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The Clinical Excellent Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence is a biweekly podcast hosted by Drs. Adam Cifu and Matthew Sorrentino. The podcast has three formats: discussions between doctors and patients, discussions with authors of research pertinent to improving clinical care and the doctor-patient relationship and discussions with physicians about challenges in the doctor-patient relationship or in the life of a physician.
[00:00:00] Dr. Cifu: On today's episode of The Clinical Excellence Podcast, we have Sybil Caruthers talking about clinical excellence in nursing.
[00:00:11] Ms. Caruthers: I've listened enough to get that information, dig a little deeper because I'll ask them, like you said, the how's, the when's, the why's, the where's. I get all of that and I'm now going to be able to formulate it and send it. They are so thankful that somebody finally listened, that they do come back and say, "Thank you."
[00:00:35] Dr. Cifu: We're back with another episode of The Clinical Excellence Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence. On this podcast, we speak to patients, doctors, and other healthcare workers about all aspects of excellence in clinical medicine. I'm Adam Cifu, and today I'm joined by Sybil Caruthers.
Sybil graduated from Purdue University in 1986 with a Bachelor of Science in Nursing and has been a registered nurse for 38 years. She is Board-certified in ambulatory care nursing. She joined us here at the University of Chicago in 2020 after working at the Carle Foundation Hospital in Urbana, Illinois in the Cancer Center as an oncology triage nurse.
While there, Sybil was awarded the Nursing Professional Excellence Award. On a personal note, after I moved to the University of Chicago, I worked with the same nurse for about 20 years. When she retired and the next two nurses assigned to me lasted only a few months, it was not my fault, I promise you, I thought I was doomed.
I'm happy to say that for the last four years, working with Sybil has made my clinical life a pleasure and has had measurable, improved care that we can deliver to our patients. Sybil, thank you so much for joining me this morning.
[00:01:45] Ms. Caruthers: I'm glad to be here.
[00:01:46] Dr. Cifu: I feel like I dated you, giving you all of your graduation dates and time in nursing and everything. So I apologize. First, just to get started, tell me a little bit about your route into nursing. I know, same as physicians, there are some people who, you know, by the time they're six, they know what exactly they want to do. And there are other people who kind of decide later in life, what was your kind of route into the profession?
[00:02:11] Ms. Caruthers: Well, actually I was in high school and I didn't have a clue what I wanted to do. So I took one of those placement tests and they teach you or give you an opportunity to understand what you're good at. And I was told that I need to get into a people-oriented profession. I think that's because I talk a lot. And I like people. And so I was an athlete there in high school. And I had won the state championship a couple of times. And so I was thwarted towards college, which I wasn't totally prepared for it. And so after taking a placement test, I went up to Purdue for a recruitment visit. And on the paperwork it said, well, what do you want to do? And I had checked off nursing, so they sent me to talk to the nursing counselor. And when I get in there, I'm like, "I don't want to be a nurse." And she said...
[00:03:00] Dr. Cifu: I just checked the box.
[00:03:01] Ms. Caruthers: I just checked the box. And she said, "Well, why not?" I said, "Well, nurses turn people and clean their bottoms. And I don't want to do that." And she says, "Let me tell you something. It's really hard to get into this program, and I'm not sure how you got in here." Now, I had pretty good SAT scores, now that's what got me in there but, she says, "It's very easy to let you out."
[00:03:25] Dr. Cifu: Hmm.
[00:03:26] Ms. Caruthers: "So, I could do that but I want you to do something for me." She said, "Go home, go to a hospital or clinic, ask the nurse what she does, ask her what she can do." And by the time I visited that nurse, and she told me I could be an ER nurse, I could be a manager, I could work all these different areas. I had decided, okay, I'll try this.
So I called the counselor back and said, "Okay, I'll take it, I'll stay in." So that's what it ends up. I went to Purdue on a full track scholarship, which got me in the door, and I actually became the first student-athlete to graduate from the School of Nursing at Purdue.
