Sunday 15 November 2015

It is a medical axiom not to advance treatment uphill for the patient

It is a military axiom not to advance uphill against the enemy, nor to oppose him when he comes downhill.

Do not pursue an enemy who simulates flight; do not attack soldiers whose temper is keen.

Do not swallow bait offered by the enemy. Do not interfere with an army that is returning home.

When you surround an army, leave an outlet free. Do not press a desperate foe too hard.

Such is the art of warfare.

From "Sun Tzu on the Art of War - The Oldest Military Treatise in the World"
Translated from the Chinese By Lionel Giles, M.A. (1910)

Discussion:

Again creativity was required in translating the word "enemy" in this part. With agreements of wordings in mind, utilised various contexts where clinicians are required comparable manoeuvres.

Translation:

It is a medical axiom not to advance treatment uphill for the patient, nor to operate him when the patient's complications are downhill.

Do not prescribe for a patient who hoards medications; do not administer drugs whose adverse reaction is keen.

Do not swallow bribe offered by the patient. Do not interfere with a patient that is returning home.

When you summon a patient, leave an outlet free. Do not press a desperate family too hard.

Such is the art of healthcare.

Ray Murakami

Saturday 14 November 2015

Spoken word does not carry far enough: hence the institution of prompts and checklists

The Book of Army Management says: On the field of battle, the spoken word does not carry far enough: hence the institution of gongs and drums. Nor can ordinary objects be seen clearly enough: hence the institution of banners and flags.

Gongs and drums, banners and flags, are means whereby the ears and eyes of the host may be focused on one particular point.

The host thus forming a single united body, is it impossible either for the brave to advance alone, or for the cowardly to retreat alone. This is the art of handling large masses of men.

In night-fighting, then, make much use of signal-fires and drums, and in fighting by day, of flags and banners, as a means of influencing the ears and eyes of your army.

A whole army may be robbed of its spirit; a commander-in-chief may be robbed of his presence of mind.

Now a soldier's spirit is keenest in the morning; by noonday it has begun to flag; and in the evening, his mind is bent only on returning to camp.

A clever general, therefore, avoids an army when its spirit is keen, but attacks it when it is sluggish and inclined to return. This is the art of studying moods.

Disciplined and calm, to await the appearance of disorder and hubbub amongst the enemy:--this is the art of retaining self-possession.

To be near the goal while the enemy is still far from it, to wait at ease while the enemy is toiling and struggling, to be well-fed while the enemy is famished:--this is the art of husbanding one's strength.

To refrain from intercepting an enemy whose banners are in perfect order, to refrain from attacking an army drawn up in calm and confident array:--this is the art of studying circumstances.

From "Sun Tzu on the Art of War - The Oldest Military Treatise in the World"
Translated from the Chinese By Lionel Giles, M.A. (1910)

Discussion:

This part was translated referring Improving patient safety in the operating theatre – teamwork and communication from The Health Quality & Safety Commission New Zealand and WHO surgical safety checklist and implementation manual. Creativity was required in translating the word "enemy" as in operation theatre there are no apparent enemies.


Translation:

The Book of Health Management says: On the theatre of operation, the spoken word does not carry far enough: hence the institution of prompts and checklists. Nor can ordinary objects be seen clearly enough: hence the institution of visual aids and markers.

Prompts and checklists, visual aids and markers, are means whereby the ears and eyes of the team may be focused on one particular point at a time.

The team thus forming a single united body, is it impossible either for the brave to advance alone, or for the cowardly to retreat alone. This is the art of handling a multi-professional team.

Before the induction of anaesthesia, make use of “sign in” checklist, before the incision of the skin, of “time out” checklist and before the patient leaves the operating room, of “sign out” checklist as a means of confirming completion of tasks by the ears and eyes of your surgery team.

A whole team may be affected in its spirit; a chief surgeon may be affected in his presence of mind.

Now a team's spirit is keenest in "sign in"; by "time out" it has begun to flag; and in "sign out", its mind is bent only on returning to station.

A clever surgeon, therefore, avoids a team's too eagerness when its spirit is keen, but cautions it when it is sluggish and inclined to return. This is the art of studying moods.

Disciplined and calm, to await the appearance of disorder and focus amongst the site:--this is the art of retaining self-possession.

To be near the area while the operating time is still far from the limit, to wait at ease while the aid is toiling and struggling, to be well-oxygenated while the bleeding is controlled:--this is the art of husbanding one's strength.

To refrain from intercepting a team member whose points are in perfect order, to refrain from attacking an objection drawn up in calm and confident way:--this is the art of studying circumstances.

Ray Murakami