Telluride Day 2

At the end of day two, one of the most striking realizations (and perhaps most uncomfortable) was how protected physicians are within a system that often fails to protect the most important stakeholder in healthcare: the patient. The Michael Skolnik story, simply put, was a case of a physician who exercised poor judgment and of a patient and family who were not made aware of the alternative courses of action they could take in a complex situation. More tragically, this is a case of a physician who exercised poor judgment in a system that allowed him to do so. One’s natural impulse is to feel anger towards the physician, who seemingly nearly coerced a vulnerable patient into a likely unnecessary procedure. While that anger may rightfully be directed toward that physician (personal accountability and responsibility should absolutely be at the forefront of such a case), investing one’s energy solely into the emotional aftermath would be energy inefficiently used. I think the lesson that I learned today was that even if we cannot prevent physicians from making poor decisions, we have ways to prevent these decisions from affecting our patients. In fact, it is our responsibility to do so.

The concepts of informed consent, shared decision-making, and second opinions aren’t new. The variability with which they are practiced and implemented into health systems is widely inconsistent, however. At the very least, our hospitals need advocates on the front lines who can ensure that patients are receiving these protections. By merely offering this alone, however, we run the risk of oversimplifying this exquisitely complex problem. The Michael Skolnik case devolved on so many levels that it is almost inconceivable. We, as a community of healthcare providers, need to collectively take responsibility for this tragedy. In taking this collective stance, we need to consider that the worst can, and sometimes will, happen when we make medical decisions. Nothing we do or say is without risk. As our system evolves, as healthcare becomes more complex, and as we continue to navigate uncharted territory in medicine, we must always return to our first and only responsibility: our patients.

Positive change can only come about when the circumstances allow it. Some of the most common (and disheartening) themes voiced by participants today was that of a culture of inertia. It seems that much of medicine is reactionary; that is, a sentinel event must occur before a coordinated effort to improve patient care and prevent harm comes to fruition. This is exactly the culture of inertia that prevents timely progress. We, as young providers and future leaders, must be the examples within our organizations of change. Inertia can only be overcome by adequate force, but once it is indeed overcome, the only challenge then becomes maintaining momentum. There will always be challenges, but with enough forces for good at play, the future remains bright. However, we must always acknowledge that the case of Michael Skolnik can, and will, happen again.

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