{"id":366,"date":"2015-12-22T16:58:35","date_gmt":"2015-12-22T16:58:35","guid":{"rendered":"http:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/?p=366"},"modified":"2016-12-14T19:58:55","modified_gmt":"2016-12-14T19:58:55","slug":"one-strike-and-youre-out","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/2015\/12\/22\/one-strike-and-youre-out\/","title":{"rendered":"One Strike … And You\u2019re Out???"},"content":{"rendered":"
\"Elizabeth

<\/p>\n

Elizabeth Donahue, RN, MSN, NP-C, practices adult primary care medicine in Boston, MA.<\/p>\n

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I consider myself a fan of sports in general, but of baseball in particular. \u00a0I grew up in a small town near Cape Cod, and I had no chance of escaping a fervent love for America\u2019s pastime. \u00a0My sister was the only girl on her T-ball team, my dad played church softball, and being born in Massachusetts, I watched endless Red Sox games from a tender age (I had no choice, really; there was only one TV in the Donahue household). To top it all off, we became a host family for college baseball talent playing in the Cape Cod Baseball League when I was about five, ensuring a seasonal parade of older brothers to teach me the rules of baseball over the course of my childhood summers.<\/p>\n

One of the first and most basic of the rules was that each batter gets three strikes before their turn at bat is up. \u00a0Recently, I\u2019ve started to notice a trend in patient care that has left me to wonder \u2014 can I get more than one pitch in this game before I\u2019m sent back to the dugout?<\/p>\n

\"JW_blog_baseball\"<\/a>Everyone in healthcare is aware we are in the thick of flu season. Four months ago, we started sending emails and posting signs in practices asking patients to remember to get vaccinated, reminding them that they were protecting not only their own health but also that of the more vulnerable patients, family members, or coworkers around them. \u00a0And yet, one after another, patients in the office have patently refused the vaccine from the first mention \u2014 citing an experience of developing an illness after their last flu vaccine. \u00a0It may have been last year or ten years ago. \u00a0It may have been a headache, a fever, a runny nose, vomiting, diarrhea (some symptoms not even associated with the flu!) or a combination of complaints. \u00a0Despite all of the data, knowledge, and discussion I can present \u2014 the flu vaccine has no live ingredients! the timing was probably a coincidence! a real allergic reaction looks radically different from this! \u2014 I might as well have started the game on the disabled list. \u00a0The vaccine\u2019s only gotten one strike, and I\u2019m out.<\/p>\n

A few weeks ago, I was out to dinner with a close friend and her mother, both of whom I\u2019ve known for years. \u00a0My friend\u2019s father had a sudden, serious illness requiring hospitalization a few years prior \u2014 long story short, it was complicated, involving multiple sequelae and considerations for his future treatment. \u00a0When seeing a physician assistant in the emergency room following his acute illness, my friend\u2019s mother questioned whether or not the treatment recommendation was the best choice for her husband\u2019s care. \u00a0The attending whose second opinion she sought agreed that the treatment may be detrimental and chose to implement another option. \u00a0After sharing this with me at dinner, she expressed her fear of dealing with anyone but attending physicians going forward. \u00a0I didn\u2019t say anything at the time, empathizing with her, understanding that managing family illness is difficult and scary. \u00a0But underneath I was thinking, don\u2019t throw the baby out with the bathwater here, there are providers who aren\u2019t attendings who can provide excellent care. \u00a0One of them may even be that particular PA who simply did not have all of the information to make the best choice at that particular juncture. \u00a0A coach doesn\u2019t bench a player after one bad at bat, and batters typically perform better as they learn more about the pitcher, or in this case, the patient.<\/p>\n

Of course, as a provider, I realize there are many times where the first strike is all you have \u2014 surgery comes to mind. \u00a0I also understand that one of these things is just a game, and the other is very much real life. \u00a0But in healthcare, thousands of decisions are debated, communicated, and implemented every day, and not every one of them is high-stakes. \u00a0When we\u2019ve swung at a single bad pitch, we may still deserve our full at bat. \u00a0In order to convince patients, I think we need to point to evidence and invest time to establish trusting relationships \u2014 raising our \u201cstats\u201d in their eyes and hopefully showing them that we\u2019ve still got a home run left in us.<\/p>\n","protected":false},"excerpt":{"rendered":"

I consider myself a fan of sports in general, but of baseball in particular. \u00a0I grew up in a small town near Cape Cod, and I had no chance of escaping a fervent love for America\u2019s pastime. \u00a0My sister was the only girl on her T-ball team, my dad played church softball, and being born […]<\/p>\n","protected":false},"author":1265,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[29],"tags":[371,373,143],"class_list":["post-366","post","type-post","status-publish","format-standard","hentry","category-patient-care","tag-baseball","tag-decision-making","tag-vaccination"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/posts\/366","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/users\/1265"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/comments?post=366"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/posts\/366\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/media?parent=366"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/categories?post=366"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/tags?post=366"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}