Friday, January 31, 2014

Silo Thinking

Teach a wise man, and he will be the wiser; teach a good man, and he will learn more
~ Proverbs 9:9, TLB ~

The wise man is glad to be instructed, but a self-sufficient fool falls flat on his face.
~ Proverbs 10:8, TLB ~

A fool thinks he needs no advice, but a wise man listens to others
~ Proverbs 12:15, TLB ~

I have a BEEF to pick with nearly every type of professional assisting our kids with chronic diagnoses or special needs.

Don't get me wrong -- We desperately need specialty groups and areas of expertise.  Without intricate detailed wisdom in small, defined areas of concern, we would be utterly lost in helping our children

But there seems to be a pervasive, toxic attitude that poisons the hope of ever having different groups and specialties work together for the best possible outcome.  It is silo thinking.

Although my own family has long been subjected to its corrosive effects, I only felt compelled to write about it when an I recently saw an ugly little piece of medical "professionalism" exposed.  I was shocked when another mother and I were talking, both noticing that on one particular hospital team, a psychologist we both worked with was treated by the other specialists like he was a low-life nothing.  Dismissive, arrogant, and tuned-out to what this psychologist had to bring to the table, these other doctors were treating him as if he were not at their professional level.  Not only was this behavior offensive, it was also detrimental to the treatment of the children seen by this team.

I have personally had situations where one specialty group is not properly consulting with another specialty group, thereby misprescribing medication that put one of my children at peril.  Without ever having had a previous discussion with me about it, I have also had one specialist give total treatment authority to another specialist rather than to me, the parent.  Completely unacceptable!

At the crux of the problem, these professionals often fail to remember that a child is a whole person.  They may talk a good talk, but in practice, completely fail to ponder how one disorder may be affecting another.  This is maddening to a parent, who is not only with that child the majority of the time, but who also wants their child to experience optimal health.

It begs the question...

When does natural curiosity die in these people?

Aren't these the same people that were once inquisitive, wanting to solve problems and break open difficulties to explore for answers?  When did these professionals suddenly decide that they would only deal with what is inside their own little box, looking at nothing beyond? 

And it is not just in medical circles.  Educational circles are also prone to silo thinking.  Administration, which can sometimes be detached from the daily schoolroom function of a child, may override the decision of special education staff.  Or the regular school staff can completely disregard how the special educational needs or special physical needs of a student are affected as they try to move a class collectively forward.

Fewer things can be more frustrating to a parent raising a child with special needs than having different pieces of all the moving parts working against each other rather than working in harmony.  But how does it get better?  What would this look like if it all worked correctly?
  • Parents would be persistent, pleasant bridge-builders.  This means that we do not pull out our "Mr. Angry Eyes" at our first inkling of something going awry.  Coming into a situation with "guns ablazing" only earns you a reputation as a problem or difficult parent.  It IS possible (and preferable) to assert yourself while being 100% respectful of all involved.  Be persistent in explaining the difficulties.  Be willing to do your part to move everyone out of their silos.  And never stop asking good questions.
  • Professionals, whether they be medical, psychological, physiological, or educational would all look outside of their own little box.  They need to be big picture thinkers who are willing to see how their piece works in concert with the whole.
  • Professionals would stop having an attitude of "that's not my job" and get out of their field if they have no desire to see our children reach their best potential.  Rather than being "professional", this attitude actually marks a person as consummately unprofessional.  No favors are done to anyone when someone who is unhappy and uncooperative stays in this sort of job with children.
  • Professionals would take parents more seriously, rather than being dismissive.  I personally have told doctors in the past, "You may know this disease better than I do, but I know how it behaves in my child better than you do."  A medical license is not a license to be rude and arrogant.
  • Everyone would to come together as a team, being more focused on problem-solving than on being inconvenienced.  The best group I ever had the opportunity to work with was a grade school team who rallied to create the best IEP possible for one of my children.  The homeroom teacher was uncooperative and moody, but the team fought to bring all of the moving parts together.  And THEY. GOT. RESULTS!  Within a year-and-a-half they had a child reading and writing to a grade appropriate level where this child was at a standstill prior to the plan being implemented.  If only all school staff saw the value of working together in such a way!
I pray that these suggestions are ones that are helpful to you or that can be passed along to those with whom we special parents work.  For my family, the battle against silo thinking continues.  We never stop looking for new methods and suggestions on integrating strategies, because when competent adults actually COMMUNICATE with one another, REALLY LISTENING to what others say, our children come out the winners.

PRAY:  Lord, we all seem to get so stuck in our own little worlds with "silo thinking".  That is easy for me, as a parent, to do as well.  Help me to treat others with respect and mercy, while encouraging them to work together as a team.  Open the eyes of our hearts, Lord!

