A recent over hear of a conversation led me to this….the problem of the minnow in the fish tank.
When I was younger, my grandmother had a fish tank that contained “house fish”. They were fish bought at a store and never would see a lake, stream, creek, or other natural body of water. One day, we discovered the fish were dying and we didn’t know why. We checked the filter, water, food and other things pertinent to the upkeep of fish in a tank and they were all fine. It was found that a fish from outside and from a different environment, a minnow, had been put into the tank with all of the other fish. It was killing the other fish, and removing it solved the problem. Being reminded of this situation has led me to see how it is relevant to situations other than fish in a tank. It is especially relevant to situations that are job related. Particularly situations that involve issues with employees. High rates of turnover for employees is a sitation that came to mind when reminded of this incident from my childhood. It isn’t necessarily that someone is a bad fit. maybe they’re just not of the same ilk as the rest of the people they work with. They’re the same things professionally, but, They’re meant to be in a different environment. It’s their nature so to speak that causes such issues in the work place. It is also a reason why I think certain people don’t belong in healthcare. I’ve worked with several people over the years who would have been a better service to the realm of business or another environment.
As a healthcare professional, I’ve been witness to people ruin environments they are in because they’re not a fit for them. Instead of solving the problem, which is to eliminate the minnow, other people suffer because of a person or two who should be in another industry or work environment. It is why turnover rates are high on certain jobs, while other jobs with similar work, don’t have the same problem. It isn’t the workload or the hours. It also isn’t the pay either. It’s the people. They are the ones who cause the problems that lead to high employee turnover rates. Usually the issue can be eliminated by getting rid of one or two people who are the minnows in the fish tank. When the minnow(s) are eliminated, the other fish thrive. It’s a problem that a lot of employers don’t address or don’t want to admit. Too often, it is easy to blame workload or low pay as the reason for employees not staying at a job. They have years of high rates of turnover because they never solve the problem. They can add money to the mix and even change the way work is performed, but it is useless if they don’t actually eliminate the problem employees. Sometimes the problem is difficult to determine as the employee(s) are a part of management or are considered good employees. It’s not about performance so much as the environment they create. Fixing the problem involves getting rid of the minnow(s). It is a problem that I’ve seen left unsolved because one or two people are good employees in spite of the environment they create or cause. Just because someone is good at their job doesn’t mean they’re necessarily a good fit for the environment or people they work with. Whether it be a different career field or a different work environment, the minnow is best dealt with by not being in the situation they are in.
Remembering the minnow in the fish tank also is a reminder that, no matter what you do, some people are never going to be a good fit for the environment they are in. Removing the minnow from the fish tank and putting it in its natural environment solved the problem. It created a good environment for the other fish, plus gave the minnow a place that was where it was supposed to be. The problem was solved and it ended up being a good solution for everyone. Not solving the issue and making it look like you did doesn’t do anything but continue stress and strife for everyone. Actually solving the problem creates the opposite. Everyone gets what they need. It’s a shame that more isn’t done to actually solve problems and eliminate the stressors that create a bad working environment. Not every management style is for everyone, and not every working environment is for everyone either. Elimate those problems, and you solve a lot of the problems with high turnover rates and poor job performance.
as a medical technologist(i run the tests for blood work) of 14 years i’ve experienced quite a lot in the way of rejected specimens. one way a specimen can be rejected by someone who works in the lab is for the specimen to be hemolyzed. hemolysis is what happens when cells burst or lyse causing what would have been yellow serum or plasma to become pink or red. the severity of hemolysis is determined by the color of the serum or plasma. light pink would be trace to 1+ with gross hemolysis or 4+ being a bright red color. hemolysis can affect potassium levels along with other tests like magnesium. it can also affect the outcome of colorimetric methods used for testing. an example would be coagulation studies. some instruments are affected by hemolysis while other instruments with a different methodology are not. thus, the reason why different labs will have different standards for specimen rejection. for example, one lab may use one test methodology while another lab uses a different analyzer with a different way of testing the same test. there is also a difference in what is acceptable as part of the culture of one lab to another, even one tech to another. this isn’t a standardized part of working in a lab, and tech discretion is something that is usually followed when determining whether a specimen needs to be rejected and redrawn. i personally will run a chemistry level if a specimen is slight to moderately hemolyzed and note that the specimen is hemolyzed IF the potassium level is normal and the patient does not have a history of low potassium levels. other techs might have different standards they set for themselves as to what they reject.
