CONTINUING EDUCATION
The five finger approach to sleep-wake complaints Dr. David E. McCarty offers a collaborative patient-centered problem-solving tool for a complex world The complexity of sleep apnea Because it arises from multiple overlapping anatomic, physiologic, and functional deviations from optimum, with variable representation of obstructive versus central apnea processes, the entity known as “Sleep Apnea” is best characterized as a complex phenomenon1 for which there is no “one-size-fits-all” solution.2 What’s more, clinical management of breathing- and airwayrelated pathology requires navigation of countless non-apnea contributors to sleep-wake complaints, nesting the complexity of the breathing/airway issues within the complexity of a larger spectrum of sleep-provocative disease. “Complex” environments differ from “complicated” ones by virtue of their unpredictability. For example, the cockpit of a 747 can be considered a “complicated” environment. Sure, there are scads of dials and knobs, but with the right training, you’d know just what to do to get a predicable result from that machine: you’d take off, you’d fly, and you’d land, and it would be predictable. On the other hand, a “complex” environment involves variables that may be hidden to the problem-solvers, responses to therapy being less predictable. Compared to an aircraft cockpit, a “complex” environment is more like a Brazilian rainforest.3 Complicated environments tend to run efficiently with expert, top-down management styles. On the other hand, complex environments require a different mindset, one which is receptive to new information and intentionally collaborative.3 To explore this, let’s go to war…
Gen. Stanley McChrystal, Al Qaida in Iraq, and the Team of Teams In his bestselling book Team of Teams, Stanley McChrystal (U.S. Army Gen, retired) describes his real-world approach to complexity and his successful strategy to harness true collaboration among America’s most elite strike forces: Navy SEALS, Army Rangers, Army Delta Force, and Air Force Special Tactics.4 Under McChrystal’s command, this consortium faced a devious and dangerous enemy called Al Qaida in Iraq in the early 2000s. In short, he found that these elite forces had difficulty merging their efforts at first — the squads seemed to compete with one another in the field and had trouble predicting one another’s
David E McCarty, MD, FAASM, is a Sleep Medicine clinician, author, cartoonist, and podcast creator/host. He is the co-author of Empowered Sleep Apnea: A Handbook for Patients and the People Who Care About Them, and the creator and co-host of Empowered Sleep Apnea: THE PODCAST.
orthopracticeus.com
Educational aims and objectives
This self-directed educational course for dentists aims to demonstrate how to communicate the complex topic of sleep medicine to patients by using the Five Finger Method.
Expected outcomes
Orthodontic Practice US subscribers can answer the CE questions by taking the quiz online at orthopracticeus.com to earn 2 hours of CE from reading this article. Correctly answering the questions will demonstrate the reader can: • Identify the concept of the Five Finger Approach as a functional and actionable method. • Realize the parts of the sleep-wake regulation Two Process Model that could lead to circadian misalignment. • Recognize how pharmacologic factors can play a part in sleep-wake complaints. • Realize that medical factors and psychosocial/psychiatric factors play a part in sleep/wake complaints, and they must be discovered by collaboration with the patient. CREDITS
2 CE
contingencies. Instead of enhancing one another’s efforts, squads often squabbled and defended their internal honor. He described the phenomenon as feeling like the coach of a soccer team of exclusively world-class players, all of whom happened to play the game with blinders on. McChrystal understood that he wouldn’t be able to command his way out of his predicament. He realized he needed to create an environment where collaboration would arise naturally. To do this, he introspectively asked what would make a good soccer team. His answer included two elements: 1. Team-members needed to share an understanding of the playing field — what it looked like, what the rules were, and how things fit together — in other words, all players possessed a “shared consciousness” of the complexity of the situation. 2. Team-members had to experience “lateral connectivity” — a term which for McChrystal basically boiled down to a combination of “trust” and “empathetic connection.” Trust empowers an upfield player to kick the ball to an empty spot downfield, born of an empathetic bond with her teammate — whom she knows is fast enough to get there, and carries the shared consciousness that that’s where she’s expected to be.
23 Volume 14 Number 3