~ Barb Dittrich
Photo courtesy of


  1. While it is certainly possible that EVERY specialist you encounter is a rude egomaniac who doesn't care about you or your child, it's very unlikely. Sure SOME specialists have zero people skills*, but if ALL the specialists you encounter seem to have attitude problems, you might want to consider looking in the mirror. You're likely doing sometime to precipitate this behavior, because a whole lot of doctors, particularly specialists who deal with kids, tend to enjoy helping children and their families.

    As a person who spent an inordinate amount of time in a hospital as kid with a rare illness, who now spends a TON of time in hospitals with my kids who inherited said rare illness... doctors/nurses/hospital staff are almost always knowledgeable, kind and helpful. The odd person has a bad day, every so often there's a surgeon with zero social skills whose so good at what he does that I'm willing to put up with it (i.e. since he will be slicing my child open and operating on his brain). Same thing with teachers/therapists -- they generally became teachers/OTs/PTs because they like kids and want to help them reach their full potential.

    It might also be worth considering that, say, the pediatric neurosurgeon knows what he/she is talking about. If you're referred to a specialist you do not like and whose expertise you don't trust, get referred to somebody else. In general, a super-duper specialist doctor has spent a lot of years in school, a lot of y ears specialising in a particular sort of illness and if you have ZERO desire to have that person help your kid because you think you're soooo much smarter than the doctor whose advice you refuse to acknowledge/follow? Well, there's an excellent change this is precisely why you find all those medical professionals so damn hostile.

    * which, when you think about it, isn't so surprizing. It takes a particular sort of person to become, say, a pediatric nephrologist. To spend 15+ years training in order to spend all day, every day looking at childrens' kidneys. It requires the kind of person to whom each kidney is so very, very interesting, that all they will do for the rest of their life is look at/test/operate on kidneys belonging to small children.

  2. Wow, Macey! Bad day? You clearly misread something in this post. Nowhere does it state that EVERY specialist is a rude egomaniac. You may have been blessed by terrific care, but many parents find challenges with poorly integrating care for their child. Thus, the encouragement for parents to be courteous bridge-builders. I pray you find better ways to spend your time and vent your frustration than to post hostile comments and swear on blogs with which you happen to disagree!

  3. Well, Barb and Macey, since we are being brutally honest here, I feel compelled to give my two cents.

    I have had very little experience with doctors and specialists for myself or during my own childhood so I cannot comment on that. I will venture a guess, Macey, and that is that the condition that you and your children see doctors for is one that has been diagnosable for many years and has a clear plan of treatment. I am so happy that you find the medical community and educational community so eager and excellent at helping both you and your children.

    My son suffers with a very rare genetic disorder that has only been diagnosable since 2005. While I have found many doctors very willing and eager to help us, it is typically within these very defined specialty boxes in which they reside. They do have quite a lot of trouble thinking outside of those boxes. I am happy to report that we have an eager staff of 12 docs, 4 therapists and 2 teachers who are able to think outside of their boxes (although some are only able with some kind prodding (:). I find what Barb has said here to be very true. I think it is a flaw of each of us as humans. We only know what we know. And with docs and their huge investment in one area of study it can become more true. And we do other medically involved families a disservice if we deny this.

    In fact, as a member of the Family Advisory Committee and several other committees at Children's Hospital Wisconsin, I can tell you that the doctors who meet with us do so for EXACTLY THIS REASON!!! They realize that they become so focused on their specialties that it becomes difficult to see the whole child. These awesome docs STRIVE to avoid this by meeting with parents and listening to our input. They tell us that the longer they do what they do and the harder they work in their own research areas, they more difficult this becomes. So yes. This is a fact of the medical system in which we operate. It is hard and yet many are working to fix it. But it is real. And special needs families need to know that they aren't alone in this fight for treatment for their WHOLE child.

  4. When this devotional was written, I was unaware of this post in the Huffington Post by a frustrated teen with a rare disorder: I think it does capture the frustration many families feel. Additionally, I have had a doctor contact me privately, mentioning that the current status of our national healthcare has become so onerous that doctors are overloaded with paperwork. This leaves them even less time to communicate with patients and one another. I would be willing to guess that it is much the same in our educational system.

  5. This is NOT a small problem! Do some patients and care-givers have attitudes? YOU BETCHA! It's called self-preservation! Are all medical professionals uncaring, inept, arrogant and whatever else you want to tack on? ABSOLUTUELY NOT!!! Is coordination between specialties difficult? YOU BETCHA! Is it more rare than not that a busy specialist is willing to step into being THE coach for the team? YEPPER! Is this problem exacerbated when a diagnosis is vague, illusive, or unknown? IN SPADES! Been there and done all of that personally! If you have walked a different road, then I'm happy for you BUT you are the exception! SAD BUT TRUE! *Note to self and others: Keep in mind that we are not talking about an ingrown toenail or the flu. We are talking about patients with significant lifetime challenges!