Thinking about the Medical Language
It has been just about a week since I returned from Marseille to Boston. Although the altitude change is welcome, the excitement of the conference is still keeping me awake at night. One such topic is the power and impact of our medical language. We heard a powerful story about the impact of a casual word thrown into a patient’s chart and how that created an anchoring bias that ultimately cost a child’s life — unnecessarily. That story was profound, but I’ll focus on this one aspect of it now. What struck me is my own transformation over the past year. As I’ve really become immersed in the world of medicine — because intern year is nothing if not an “immersion” experience– the language I think in has fundamentally changed. Most of my day is spent either talking about patients to other providers in Medicalese or documenting in the same… Continue reading
Shared Decision Making #SDM
Today’s discussions revolved around the importance of involving patients and families in care planning. We touched on a number of important topics within this theme — informed consent, outpatient medication choices, code status/goals of care, and much more. I appreciated that today’s SDM discussion was paired with a fantastic workshop on negotiation led by Paul Levy, which broadened the concept of negotiation for me. Some of the stories regarding SDM were striking. Parents having procedures performed on their children without their knowledge or consent. Patients consenting while heavily sedated. Many terrifying stories today. I think the toughest barriers to involving patients and families in care planning are the incredible asymmetry of knowledge and the difference in perception of severity between provider and patient. What I consider a routine procedure or a common medication may be the biggest risk/benefit decision the patient has ever had to make. We need educational systems… Continue reading
Gemba
Today- the first day at Marseille 2014 – was filled with stories. I expected lessons on safety and quality, but the teaching was much more organic. We heard incredible, emotional stories that left many us of us jarred, uncomfortable, and often in tears– especially Helen Haskell’s story. As a new parent myself, the idea of the loss of a child is incomprehensible. Today’s teaching came out of our own reactions to the difficult stories we heard as a group. My takeaway today goes back to Paul Levy’s book and the concept of going to Gemba — the “actual place.” As I finish up my PGY-1 year and think about all of the very sick patients I cared for, I realize the importance of physically being in the place of importance– the bedside. So much of my work this year has been away from the bedside, reviewing charts and entering orders,… Continue reading