow" is something we should be able to promote in medicine. At the very least we should be able to redesign our environments to promote the chances of us being able to deliver an optimal experience.

Here are  a few suggestions to be going on with:

• Prevent interruptions when focus is needed- do not disturb rules.
• Promote an environment which facilitates relaxation
• DO ONE TASK AT A TIME
• Turn off e-mail notification, mobile phones etc.
• Plan the session to reduce breaks in flow- prepare papers, tools etc.

I'm sure there are dozens of other ways we can go with the flow, I'll keep looking and let you know.

What's in a name?- it's a Quantum Thing

People often talk about primary care, secondary care, General Practice, community care. But really what does it all mean?

Sometimes General Practice, which is strictly speaking General Medical Practice is used interchangably with primary care and equally community care is also blurred in the boundaries. 

The reality is that Primary Care is probably better thought of as a space rather than an organisation. A space in which multiple services operate providing care appropriate to deliver within "Primary Care".

Lets face it-there are Hospital Nurses who spend their days delivering primary care, being the first port of call for a child with diabetes, or a stoma patient, or specific illness. These nurses are by default part of the primary care approach, albeit operating from a secondary care base.

Equally most General Practitioners spend considerable amounts of time delaing with complex patients who have been through the halls of secondary care institutions and now need to return to some kind of normality.

I suppose my point here is that sometimes naming the process or issue, tends to fix the observed packet of care in place. It's probably best thought of as a quantum event, until you name it it is potentially everywhere, but once named it becomes fixed in time and space as a primary or secondary event.

The trouble with quantum observation is that it also changes the observer. Until the box was opened on schroedingers cat the observer wasn't happy or sad- not knowing if the cat was alive or dead.

Once opened, defined as dead, the observer is also "fixed" in sadness, so we also change who seek to define what should be in primary care, what is and isn't possible in each domain of care.

Perhaps we should seek less to define what should be done where and concentrate on the infinite possibilities that a quantum view of healthcare might provide.