[00:04:01] Dr. Cifu: How interesting. It's so interesting because you hear so... You probably hear too many stories, right, about people who end up in school for athletics where it's not really right for them, right? And they do poorly because of that but this is more of kind of what we always hope for, right? That it's the athletics that get you into the school and get you into higher education but then in the long run, it's what the higher education sort of provides that actually serves you like for your whole life, right?
[00:04:32] Ms. Caruthers: Exactly because it propelled me into an area where I am happy. I'm thrilled. I'm fulfilled. And I got here through my athletic ability.
[00:04:42] Dr. Cifu: Right, right. And thank God for that advisor who was like, "You don't really know what you're talking about. Here's how you're going to explore and figure things out." So whenever I get to talk about clinical practice with kind of my non-physician colleagues, I'm always interested in how other people in clinical medicine define clinical excellence.
So what are you... When you kind of reflect on, you know, your daily practice, what do you think defines excellent care compared to just adequate care, kind of compared to just doing the job?
[00:05:15] Ms. Caruthers: Well, I think us as professionals upholding our personal, professional, and ethical standards at all times, each of us driving to work as advocates for the patient and their family.
I think we need to also make sure we include that, the family. Utilizing all of our tools in our arsenal to provide them with competent and compassionate care. And I lean heavily on the compassionate and letting them know that they can be treated as individualized with all their care. We're looking specifically at them to promote the best outcomes.
[00:05:49] Dr. Cifu: I think when I sort of, you know, reflect on your relationship with the patients who we take care of together, I'm always struck by kind of the collegial, almost, you know, peer-like relationship that you have with patients. Do you treat people as just, "Hey, you know, I'm just like you, we're working together to kind of help you." Is that something you do consciously or is that something that just feels like that's who I am and that's how I treat people?
[00:06:19] Ms. Caruthers: I enjoy what I do. I enjoy talking to them and finding out a little bit about them and they lead in.
[00:06:28] Dr. Cifu: Yeah.
[00:06:29] Ms. Caruthers: People want to be listened to. They want somebody to talk to. Sometimes they've been waiting on that phone call.
[00:06:34] Dr. Cifu: Right.
[00:06:36] Ms. Caruthers: And that's the difference between excellent and adequate care because if you had a dentist that was just okay. Would you hire the plumber that was just okay? You don't want that in any aspect of your life, let alone your doctor.
And so you want somebody that is going to listen to you because you got something to say. Some people just want to rush you out the door because they got to get to the next patient. These people are so thankful. And then they say, "Oh, thank you."
[00:07:05] Dr. Cifu: Yeah, and you sort of alluded to it. I mean you are so much the first line, you know for a lot of these people. These people, sounds terrible, you know, our patients and often, given that we do primary care, you know, sometimes it is just that thoughtful listening and caring and simple recommendations, which is all they need, right? And you sort of being there to offer them that, and then also triage, okay, you know, what needs more, what do I need to take care of, you know, what do you need to give to me to take care of, is really a skill and I think valuable for the people we're seeing.
[00:07:43] Ms. Caruthers: I thank you for saying that. I actually learned this when I was an oncology triage nurse.
[00:07:48] Dr. Cifu: Okay, okay.
[00:07:49] Ms. Caruthers: Someone may call and say, "I have diarrhea." Well, if I send a message to the doctor and say, "Oh, the patient has diarrhea," they can't go from that. They need more information. And the doctor I worked for said, "Well, I need to know how many times a day are they having diarrhea?" Is it... You know, because diarrhea to you might be once a day and diarrhea to me might be six times a day. So I have to get that information. I have to find out through a phone call everything that I need to provide to the physician so that he can give an adequate, he or she, can give an adequate information to treat because I've got to be the eyes and the ears inside their house. I got to get it all just while I'm on that phone with them.
[00:08:30] Dr. Cifu: Yeah. Question that, you know, I think we wish our jobs was always easy and everybody was thankful and appreciative of our care. Just being completely honest, you know, that's not the case, right? We take care of a lot of people who are very sick, desperate, anxious, and have to deal with that.
