Today's Eventsno events today
Simply the Best
(Musings on tribalism among transfusion professionals)
by Pat Letendre
This blog is the second in a series written for the British Blood Transfusion Society. In this entry, I'll muse on surprising similarities between the worlds of football (soccer in NA) and transfusion medicine.
The blog's title derives from a song covered by Tina Turner, one much more successful than its original recording by Bonnie Tyler.
DISCLOSURE: I've followed football for years but became fanatical when I discovered that televised English Premier League (EPL) games were available in Canada for an extra charge from cable suppliers. The good news came from a neighbour. The sad news is he's a Manchester United fan. Not a good place to be in 2014.
My club is Chelsea FC, Chelski to others because of our billionaire owner, Russian oligarch Roman Abramovich. Unlike many footie fans, I'm not particularly tribal. However, if Chels isn't your club, pity. We have admirable players, including our Brazilian geezer, David Luiz.
TRIBALISM IN FOOTBALL
Tribalism can be defined several ways. The definition that fits what I see in football is Merriam-Webster's:
Loyalty to a tribe or other social group especially when combined with strong negative feelings for people outside the group
Many have written about tribalism in the EPL. What the articles show is that tribalism in football means loyalty always trumps objectivity. Fans thrive on a we-they mentality. You're with us or against us, there's no shades of grey.
Bullying: Tribalism also involves bullying fellow fans who challenge a club's orthodoxy. For example, Chelsea fans who don't see Mourinho as the club's invincible saviour will be called plastic idjits and worse.
On my Twitter timeline @eurofutball I routinely see players, managers and fans of other clubs, especially our main rivals, described by Chelsea fans as scum or similar. The same is true for fans of any EPL team. Everyone mindlessly verbally abuses everyone else due to tribalism whether on Twitter, in bars, on buses and trains, in the stands at matches. Footie tribalism is pervasive.
On one level it's harmless, fans enjoying a shared camaraderie and loyally supporting their club. On another level tribalism promotes a sports culture that's destructive. It excludes objectivity and precludes cooperation and a shared perspective that we're all in this together, all fans of the beautiful game.
TRIBALISM IN MEDICINEThe most examined tribalism among health professionals is between physicians and nurses. Traditionally, the medical profession has been seen as a nuclear family, with doctor-father, nurse-mother, and patient-child.
Note: In this blog, medicine includes all health professions and technologist and tech encompass biomedical scientist and similar designations.
Resources that discuss the issue include
Savage J, Smith R. Doctors and nurses: doing it differently. The time is ripe for a major reconstruction. BMJ. 2000 April 15; 320(7241):1019-20.
The relationship between doctors and nurses has never been straightforward. The differences of power, perspective, education, pay, status, class, and - perhaps above all - gender have led to tribal warfare as often as peaceful coexistence. Nurses' readiness to be slighted and doctors' reluctance to be challenged create an undercurrent of tension.
Davies C. Getting doctors and nurses to work together. BMJ 2000 Apr 15;320:1021-2.
Working together means acknowledging that all participants bring equally valid knowledge and expertise from their professional and personal experience.
Do doctors and nurses hate each other (May 30, 2011)
In one sense, nurses have spent the last half-century fighting to overcome the stereotype that they are defanged doctors. It's a division rooted in education, income and gender. Doctors - men, affluent, with a professional education - reigned supreme in the hospital. Nurses - female, working-class, with a trade school-level education - were their handmaidens.
Physician, heel thyself (May 7, 2011)
It was morning rounds in the hospital and the entire medical team stood in the patient's room. A test result was late, and the patient, a friendly, middle-aged man, jokingly asked his doctor whom he should yell at.Turning and pointing at the patient's nurse, the doctor replied, 'If you want to scream at anyone, scream at her.'
Doctors behaving badly? They say it happens all the time (May 25, 2011)
Disruptive physician behavior is the issue that just won't go away. Our profession is still plagued by doctors acting in a way that is disrespectful, unprofessional and toxic to the workplace.
And it's not just tribal physicians dumping on the nursing tribe: Nurses eat their own
Physicians also eat their own: The bullying culture of medical school
Physicians also have tribal issues with other health professionals. For example, a case study from the Agency for Healthcare Research and Quality - Morbidity and Mortality Rounds reports on a medical intern who ignores a suggestion by a pharmacist on how a particular dose of drugs should be given:
FOOTBALL VS MEDICAL TRIBALISMThe following table shows similarities and differences between tribalism in two seemingly disparate fields.
Tribalism in Football and Medicine
|Tribal reaction to||Football||Medicine|
|Loyalty & pride||Fans stick by players accused of 'sins', whether guilty or not|
Use acronyms, e.g., KTBFFH (Keep the Blue Flag Flying High) - CFC and COYS (Come on You Spurs)
|Drs seldom, if ever, testify vs other Dr-tribe members|
The lower status tech-tribe develops mottos like, 'We get results'
|Success of other tribes||Derogatory names for successful clubs, e.g., Chelski (CFC), Barscum (Barca)||Resentment or admiration depending on individual tribe member|
|Perceived traitors||Derogatory names for players, e.g., Robin van Pursestrings||Dr-tribe shuns health professional whistleblowers|
|$ and privilege||Fans of small clubs resent clubs with billionaire owners|
Fans of poorer clubs ridicule rich clubs for 'unearned' success
|RN-tribe resents Dr-tribe who they view as having it all, having it easy|
Lesser tribes may see slights everywhere, real and imagined
|Dominance threatened||Fans attack managers, strikers if losing becomes the norm||Dr-tribe attacks any tribe who dares to challenge its authority|
|Responsibility for errors||Falls to managers, strikers, keepers more than others|
Club heroes forgiven. Flops, especially strikers, bear every loss
|Responsibility often transferred to lower tribes or ignored, e.g.,|
Dr-tribe seldom held responsible for ordering inappropriate blood products
|Regulation to save $,|
create even playing field
|Clubs that spend most $, win most and find ways around Financial Fair Play|
Unfair advantage to clubs with billionaire owners, who can partly cover losses
|Every tribe fights to retain its scope of practice and monopoly |
Tribes believe lower qualified staff may cost less but threaten patient safety
TRIBALISM in TM LABORATORYTribalism and its inherent bullying are not relevant to transfusion medicine, you say? Think again.