what causes hemolysis? i don’t pretend to be an expert by any means, but i do have enough experience to explain the more common causes of specimen hemolysis.
the most prevalent reason a specimen becomes hemolyzed is because there was trouble acquiring the specimen. either the patient was a hard stick, or the person drawing the blood had a hard time getting blood from the patient. blood should flow free. it should be a smooth draw with no stops and starts. the easier the blood is to obtain, the less likely it is to be hemolyzed. the longer it takes to get the blood in the tubes means there is a chance for clotting(cells clump together) which when forced into a tube can cause hemolysis. another method i know of that causes hemolysis by force is when a health care professional uses a syringe to draw from a line or port. instead of pulling back the plunger of the needle a little bit at a time, the plunger is pulled all the way back to the back of the syringe forcing the blood to fill the syringe. the blood is forced into the syringe instead of being coaxed into it a small amount at a time which damages the red cells and causes hemolysis.
the needle crimp-another way to cause hemolysis. when drawing with a smaller gauge needle, it is easy to bend the needle when either drawing the specimen or putting the specimen in the tubes. the average size of a rbc is 6-7 microns. the lumen of a smaller gauge needle is just enough for those cells to pass through without being damaged. when the needle on a syringe is bent, even if it is straightened, the crimp will damage cells that pass through that part of the needle. the cells are shredded or burst open causing hemolysis. the solution is to replace the needle and use a new tube if possible.
another reason hemolysis can occur is the patient’s disease process. the cells are more fragile than normal. this can be part of the disease state or due to medications or other substances the patient is exposed to. these occurrences of hemolysis are relatively rare and are usually discovered after multiple collections with different people drawing the blood. it was easy to collect, but it is still hemolyzed usually means there is something going on with the patient and not the people drawing the blood.
prolonged tourniquet use can also cause damage to cells as well as vigorous mixing of the tubes blood is collected in. the goal of mixing anticoagulant tubes is to get the anticoagulant in the tube to mix with the cells preventing clotting. not all tubes require inverting or mixing, but the ones that do should never be shaken. inverting the tubes several times is enough to mix the specimen.
in general, a lab is only as good as the specimen it receives. there are exceptions, but a phlebotomist or person drawing blood has an important job. the way a specimen is collected can influence a patient’s lab results. i hope this helps people realize the importance of a properly collected specimen.
I wonder if the reason why some people rape is because they know they cause lasting damage to another person. And if a person who has been raped chooses to move on and have a healthy sex life, should they be judged for it? Is that something that people have a right to have a problem with? It’s your life, why waste it dwelling on some person who doesn’t deserve it. He/she took from you without asking. They shouldn’t get the right to interfere in the rest of your life too. We scrutinize victims of rape but don’t do the same the same for the rapist. The same goes for life after rape. Why should anyone live their lives thinking about a person, or giving their attention to someone who forced you to.
