Applying rules of engagement to real-life scenarios

Take-home message: Rules can serve as invaluable guidelines for the future, as they are lessons learned from experience.

By Dianna E. Graves, COMT, BS Ed

I have been a faithful follower of “NCIS” for 11 years, ever since it was a spinoff from the “JAG” television series.

I almost didn’t survive when Ziva David left-but stuck with it, and am still a faithful follower even with all the different scenarios and conspiracy plots. At one point, I even tried to make a running list of “Gibbs’ Rules.”

The character, Leroy Jethro Gibbs-better known as actor Mark Harmon-is a former Marine Gunnery Sergeant/ex-sniper. He is a no-nonsense leader with a ferocious head-slap and a steely stare, but deep down he loves his team, and to him, they are the only family he has left.

Gibbs has a rule for everything, and his team knows them by heart. These rules are interspersed throughout various episodes tying his past to the future of the team.

When “NCIS” first started, I was much younger and thought these rules were a little too restrictive to the investigators’ creative flow. But, they always seemed to tie everything together by the end of the show.

Rules of the road

Somewhere along the way, I began to develop my own set of rules.

While I was teaching, I would espouse:

Diane’s Rule Number 28: “If you used the last one-get another!” or Diane’s Rule Number 2: “Never take your eye off the patient while doing the exam-even if you think they are perfectly normal. Those are the ones to especially watch.”

One year, as a gift from a graduating class, an enterprising student recorded all my rules in order. Wow, I never knew I had that many rules. Quite honestly, I always used a different number because I never kept track of what number matched what rule.

Looking through the list, I feared that it, too, was very restrictive. Even though these were my “rules of the road” that I had developed after experiencing many scenarios, they might not always fit someone in a different clinic location/setting (private office versus hospital setting).

I realized that such rules did make sense, regardless of where they were taking place. As an example, for the above-mentioned Rule Number 28, have you ever reached into the refrigerator and grabbed a carton of milk, before realizing there was a teaspoon of milk left in the carton? And you had just come back from the grocery store?

After writing my rules and giving them a decreed set number this time, I went back and reviewed Gibbs’ Rules. They weren’t so different, except that I am in the medical field and he is in the crime-fighting field. They fit – and for me they flow.

Here are my top “go-to rules” that might apply to your office.

Rule 1. If you’re not going to do it right, don’t do it at all.

Nothing irritates me more than employees who go into a task knowing they are not going to give it their best. You can see it as they enter the room-the “When’s lunch?” look on their face. They know the rules and they know the skill, but instead they perform at 75% because they are not into it. If they are going to sleepwalk through the day, send them home. They are not helpful to you or the patients and may even pose a danger by performing incorrect tests/procedures.

Rule 2. Never take your eye off the patient while doing the exam-even if you think they are perfectly normal. Those are the ones to especially watch.”

On one particularly busy afternoon at the hospital, we were all fried. I went to the waiting room and called a patient. A “business woman” stood up, smiled, and entered the room. I thought: Relief, I finally got someone who’s not talking to the ficus tree in the waiting room, or threatening to sue the clinic because we won’t let them watch “Dr. Phil” on the TV.

We sat down, and I began to review the chart. My guard was down, she was talking to me and telling me what her concern was, and even laughed once in a while. Then I began my routine by saying: “Let’s see what we can do for you today. Okay, how old are you?” That was the last thing I remembered.

She caught me with a right hook to the jaw and down I went. Evidently, she had an age problem. How could this happen with my professional woman patient? The reason she was dressed up was she thought she was Cybill Shepherd from the TV series “Moonlighting.” Funny, I watched that show every week-no real resemblance.

Rule 2 subparagraph b. “Just because their feet are pointing in the right direction doesn’t mean their legs are attached.”

This occurred during my Veterans Affair hospital tenure, but also pertains to any situation where a patient might be transferred from a wheelchair to an exam chair.

I had a gentleman wheel his way into my exam lane. He had a Navy lap blanket covering his legs. We discussed his blanket and the logo and how his wife had done a great job knitting this for him because his legs got cold. He was there for a follow-up from a stroke. I asked him if he needed help getting into the exam chair. He said he could do it himself, and began to do so.

The last thing I saw out of the corner of my eye was he started to fall. I reached my right arm out, he grabbed it, and we both went down. I ended up in a cast on my arm for the whole summer. Two other technicians helped him into the exam chair. Still lying on the floor, I looked at his chair. There were his two prosthetic legs-pointing in the right direction. He did not have his remaining legs in the prosthesis because they were sore-and he had forgotten. Moral of the story: Do not presume patients can transfer themselves simply because they say they can. Pay full attention and be close by to assist.

Rule 3. If you tell one person a secret, it isn’t a secret anymore.

Be careful of the information, feelings, and opinions you share with the staff. It will get spread around-even if it is innocently done.

Rule 4. When you think you have seen it all-look again.

Rule 5. There is no such thing as coincidence-you just weren’t paying enough attention to see it coming.

Rule 6. Don’t be afraid to apologize. It is NOT a sign of weakness.

This is where I disagree with Gibbs’ rule of never apologizing. The ability of leaders to apologize when they have been wrong is a sign of strength, and shows respect for staff. We don’t always have the answer, and we can make mistakes just like the next person. But laying blame for mistakes on others, or ignoring that it happened, is a poor leadership attribute that needs to be corrected immediately. Your staff knows you made a mistake-admit it and move on.

Rule 7. Been there, done that, bought a T-shirt, and sold it at the yard sale.

Don’t forget the past and the lessons you can learn from it-but don’t dwell there or lean too heavily on it. Use the past to guide you into the future, but leave the past in the past.

After writing down the first seven of my rules, I realized there were more. The good thing about rules is they act as invaluable guidelines for the future, as they are lessons learned from experience.

Use the past as a strong base for future plans. Just make sure to remember another rule:

Rule 36. Rules are always made to be broken as long as you have a better one to take its place.

Dianna E. Graves, COMT, BS Ed

E: dgraves@stpauleye.com

Graves is clinical services manager at St. Paul Eye Clinic PA, in Woodbury, MN. Graves is a graduate of the School of Ophthalmic Medical Technology, St. Paul, MN, and has been a member of its teaching faculty since 1983.