Former NHS manager awarded £1m in racial discrimination case. Manager subjected to 'systematic bullying and harassment' (Jan. 9, 2012) | His division included pathology, radiology, anaesthetics
Government bullying of Alberta MDs systemic, say medical groups (Nov. 15, 2011) Many health professionals were told to shut up about planned changes or risk job loss.
Personal ExperiencesOver many years as a TM professional I've experienced first-hand both minor bickering and significant conflict between clinical staff (nurses and physicians) and medical technologists/scientists in the TM laboratory and continue to hear such anecdotes second-hand.
For example, a common occurrence involves physicians (or nurses) being rude and bullying to lab staff who try to uphold safety standards related to patient specimen identity. The docs and RNs uphold their tribe's superior positions over the TM laboratory (historically the lab was seen as troglodytes in the basement) and attempt to bully us into submission. In the past lab boy and lab girl were sometimes used to put our tribe down.
As a clinical instructor I once had a paternalistic physician as a department head who had a habit of glaring at subordinates menacingly in an effort to bully them into complying with his views. The tactic was comical (See Dilbert example) but it scared the bejeesus out of staff unfortunate enough to experience it, including me. My incident involved having failed a student on a TM research project. Being young, I was intimidated and never did that again.
Such experiences sent a message. Physicians and nurses were not part of my tribe. They were loyal to their own and I, as a medical laboratory technologist, was an outsider.
Similarly, I've heard transfusion service laboratorians 'diss' nurses as lower beings. Nurses are apparently mathematically challenged and don't understand quality control and assurance, poor dears. Plus they're pit bulls who think they can bully the lab into covering for their incompetence in mislabelling specimens and seem immune to understanding, 'It's about the patient's safety, stupid'.
As for physicians, many clinicians lack adequate education in transfusion medicine. Many are lucky to get an hour or two.
Accordingly, clinician orders often don't follow current transfusion guidelines. But we in the lab cannot tell them that because our tribe is inferior to theirs. We must let the transfusion service's medical director discuss the transfusion order with them, one tribal member to another, peer-to-peer.
Blood supplier vs hospital transfusion servicesIn Canada the blood supplier (first Canadian Red Cross, now CBS, but with many of the same TM professionals) has historically been seen as 'the enemy' by hospital transfusion service staff or, half jokingly,'the dark side'. It's long been our tribe vs theirs.
Typical Tribal ViewsThe transfusion service tribe thinks the blood supplier tribe doesn't know what it's like to work on the frontlines of health care where patients experience life-threatening hemorrhages and have unidentified antibodies that threaten their safety. At best, blood suppliers are pampered, paper-pushing government poodles, safe in regional or head offices far from the real action.
In contrast, the blood supplier tribe may see their clients, transfusion service tribes, as no more than siblings competing to get a special share of parental love, i.e., adequate blood supplies, and not above lying to do so. Such children need to be controlled with a stern parental hand on the supply lever using blood stock management schemes.
LEARNING POINTSWhat's it all about? To me, transfusion medicine tribalism mimics EPL football tribalism in many ways, and not in good ways.
Similar to fans loyal to a football club, health professional tribes forsake objectivity for loyalty to their tribe (physicians, nurses, medical laboratory technologists / scientists).
Like footie fans, bullying of those viewed as not loyal to the tribe and its prevailing orthodoxy occurs often.
Just as football tribalism decreases a sense of being part of a global community of fans who love the beautiful game, health profession tribalism decreases cooperation and collaboration among TM practitioners and, ultimately, undermines patient safety.
FOR FUNAnna Mae Bullock, aka Tina Turner, is now 74 and resides in Switzerland. She's a survivor of spousal abuse who in her youth worked as a nurse's aide and dreamed of becoming a nurse.
I chose this song because it exemplifies what all tribe members believe about their tribe. It's what I believe about Chelsea FC and its current striker Fernando Torres, regardless of what the facts are. It's what I believe about all transfusion medicine professionals, regardless of tribe.
Simply the best (Tina Turner, live in concert, 1990)
Cause you're simply the best
Better than all the rest
....I hang on every word you say....
As always, the views are mine alone and comments are most welcome.
Pat Letendre is the webmaster for the TraQ website of the BC Provincial Blood Coordinating Office in Vancouver, British Columbia, Canada.
Pat specializes in developing transfusion-related websites and managing mailing lists for health professionals. She has extensive experience as an educator and clinical instructor.
View Pat's Full Bio
12 Apr 2014
21 Apr 2015