Wow, there’s some click bait. I feel a little arrogant writing that. I have no medical training at all. What do I know about this? And by the way – if someone wants to take me to task for what I am going to write – you should do so. Your comments may be helpful to someone. Please try to be polite. With all due respect though, anyone who feels criticized by this is missing the point – so please read the entire thing before you yell at me. I am criticizing a process, not a person.
Awesome! This is the word I use to describe the people who work at my local medical facility. Many people have had negative encounters with medical staff who are unconcerned or rude. I have.
Those people don’t work at the place I have been going to for treatment. Every doctor, every nurse, every staff member I have worked with is outstanding in my opinion. I know of at least one doctor who works on their day off for free each week due to the workload. These people are the salt of the earth. They are trying to save my life. They really care and it shows. They are heroes. This is not about them, but rather a systemic problem that flashes red to me given what I do have a background with.
I have been a freelance software engineer for most of my career. I have worked for several dozen companies and hundreds of projects over the years. I know this stuff.
Curing the flu is a task. Treating cancer – at least what I have now – is a project that is treated as a task. This is the problem I’m trying to raise here. There is no Cancer Project Manager. Not for me.
A software product usually involves a number of skillsets or ‘hats’ as we tend to call them. Data Base Administrators, Developers, Analysts, Testers … the list can go on depending on the skillsets needed for that project. But – one very essential team member is the Project Manager.
This person has a thankless job. The PM isn’t the top gun. The people on the project typically report to the PM’s boss as well. But what the others do or don’t do is on them. We call the PM the ‘cat herder’ because it is their job to deal with the nerds with their headphones writing code in the corner somewhere. They often begin their day hoping the ‘cats’ will get up early enough to show up for the morning standup meeting at 10:00 – the one that was moved back from 9:00 because no one showed up on time. But they have a very vital and critical job – which is to manage the project. They track tasks and make sure Task A is ready in time to incorporate it into Task B or whatever needs to be done to achieve the goal.
They have a deadline to meet. If this is slipping, it is their job to figure out what the problem is and correct it. It may be a lack of communication. It may be a lack of resources. Maybe they will pull a developer who is ahead on their task to help with the one that is now behind. If all else fails, they have to go to management and explain that the deadline must be moved back. They seriously don’t want to do this.
I have never had any desire to have this job. I want to sit in the corner and write code all day. But there is always a PM. They must be there and involved, or things can go south very quickly.
Before getting to the real point, I would like to relay an example of what can happen when there is noone at the wheel – the project I nicknamed ‘The Titanic.’ It was absolutely the worst by far I have ever seen. This is an extreme example to illustrate the point. Something like this is not going to happen at a medical facility. The doctors are not untrained and incompetent as they are in this story. But this worst example case does illustrate what can go wrong with no Project Manager involved.
The two developers working on the project were seriously out of their league. There was a Project Manager on paper, but he was working on other projects and AOL on this one for whatever reason. By the time anyone checked what these people had been doing over the previous several months, the lifeboats were starting to launch.
I was pulled onto the project very late. There were two people doing this initially, but when management discovered what was going on, they pulled everyone off their projects to try and salvage this one. I knew it was no use when I saw what had been done. It was all crap – no hope.
My desk was already cleared out (while my co-workers laughed me – Mr. Negative) several days before we were told to take off and go home for good. This part of the project was so bad – the client fired the entire company. No more project. No more tasks. Crash burn. Huge financial mistake that very easily could have been avoided. This cost my client (ex-client now) some serious money and a lucrative contract.
I’m a ‘full stack’ developer. I can do everything. I am an expert with SQL, but I don’t bill myself as such. The ‘DB Administrator’ certainly wasn’t one and really didn’t even understand the basics. He was totally useless (nice guy, wrong profession). After I came on board, he was constantly coming to me for help. “I need a crosstab query for this, but they are really hard.” Ok – I learned how to do a crosstab query and an hour later I handed it to him. I have a brain. I use it. It’s my job to learn ‘hard’ stuff. “This is why you make the big bucks.” They used to tell us back when I was a Computer Science major.
The Crystal Reports guy was worse. I’d never worked with CR. I spent a weekend cramming. Yup – I billed my client for that. The next day, the CR expert was coming to me for help. He didn’t know how to do even the simplest stuff. No credit owed to me. It was my job to do this and I did it. It was his job and he couldn’t.
These people should have never been on this project or ever hired to do any of this stuff in the first place. But – the real problem and the point I’m trying to make here is that the project manager was nowhere to be seen. This should have been caught the first week – not after it was too late.
In my own experience, cancer was found in my body back in April via an annual image for a previous issue. At the time I was told I was lucky because it was caught early – very important with cancer.