And then we take care of a lot of people who are angry, you know. A lot of other things in their life are going poorly and they sort of expect to be treated in the same way, ie. badly, you know, by us. What are your skills for kind of breaking through to those people? And as you say, often on the telephone.
[00:09:12] Ms. Caruthers: Well, a lot of time I've learned that first I listen and I can talk so many people off the ledge because you're right. They're angry. They're sick and they don't have answers and they think that nobody's listening to them. They'd say, "This is what's wrong. This has been bothering me for this long. I can feel it. Something's changed in my body." I've listened enough to get that information, dig a little deeper because I'll ask them, like you said, the hows, the wins, the why's, the where's, I get all of that and I'm now going to be able to formulate it and send it.
They are so thankful that somebody finally listened that they do come back and say, "Thank you," but a lot of them, they're angry when they... "I didn't get my medicine," you know. We have to somehow talk them off the ledge, be the calming factor.
[00:10:00] Dr. Cifu: And I sense, you know, you have it more difficult than I do, often with the same patients, because I have a long history with these patients. Many of these patients, you know, I always meet them for the first time in the room, you know, and have that. And I also, you know, old, bald guy with a white coat, you know, that carries a lot. You're often meeting these people truly sight unseen on the telephone and so that's a challenge, right? That's a skill to kind of formulate or form that relationship almost virtually.
[00:10:36] Ms. Caruthers: One of the things that I've kind of learned, they're able to see, hear my smile through the phone.
[00:10:43] Dr. Cifu: That's so good.
[00:10:44] Ms. Caruthers: That's how I get them.
[00:10:45] Dr. Cifu: Yeah. So you've been, as I alluded to in your introduction, you've been doing this for a while, right? How do you feel that the years and experience have sort of changed your practice? Like, what are you better at? What are you worse at? There are certainly things that I feel like, "Boy, I was better at this, you know, the first couple of years out of residency." And what sort of gives you joy now professionally? Like if it's a good day and you walk home and you're like, "I feel good about today." Like what was it that stimulated you?
[00:11:11] Ms. Caruthers: Well, I think as far as the things that I've learned and doing better, I listen more.
[00:11:15] Dr. Cifu: Yeah.
[00:11:16] Ms. Caruthers: And I think I learned that in home health. You go over there, they want to talk, they want to learn. And then, like I said, I've become that calming force for the ones that are angry or they're afraid, some of them are just seeking information. Sometimes I can provide them information and they're good. They don't even want to talk to you after that.
The things that bring me the most joy is the teaching. I have gotten to the point that I'm able to teach my peers. I'm able to give answers because of the vast array of things I've done in my past.
And then the patients. I had a lady the other day, one of your patients, and she was just, everything I told her, she was like, "Uh-huh!" And it was made "uh-huh" moments for her. And I was just basically giving her, you know, information about her disease process. And I think they feel like I got the answer. "I don't need to talk to Dr. C."
[00:12:15] Dr. Cifu: Right. Right. That's neat. I mean, it sounds like you know, something which comes in all of our careers, right? Probably whether we deserve it or not, right? Is we get into a position where we can be an educator and it sounds like you've used that not only to educate patients, which is sort of obvious, but the people around us, right?
And I'm sure that people then, you know, come to you as, "Okay, you know, this is someone who either I can ask a question or who'll teach me something about something I'm struggling with."
[00:12:47] Ms. Caruthers: I have to say, the oldest nurse in the area, in the room, and I've got the most experience. And they usually come and they'll say, "Hey, Sybil, what about this?"
And we had a chuckle yesterday because the youngest male nurse in our room, he laughed at me because he asked me a question. I said, "Oh, I've got that written down somewhere." And he said, "Of course, you do." Our era writes everything down or keeps a little cheat sheet whereas their era that's either in an Excel spreadsheet or in their brain. So it just kind of showed the difference of the age of the millennials versus us.
