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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 FCChelski 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:

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 MEDICINE

The 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

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 TRIBALISM

The following table shows similarities and differences between tribalism in two seemingly disparate fields.

Tribalism in Football and Medicine

Tribal reaction toFootballMedicine
Loyalty & prideFans 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 tribesDerogatory names for successful clubs, e.g., Chelski (CFC), Barscum (Barca)Resentment or admiration depending on individual tribe member
Perceived traitorsDerogatory names for players, e.g., Robin van PursestringsDr-tribe shuns health professional whistleblowers
 $ and privilegeFans 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 threatenedFans attack managers, strikers if losing becomes the normDr-tribe attacks any tribe who dares to challenge its authority
Responsibility for errorsFalls 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 LABORATORY 

Tribalism and its inherent bullying are not relevant to transfusion medicine, you say? Think again.

Personal Experiences

Over 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 services

In 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 Views

The 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 POINTS

What's it all about?  To me, transfusion medicine tribalism mimics EPL football tribalism in many ways, and not in good ways.

FOR FUN 

Anna 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. 

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

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www.patletendre.com

Your Comments

rmcrat
12 Apr 2014
3:49 am

Hmm. I can see that in sports there is a prize (winning)that can only go to one team. On the other hand,in healthcare we have a common goal of what is best for the patient. Too bad that gets lost, such that your analogy has truth.



7 Jul 2015
2:30 am