By the time I began treatment in November, I wasn’t lucky anymore. The ‘early’ talk was 7 months in the past. Now I was told it was very aggressive, and I would die in 6 months without treatment, which might extend my life by a few years. Quite a difference 7 months makes!
So far, this has involved 4 doctors, many nurses, many labs, 3 biopsies and a CT Scan. There should be even more hats involved, as I will describe below. *THIS* my friends is not a task, it is a project.
But there is no Cancer Project Manager. There was no one with a Gantt chart tracking the deliverables with an estimated target date for completion. If you review the major tasks above and do a little math, you will see that each one took an average of a month or so – hence the delay.
Each individual did their job with great competency, but there was no one looking at a high-level view. Triage should be used when it comes to scheduling. In the ER, someone with a heart attack will be treated before someone with a broken leg. The first case requires attention right away. The person with the broken leg doesn’t want to wait, but they aren’t going to die waiting. The other patient might. There just doesn’t seem to be this process at work – not where I’m being treated – not for me at least. I received the ‘broken leg’ version.
These delays appear to be quite common – at least anecdotally – but each anecdote presents an opportunity to correct this problem. No study needed for this. Just do it IMHO.
Here is an example of how a Project Manager might have approached my cancer project as if it were a software product:
- This patient has aggressive cancer that was caught early via an annual image and needs treatment ASAP.
- We are setting a deadline for treatment to begin mid-June at the latest.
- Due to the nature of this case, there are potentially an unknown number of procedures that may need to be completed before treatment can begin. This is a potential risk to completing the deadline on time and warrants special attention.
- Given the previous point, it may be necessary to make some adjustments regarding scheduling to ensure completion of the deadline.
Sure, you can say that it is me who should be doing this. Ok – fair – except I’m a nerd not a doctor. How would I have known this? I was told I was lucky it was caught early. I didn’t know at that time there was even a chance in the world that it would take this long or why. So – sure I’ll take some blame if you wish – but that isn’t going to solve this problem. Lives will be lost by people who ‘should have known this.’ That is not an adequate solution. Not without at least presenting the patient with a big sign that says:
You are on your own as far as managing this!
If I had received tris caveat, *my* actions may have been different. It is too late now. There is no way to know for sure – but what *I* think is that I had a good chance to beat this, but the opportunity was squandered away and now I am terminal. Being told you have a life expectancy of 6 months after no treatment for 7 months kind of sucks. It’s hard to put a different spin on that.
Well we shall see about that. Anything that wants to kill me is going to have to get past me first. I have a brain. I have skills. I am not a wimp. Don’t count on the diaries ending that soon. I have a Cancer PM now (me). And that WILL improve my odds. It will. Be yours too.
What I am talking about would not take a lot of resources – not this. A cancer nurse coordinator could probably manage a large number of patients at such a high level. Most would probably need no action at all – everything on time. A few might require more attention – but this would be a phone call or perhaps a meeting. I’m not telling anyone how to do medicine. I’m telling them how to run a project.
One more thing. I will be writing more about this in future diary, but it does not stop here. The oncologist is a hat with a task. It takes more than that to do this. Cancer’s crack is sugar and its crack house is inflammation, but no one has been doing anything about my nutrition to address these things or even mentioned this to me.
Ok – on me? Sure – but wish I had known this earlier. If the patient needs to manage their own project, they need to know things like this. I found this out by doing my own research. Seems like some medical professional somewhere should have at least mentioned it. I don’t mean the oncologist. This person’s job is to administer chemotherapy. It’s not his job to know about nutrition.
The oncologist has no business giving advice about nutrition. Cancer nutritionist is a specialized skill. No one asks me about testing procedures. This isn’t my job. Nutrition is not his job. And – I checked – the stuff about nutrition I find on-line is illogical, contradictory, inaccurate and useless to me. I need a real expert not a web page.
Does anyone out there think it’s a bad idea to address nutrition? That would seem silly to me – but if so – by all means speak up! Tell me what I’m missing. This is western medicine.
Assuming it is a good idea – why was it never mentioned to me? Because there was no Cancer PM to see to it. That’s why!
I suggest there are a number of roles, tasks and advice that the Cancer PM should be managing:
- Oncologist
- Cancer Nutritionist
- Therapy
- Spiritual (as applicable)
- Financial assistance
- Coordination with the patient’s GP
- Exercise
- Family outreach
- ...there must be many more…
I’m not talking about a website portal that the patent can refer to – a human needs to do this. If this project was a software project and I was the PM, at least the people on the list above would be on the team.
Anyone who understands this stuff should realize that I am not talking about a huge increase in reasorces to do this. An arguement can be made the a well run project actual makes better uses of the resources available. And — it is my firm believe — that this system may very well have resulted in life-saving care for me. If you don’t have a Cancer PM — and you probably don’t — you need one even if it’s you. It may save your life.
I’d love to read your comments!!!
