Identifying Your Blind Spots

By Justin Kreuter • May 8, 2017

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I was recently at a patient blood-management conference where a surgeon spoke about the need to transfuse trauma patients with whole blood (rather than using a balanced ratio of blood components). After his talk, a comment was made that the blood bank made the switch to component therapy out of self-interest. Time out. No. I stood up and roughly made the following points.

We made this change for our patients. Blood remains a life-saving product that is in short supply.

By separating blood into components, we are able to take a single blood donation and create up to three blood products. Importantly, trauma patients only comprise about 10% of my hospital’s transfusion practice; 90% of my hospital patients need a specific component that is manufactured from whole blood (i.e., red cells, platelets, or clotting factors). Blood banks made the switch to component therapy because it makes the most of a limited resource, and it is the ideal product for most patients. Additionally, in the United States, there is growing concern for donor iron stores, which probably will further limit our blood inventories.

I am expressing the frustration that I felt in the moment. Honestly, I felt that frustration for about a solid week. My thoughts festered on the idea captured by this slide that was presented:

This slide shows surgeon and anesthetist as the only named players collaborating to score a "goal" for patient blood management. I wish more had been named.

Where are the nurses, transfusion medicine specialists, hematologists, and administrators? Hopefully, these folks are not "barriers to change"!

Thankfully, May is Trauma Awareness Month, which has helped me reflect and achieve perspective. Interestingly enough, my breakthrough came from a parenting book that I was reading by Paul David Tripp. In his chapter on process, the author opens with, “You must be committed as a parent to long-view parenting because change is a process and not an event.” I certainly see surgeons labeled on my diagram of the soccer pitch. What is my "long view" of this process of engaging our larger surgeon community? I doubt the comments that I made in front of the conference audience will get me an invitation to speak at any surgical society meetings. At the conference (and the week following), I was too self-assured of my perspective. Ironically, I thought that was the surgeon’s problem, not mine!

Going back to Tripp’s book, he describes both parents and children as being "blind to our blindness." It turns out that we all have our delusions. One of mine is my self-concept as a collaborative transfusion medicine physician. However, reflecting on my emotional reaction, my behavior was not collaborative. I wish that I had listened better to the surgeon’s presentation. I wish that I had considered the contexts of our professional environments. If I had, then I would have been more constructive with my comments. I would have still represented the blood bank and donor center perspectives, but I also would have invited him to collaborate on building a donor base to support the ideal trauma program. I should have looked for opportunities to engage based on our shared values.

Please share your reflections below. What is your method for identifying "blind spots?" What are you treating as an event that should be a process? What are your mission and goals?

By the way, our blood donor program is collaborating with our trauma center to build our blood donor community. You can check out our radio interview Sunday morning, May 14.

Justin Kreuter

Justin Kreuter, M.D., is a clinical pathologist at Mayo Clinic in Rochester, Minnesota. His practice consists of both general and subspecialty aspects of clinical pathology. At Federal Medical Center-Rochester, Dr. Kreuter runs the general laboratory that supports a local in-patient population and does a large amount of reference work. At Mayo Clinic, Dr. Kreuter's time is split between the transfusion medicine service and transplant laboratory. In addition to clinical activities, his academic interests include several aspects of medical education, including teaching clinical judgment, frameworks for feedback, and reflection in medical practice.