~you wouldn’t need to get involved in your wife’s problems with other women thereby making it worse
~you wouldn’t need to trash talk other women to make your wife appear better
~you wouldn’t tear a woman down career wise or dog her to make yourself or your wife or girlfriend appear better
~you wouldn’t need to call someone else your wife’s name so that person has to deal with stuff your wife should have to deal with
~you wouldn’t call your wife my name so people do stuff to me or say stuff about me instead of her
~you wouldn’t have a problem saying you want to be with me
~you wouldn’t enjoy seeing me hurt, upset, or sick
~you wouldn’t make fun of or humiliate me
~you wouldn’t try to control everything in my life
~you wouldn’t try to take me from my family and friends
~you wouldn’t needlessly create drama in my life
~you wouldn’t interfere with my job
~you wouldn’t have a problem with me being independent, having a job, or with me wanting to make my own money
~you wouldn’t have a problem with my intellect
~you wouldn’t have a problem with me having emotions
~you wouldn’t use your friends against me
~you wouldn’t have a problem with my beliefs even if they weren’t the same as yours
~you wouldn’t have a problem with my appearance and wouldn’t be cruel in the way you speak of me
~you wouldn’t be bitchy and dog me to others
~you wouldn’t be afraid of me 😉
~you wouldn’t be afraid of other people and what they would say if you spoke to me
~you wouldn’t be such a jerk to me
~you wouldn’t make stuff up about me that isn’t true
~you wouldn’t try to ruin my reputation
~you wouldn’t broadcast the details of my private life
~ you would respect my privacy
~you wouldn’t put me at risk-diseases, illnesses, bankruptcy, etc.
~you wouldn’t use me for your own gain
~you wouldn’t mind my hang ups or flaws
~you wouldn’t mind spending time with me
~you wouldn’t mind being seen with me, knowing me, or loving me.
~you’d not care if my family liked you more than me
~you’d keep your wife away from me. i am not having an affair with you and quite frankly am sick of you using me to cover for whatever sorry person you actually are having an affair with.
~you wouldn’t need to read this
not an all encompassing list, but it’s a start. it could work for women too..
~ i want to be able to make an appointment without getting attitude from your office staff. without having to explain in detail why i need an appointment. without having to prove or persuade your office staff i need an appointment, and without having to give them my social security number.
~i don’t want to have to wait an hour to see a nurse or p.a. when i arrive for my appointment.
~i want the nurse i see to not announce my weight to everyone within earshot and i want an accurate blood pressure. tip: use a machine to do the blood pressure because if not your results will always be called into question as to their accuracy.
~i don’t want to have to fill out a questionaire that isn’t relevant to my doctor’s appointment. my family history isn’t something that i want everyone to know, especially if it has no bearing on my being treated.
~i want to talk to you, not the nurse, p.a. and office staff about my symptoms. i shouldn’t have to repeat the same information over and over. on some visits, by the time i get to see you or the physician’s assistant, i have repeated myself 3-4 times.
~if your nurse does a history on me, actually read what he or she wrote before you ask me the same exact questions they asked me.
~i’d like to actually see you-eventually. i know physician’s assistants have their benefits, but they do not have the same skills as you.
~i would like to not have to wait so long to get an appointment to see a you. you can try to make this look like you are so busy, but we all know that’s not the case.
~i’d like you to know my name before you walk into the room to see me.
~i’d like to NOT have to shake your hand. i don’t know where its been. you are a doctor and you see sick people all day. why would i want to expose myself to that?
~i’d like you to listen to me and ask questions relevant to you being able to treat what is wrong with me.
~i’d like you to actually read my chart before you see me so you know WHY you are seeing me. the same goes for performing procedures. i’d like you to review my chart beforehand so when it is time for the procedure you know why you are doing it.
~if i ask you a question i want you to answer me. i ask because i want to know, to understand-not because i am stupid. if you don’t know say so and send me to someone who does know, could know, or would know. don’t feed me a line of bs. i’m not a doctor but i do know enough to know when you are full of it. don’t waste my time and money. i don’t go to the doctor for fun. i go to get treated. so you calling me a hypochondriac because you lack the skills or work ethic to treat me isn’t doing anything to help your reputation.
~i want you to treat me like a person. i’m not your subject to be treated the way you want to treat me. i am your patient and your job is to provide a service to me. your job is dependent on patients using your services. i shouldn’t have to be grateful that you actually treated me like a person and was kind enough to actually want to fix whatever illness i had.
