by David Mayer, MD
Last week was the first of three annual Patient Safety Summer Camps for graduate resident physicians in 2017. Each year, I learn from the resident scholars who attend about the current safety challenges and barriers they face on a daily basis as they both try to deliver safe care to patients, and learn to become good physicians. Over the last few years, however, I have noticed a growing concern among our Telluride Scholars, a theme that centers on the overall well being of resident physicians in the healthcare workplace.
Last week, discussions around resident well being reached an all-time turning point, during an interactive presentation on Care for the Caregiver programs led by Crystal Morales from MedStar Health. During the presentation, Crystal asked the residents to think back, and remember the first patient death that happened while under their care—not from a medical error, necessarily, but… Continue reading
Being in the Air Force myself I really appreciated John Nance’s ending story about his time flying C-141’s. I can appreciate the A1C’s fear in speaking up against a Lt Col, especially since he has no actual flying experience. Co-pilots in the AF constantly struggle with correcting senior officers during flight. Like surgeons they to embrace the god-like aura and often think they are above criticism. I agree with John in that the AF is making a great commitment towards true leaders. They’ve also started 360 feedback which is a way for these senior pilots to get feedback from everyone they fly with.
Day 2 was eye opening! The Skolnik’s story introduced the concept of informed consent- an essential part of shared decision making. This stressed the importance of clear communication and patient involvement in medical decision making. It was fun to apply what we learned in group breakout sessions. The day shifted in focus and the talk by David Claussen peaked my interest. The talk dissected EMR systems and I learned that the rush to implementation and false advertising by vendors has led to many of the frustrations that surround use- particularly the lack of human factors engineering considerations which ultimately have led to significant patient safety issues. To close off the day it was insightful to hear John Nance speak of his experiences in patient safety and inspire future healthcare professionals to make a commitment to change the system!
Today was the most intense day I could possibly imagine. We were challenged physically and emotionally to strengthen our bond as a team, to communicate honestly and effectively, and to view our patients’ stories in a deeper and more meaningful way. Our hike today was confidence boosting, fun, and strengthened our friendships into ones that will last forever! I also enjoyed the way Dr. Sherwood made us all think about ways to see our patients differently than what is easy or obvious. Her distinction between Reflective Practice and Righteous Indignation made me laugh!
Carole’s presentation of Connecting the Heart and the Head has changed the way I think of the families of the babies in my care for the rest of my career. While I have always loved my babies and felt honored to be entrusted with them by their parents, I have always kept… Continue reading
Can a conversation save a life? I recently learned about the importance and impact of informed consent. In a video, we learned about Michael Skolnik and his story. Michael was an aspiring nurse who unfortunately passed away due to complications from neurosurgery. His parents were shocked from the outcome because they were never informed about the risks and alternatives to surgery, which are essential elements of informed consent. Had they known all the information, they could have been better equipped to decide the best course of treatment for Michael. One important tool I learned today was shared decision making, which includes informed consent but also includes a more comprehensive conversation about the needs and wishes of the patient and his or her family regarding treatment. It starts with an honest conversation, with the patient at the very center of the treatment team. A conversation can save a life.
Today was exhilarating! Starting with the breathtaking hike up to the falls and ending with Carol’s presentation. Today was also very emotional. However, it was by far the best day here. I will never forget the hike and all the amazing people I talked to and connected with. I still can’t believe how close we all are now; especially in just a few days. I am so grateful.
My favorite activity today was the art interpretation session. It really reinforced the importance of balancing assumptions and behavior. On the one hand, context can be very important in medicine. We use epidemiology to form a differential diagnosis based on a patient’s demographics. On the other hand, assumptions can be false and lead to misdiagnoses. In the end, I think it’s important to keep both approaches in mind. Sometimes a patient’s presentation is ambiguous. Eventually, we must choose a course of action and develop a treatment plan. However, in going forward with this approach, I must be open to new evidence and embrace a willingness to change my diagnosis based on new information. If this happens, I shouldn’t castigate myself for being wrong, but encourage myself that I have the strength to admit my error based on new information. Admitting being wrong is not a sign of weakness, it’s a sign of strength.
Losing a patient never gets easy and neither does delivering anything but compassionate care. I commend and thank our instructor for sharing the story about the death of her daughter today, as I am still shaken up.
I am proud that I have cried during rounds and have held patients and their loved ones while they (and I) cried. This week, we have talked about how little support loved ones receive following the inpatient death of a patient. Not to belittle this fact at all, but tonight, some of us talked about how little grievance support there is for medical staff.
I found out that one of my favorite patients died in November through snap chat, and I am beyond ashamed to admit this fact. His death was written on the white board of our work room – as if this announcement was comparable to our unit’s hand-washing statistics.… Continue reading
Today was incredible. We started our morning with a daunting, challenging, and utterly gorgeous hike on Bear Creek Trail. After a wonderful lunch of grilled cheese and ice cream we gathered once more at the school. One of the most important points that I took away from today’s discussions is illustrated in this quote from Lucian Leape, “The single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes.” When I heard it, this made perfect sense to me. Making a mistake on an exam is just about the most effective way of learning and retaining information that I have ever experienced. Nothing ingrains a fact in my mind more than if I have previously made a mistake regarding that fact. I learn from my mistakes because of a mix of frustration, embarrassment, and sometimes even shame for making them in the first… Continue reading
For me, today revolved around humanism and our basic human needs and vulnerabilities. Humanism and medicine is defined by the Gold Foundation as being “a respectful and compassionate relationship between physicians, as well as all other members of the healthcare team, and their patients. It reflects attitudes and behaviors that are sensitive to the values and the cultural and ethnic backgrounds of others.”
We investigated Caring for the Caregiver, which focuses on that compassionate relationship between the members of the team. We saw an incredible video of a discussion between two physicians following a medical error with a terribly catastrophic outcome for the patient and the emotional response of the physician.
Then we learned about stories, something that are uniquely human, and how they are an important part of medicine. Understanding the story of the patient, having that human connection will make us better doctors. I have been fortunate to… Continue reading