{"id":40737,"date":"2017-12-05T11:35:49","date_gmt":"2017-12-05T10:35:49","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=40737"},"modified":"2017-12-05T11:35:49","modified_gmt":"2017-12-05T10:35:49","slug":"jen-gosling-difficult-is-a-difficult-word","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/12\/05\/jen-gosling-difficult-is-a-difficult-word\/","title":{"rendered":"Jen Gosling: \u201cDifficult\u201d is a difficult word"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/11\/Jen_Gosling_photo-1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-40739 alignleft\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/11\/Jen_Gosling_photo-1.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a>\u201cThey keep saying I\u2019m difficult\u201d, the patient wept. \u201cI feel so guilty; I worry that they think I\u2019m not co-operating\u201d. It was the second time in a week that we had met. Both times, after multiple unsuccessful attempts at cannulation, the patient had been told that the anaesthetist would be along \u201cto have a go\u201d.<\/p>\n<p>Intravenous cannulation is a basic skill, required to facilitate numerous treatments. Yet there are many reasons why cannulation attempts may be difficult and ultimately fail. Operator experience, human factors, patient anatomy, and patient physiology could all be contributing factors.<\/p>\n<p>We recognise that early identification of patients for whom practical procedures are likely to be challenging creates opportunities for advance planning. Thus we have developed concepts of the \u201cdifficult back\u201d, the \u201cdifficult airway\u201d, \u201cdifficult access\u201d, etc.<\/p>\n<p>While we appreciate that communicating these issues between professionals can reduce the likelihood of morbidity and mortality, \u201cdifficult\u201d is a\u2026well\u2026difficult word. The word has a moral dimension; a suggestion of volition. It is how we might describe a sullen child.<\/p>\n<p>Without careful and sensitive explanation, and coupled with an aggressive phrase like \u201chave a go,\u201d being labelled as \u201cdifficult\u201d can be deeply upsetting to someone already traumatised by the physical pain of repeated needling. Is our preoccupation with this word actually a reflection of our own frustrations when faced with failure of a supposedly simple task?<\/p>\n<p>Access to ultrasound and other vein visualisation aids is increasing and offers sophisticated solutions for managing technical challenges; however, we can still make better use of basic tools, like choice of language. \u201cDifficult\u201d could be replaced by \u201cnot straightforward,\u201d or the patient could be told that the procedure \u201cneeds some planning.\u201d<\/p>\n<p>There is an opportunity here. \u00a0Very simply, by paying more attention to how potentially challenging procedures are discussed, we can enhance the care we give to our patients.<\/p>\n<p><strong>\u00a0<\/strong><em><strong>Jen Gosling <\/strong>is an ST4 in anaesthetics at Northwick Park Hospital, Harrow<\/em><\/p>\n<p><em><strong>Competing interests: <\/strong>none declared<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u201cThey keep saying I\u2019m difficult\u201d, the patient wept. \u201cI feel so guilty; I worry that they think I\u2019m not co-operating\u201d. It was the second time in a week that we [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/12\/05\/jen-gosling-difficult-is-a-difficult-word\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-40737","post","type-post","status-publish","format-standard","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Jen Gosling: \u201cDifficult\u201d is a difficult word - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/12\/05\/jen-gosling-difficult-is-a-difficult-word\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Jen Gosling: \u201cDifficult\u201d is a difficult word - The BMJ\" \/>\n<meta property=\"og:description\" content=\"\u201cThey keep saying I\u2019m difficult\u201d, the patient wept. \u201cI feel so guilty; I worry that they think I\u2019m not co-operating\u201d. 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