Having 1 year of residency training under my belt, I see first-hand the issues that come along with the “informed consent” or it might as well be called “un-informed consent” in regards to how we as a profession have limited what we tell our patients. The best patient outcomes come from honesty that starts from the day you meet your patient, to an in-depth discussion regarding the named procedure and associated risks/benefits/alternatives. One way we could make the informed consent process better is by limiting the amount of information that can be pre-populated on the form and requiring risks/benefits/alternatives to be hand-written with no abbreviations during the time we are at the patient’s bedside. It will make the entire process seem smoother and less rushed.
The informed consent process has turned into a task rather than a detailed, engaging conversation between patient and provider. I feel this is a… Continue reading
Yesterday we began the morning by watching a film about Michael Skolnik, a young man who died from the aftermath of an unnecessarily aggressive brain surgery for what was ultimately an incidental imaging finding. This case highlighted several errors in the delivery of his care, but the most obvious was the absence of shared decision making. The Skolnik family was not given a complete picture of the risks of their son’s surgery as well as the alternatives available to them. Following the film we discussed several problems with the existing informed consent process. Many people noted that the current function of informed consent documents is to provide legal protection to the hospital and providers rather than truly inform the patient or obtain their consent in any meaningful sense of the word. Others noted the inherent conflict of interests that underlie the process: when hospitals and proceduralists rely on volume to… Continue reading
KPW shared an incredible story about her husband having a hernia surgery. She was in the waiting room, and even as an experienced health professional, she was concerned that the procedure was going over time. She was not informed of what was happening. Her only comfort was knowing that if something serious was happening, she would see people rushing down the hallway.
Especially in her case as a health professional, she has the health literacy, willingness, capacity, and right to be fully informed. This begs the question, though – is there an excuse as to why she was not kept in the loop? What might it be?
In a situation when a patient is told that something wrong may have happened, panic and fear are common immediate reactions. Hope is on the line, and holding out hope is often an unconscious rationale for delaying or withholding true transparency.… Continue reading
During the debrief following the video on our first day, we discussed the importance of everyone stepping up. We identified this work in medicine as a “team sport,” where all members must work together, communicating clearly, and having the power to take ownership of the tasks ahead. This is crucial in the provision of effective patient care, and it is unfortunate that these often-considered “soft skills” are minimized or absent from medical education and practice.
We also highlighted industries such as military and aviation, where teams also taking on high-risk yet different scenarios must work together and do so effectively. They minimize risk, keep clients safe, and experience nearly no adverse effects. In these industries, members of teams are conceptualized as interchangeable parts – cogs in the machine/part of the assembly line – yet also intelligent actors with capacity and power to step up.
Our conversations hinted at this idea… Continue reading
The story of Michael Skolnik drove home the importance of informed consent and the need to move from informed consent to shared decision making and having meaningful conversations with families. As noted, informed consent is written at the level of scientific journals! Time taken to have meaningful conversations to engage patients in developing their plan of care can can prevent unnecessary procedures that are life altering in so many ways. Shared decision-making incorporates the elements of an informed consent; moreover, it includes identifying patients’ needs, preferences, values and goals, as well as discussing uncertainties and costs. It is a two-way conversation between patients and their health care providers. Time must be spent to engage with families and not see the consent process as one more thing to do on the to do list of our busy days as we are asking patients and families to make really serious decisions that… Continue reading
Similar to the previous day, I found myself incredibly moved by the film presented regarding Michael Skolnik’s experience and subsequent death. While I was shocked to learn of the neurosurgeon’s actions and attitude during the whole ordeal and resulting consequences, I was truly surprised by the number of conference participants who could identify an instance when they had encountered or interacted with a similar physician. It seems like common sense that in a field dedicated to improving people’s health, all of the members in the profession would require basic traits such as compassion and empathy to succeed. Yet, I am instead hearing of countless examples where the opposite is true, and it leaves me dumbfounded.
The paternalistic model of patient-doctor communication has allowed the past generation of physicians to build an exaggerated sense of self-worth and importance, given the authority to quite literally dictate the lives… Continue reading
Just like in the video of the shirtless dancing guy where a first, then a second, then more and more followers joined in the movement voluntarily and with excitement and created this momentum where change was in effect, the change in the culture of healthcare is happening and it is about time.
I am proud and happy to be part of the movement of change, changing this centuries-old culture of practicing physician-centered paternalistic medicine and finally focusing on what matters the most: the patient.
The past two days have been an eye-opening and challenging experience. Going into the second year of my medical school education, I looked to my future training years with a cheery optimism. While I recognized the various challenges in the delivery of quality and safe care in American hospitals, I lacked clarity on the complexity of this issue. For one, patient safety is often compromised because an individual’s negligence can slip through a culture that fosters silence and not enough transparency. As trainees recognize medically inappropriate procedures, it takes both courage and skill to speak up and intervene on the patient’s behalf. As health providers caring for patients, it takes a patient-centered perspective to go beyond consenting a procedure for liability waiver, and really advocate for patients through open and thorough discussions of their care.
Much like patients stuck on an island of suffering and helplessness, we the providers are… Continue reading
Reflections from Day 1 and 2 of Napa Telluride patient safety camp has left me amazed. I heard of the Lewis Blackman’s story but never watched the video until today. From one mother to another, I cannot begin to imagine the level of pain and guilt that Helen Haskell experienced. I shudder to think of what would I have done had it been one of my children. Both stories of Lewis Blackman and Michael Skolnik will forever be etched in my mind. I hope and pray that no one ever has to experience the loss of a child, a parent, a spouse, or a beloved family member due to medical error. If only I had a magic wand, my greatest wish would be to eliminate all patient harm due to medical errors.
I came here to Telluride wanting to learn all that I can about Patient Safety and so far… Continue reading
This first day has been incredible! Meeting nurses, residents, and other medical students has been an amazing way to discuss patient safety issues. With so many different perspectives, we are able to piece together a much clearer picture of patient safety issues that can occur on a day-to-day basis. During our discussion of Lewis Blackman’s heartbreaking story, I learned the term “premature closure”. The term refers to a diagnostic error made when a medical professional makes a diagnosis without completely analyzing everything on the differential. I realized that premature closure could cause two very serious issues.
If an attending or other senior member of the team announces a diagnosis, everyone else on the team feels like they can stop going through the differential in their heads. It is so important that we constantly have a voice in the back of our heads asking, “What’s the worst that can happen?” rather… Continue reading