This is a copy and paste of an entry that I posted on the Mercy Ships intranet site:
In the Madagascar 2015/2016 Field Service, 85% of the patients that we encountered during our 11 field screenings had problems that are not captured within the surgical scope of practice on the ship. This is a significant statistic because it represents thousands of patients to whom we have had to say, “No”.
Most people that understand the screening process within Mercy Ships get this. We’ve been given several wonderful opportunities over the years to share this difficult part of our jobs – from programs reporting time to community gatherings. Our closest confidants know how much this part of the job eats away at our spirits. We caution our applicants about this fundamental aspect when they apply for a position on the team.
For me, one of the most beautiful parts of the Mercy Ships community is how incredibly it supports our team throughout this difficult task. Extra portions of grace are extended to our team especially in our busiest of seasons. We truly do feel loved and supported. With this post, I wish to express our sincerest gratitude and appreciation to you all.
We are in the midst of one of the busiest prep and planning periods that we will do for the upcoming field service. It seems as if a constant stream of numbers run through my tired brain. How many patients for this specialty? How many surgical slots do we save for patients from the interior? We can gain an increase in surgeries here but how does that affect rehab? Or the wound care team? Or outpatients? How do we adjust for “no shows” and patients that ultimately will not be surgical candidates?
For our surgeon screenings we always bring in extra patients as a buffer in case some simply do not show up for their appointment, are sick or have a medical problem that delays their surgery, or are ultimately not a surgical candidate according to our scope of practice and the skills of the surgical team. We do our very best to calculate this as precisely as possible but inevitably we end up with an excess of patients and therefore must triage them, something most medical people are unfortunately all too familiar with.
This evening as I went over some numbers on how many neglected clubfoot patients we would bring in to screen in September, I paused at a thought that I surprisingly have never had before:
I am knowingly bringing in more patients than we can help.
I am planning on saying “No” to a certain number of patients during every screening.
In this particular case, it was just a mere 3 extra patients that I would bring in for this buffer for “no shows” and “no candidates”. For most surgeon screenings it is usually 10-15. Is that not such a dismal thought? Planning to give bad news?
My shoulders slumped and my face fell into my hands as that thought registered with me. I find it difficult to find a silver lining that comes with delivering bad news. It is simply no fun and each “no” weighs heavily on me. But that doesn’t mean I still don’t view this job – this work we do as an organization – as the greatest privilege I have ever had. Because for me, it truly is. We have the privilege of walking with others through this harrowing process of life and experiencing the vast spectrum of the human experience. The pain, joy, sorrow, laughter, anxiety, freedom, and adventure. These dynamic emotions and experiences remind me that we are all connected.
That deep connection that we all share ultimately makes me want to work harder. I want to strive to improve our procedures and processes in order that they reflect the patient’s best interest. I want to pursue clinical excellence so that our medical assessments result in fewer patients being canceled for surgery and therefore fewer OR tables empty. I want to stay up late at night dreaming of creative ways we can improve the efficiency and safety in how we reach out to find and select patients.
What a privilege this truly is. Again, my sincerest thanks to the entire organization for the love and support that is poured out onto this team.
Nathan Claus, Screening Supervisor