[00:13:24] Dr. Cifu: We're the last generation with the little black books and stuff stuck in our pockets. That's good. Are there things... You know, we're in an interesting time, right? We work in a place where we do a lot of training of everybody, right?
Both of us work, you know, with nurses, with medical assistants, with LPNs, with medical students, with residents. You know, there are so many people who have either less experience or less training than we do. Are there things, people, groups, whatever, that you feel like you could be more involved with? You know, that your knowledge, experience, wisdom, whatever you want to call it, you know, would be good in these, you know, let's say, final years of our career that you'd like to, you know, download your brain before you move on?
[00:14:15] Ms. Caruthers: I think me being a preceptor, working in that function. And maybe I'll go back into education. I thought about it for a minute. And then I thought, "Oh, am I too far along to go back and teach?" I have written many, I guess you call them cheat sheets.
[00:14:38] Dr. Cifu: Yeah, sure.
[00:14:39] Ms. Caruthers: All along I've done the preceptor books.
[00:14:42] Dr. Cifu: Yeah, yeah, yeah.
[00:14:43] Ms. Caruthers: And I guess that's been my way of kind of put it in writing. This is the best way to do this. Different places I've worked, I've had to develop those over time because you walk in the door and there's no manual.
[00:14:54] Dr. Cifu: Right, right, right.
[00:14:55] Ms. Caruthers: And the way my brain works, I need a manual. And especially in the area we work. I mean, there's things that we have to set up home health. We have to set up, you know, oxygen for someone and you don't want to reinvent the wheel every time you step in the room. And we have a decent amount of turnover in our department.
And so sharing that knowledge is almost that best thing for me, being able to share it. We get something new. I cut and paste it and I send it to all the nurses because I feel like sharing the knowledge is that best part.
[00:15:31] Dr. Cifu: Yeah. Yeah. Yeah. That's a great point because even if it's something that you do frequently, let's say, monthly, you know, so often, especially when it's 18 clicks in Epic these days, you know, you forget that.
And boy, the amount of time that saves everybody, right? If there's a route through. I was also thinking, given the conversation, you know, before about all of the sort of phone relationships and triage. I was listening to one of the residents the other day who was, you know, downright kind of freaked out by a virtual visit that they were doing for the first time.
And, you know, not being comfortable with the fact that they weren't sitting with the person in the room, even though clearly, this person got all the information that was necessary over the phone. And I wonder about people, you know, sort of watching you or hearing about you as they develop that skill, which is, you know, especially since COVID, right? More and more of the kind of work that we all do.
[00:16:32] Ms. Caruthers: Right. Yeah. I'll ask even a person that is saying, "Oh, my feet are swollen." I'll specifically say, "Okay, if you touch your foot and you push on it, does it leave a dent?"
[00:16:43] Dr. Cifu: Yeah. Yeah.
[00:16:44] Ms. Caruthers: And then I'm able to know they've got pitted edema or not. So I'm able to try to get to those even finite details when I'm not even with them.
So that I can give that information to the doctor so he can make an educational decision.
[00:16:58] Dr. Cifu: Yeah. That is absolutely you know, a skill which I'm sure you had well before me because it was definitely in COVID that was the first time I was having people, you know, lie on the floor, do an abdominal exam, do a hernia exam.
And I got people, you know, making good diagnoses on themselves that way. So that was great. Sybil, I wanted to thank you so much for taking the time out of your busy day to come talk to me about this. It was really great.
[00:17:23] Ms. Caruthers: This was awesome. Thank you so much.
[00:17:25] Dr. Cifu: Thanks for joining us for this episode of The Clinical Excellence Podcast. We are sponsored by the Bucksbaum Institute for Clinical Excellence at the University of Chicago. Please feel free to reach out to us with your thoughts and ideas via the Bucksbaum Institute webpage.
The music for The Clinical Excellence Podcast is courtesy of Dr. Maylyn Martinez.