~wait until i see you to diagnose me. i want to be treated for what is wrong with me, not what other people think might be wrong with me, what you assume i have wrong with me, or what you have decided you are going to say i have wrong with me. to do this you have to do something that every doctor should know how to do–listen.
~i want you to treat me. not other people. i am not a fake patient, part of role play, a game, or part of a reinactment. i am an actual patient who works for a living. i am not independently wealthy. so, your attempts to milk me for more money than what i have might be the reason why i don’t like to pay your bills.
~how about not charging an arm and a leg for less than 5 minutes of your time. i am not rich. i have a problem having sympathy for you and your finances when i have to spend my money and time to see you for such a brief period of time. i spent part of my day to see you when i could have been doing other things. i may/may not have been given an adequate diagnosis, treatment, or time to explain my medical problems and you want me to pay you a high fee for it?
~i want a doctor’s appointment that isn’t a gamble. are you a good person to see? are you going to be an asshole? are you going to treat me for what is actually wrong with me? are you going to charge me an outrageous bill? are you going to be someone i see again, or am i going to have to spend more money trying to get treated by someone else?
~i want to know what the charges are. you don’t know? why not? and your office staff doesn’t know either? that’s something you should know the answer to.
~if you are a woman, how about not being a total bitch. maybe i came to see you because i preferred being seen by a woman. i know medical school can be tough, but really? you have to take it out on me?
~i don’t want to question whether or not my exam, procedure, or visit was legit. how about you do things the way they are supposed to be done. i am not made of money and do not have the time or finances to be seen by multiple people to find the right person to treat me. be the right one the first time.
~HIPPA do you know what that is? then why aren’t you and your office staff adhering to it?
~billing-does your office staff know what to do? if not, why are they still employed? they are a part of your office along with your front office staff. they represent you. i don’t want to be charged for stuff you didn’t do. i don’t want outrageous bills for things i could have had done elsewhere without insurance for less money. if you were involved just a smidge with your office’s day to day operations, you would know things that could enhance your practice.
~treat me as a person. i know you might be seeing me for one body part, but some other part of my body might be causing my problem. this should be common sense.
~don’t joke, make fun of me, or talk about me where i can hear it. don’t talk about me or make fun of me to your office staff, friends, or colleagues. my office visit and medical records are private and should remain that way. your office staff needs to learn this too. professionalism is something you should have mastered before you graduated from medical school.
~explain to me what’s going to happen, what can happen, or what i have. i shouldn’t have to ask everything. part of your job is to communicate to your patients.
~take a cue from the doctors people like. study them. try to be like them. because they are going to take all of your patients if you don’t learn from them.
serotonin syndrome-a sad effect of a happy drug.
how many people would be alive today if more information were shared with the public about the negative side effects of mental health medications. how many people went to sleep and didn’t wake up because of the medication they were prescribed? if they were placed in a category that defined them as being at risk of being suicidal, why bother investigating? they were at risk of being suicidal, right?
how many doctors prescribing these medications know about serotonin syndrome? how many explain to their patients that they can have serious problems as a result of the drugs they prescribe? how many doctors even know the difference between how these medications work? how many doctors care enough to not medicate patients who don’t need it?
the signs, symptoms and definition of serotonin syndrome can be found online, and with the prescription information provided with certain mental health drugs. i urge anyone currently taking mental health medications to become educated as to the side effects they can cause.
hepatitis c is a lot easier to be infected with than hiv. hep c can be acquired by the same method of transmission as hiv, plus, it can be acquired by household contact. hiv only lives for hours if the virus is outside the body. the hep c virus can live for up to a week outside the body. more people have hep c than hiv, and most people that have hep c don’t know they have it. they are asymptomatic and can be that way for years. by the time symptoms occur, the person has irreversible liver damage. like hiv, you never get rid of hep c. i think they are both horrible diseases to have, but the acquiring of hep c versus the acquiring of hiv? hep c wins.