The domino game we participated in today really hammered home the point of read-backs in communication and allowing all involved in the process to feel empowered enough to speak up. We think that what we tell someone makes perfect sense…it did in our head! However, when you are on the other side of the coin it is usually clear as mud. When we had the chance to clarify instructions by processing the information in our minds and making sense of it, then relaying it back to the instructor, it not only allowed the instructor to adjust in that one detail, it also allowed them to adjust for future details to improve the efficiency as the game proceeded. This exercise was very helpful and will be brought back and shared with my residency program!

As we were going through the video and watching as the neurosurgeon explained the situation and presented the option of surgery as the only lifesaving option, it seemed to me that he had some sort of professional bias to preform that procedure. Even as the PCP tried to weigh in and tell the family it was benign and the would need to follow up with repeat MRI in a few months, the surgeon wrote that second opinion off. As a primary care resident, I take care of my own patients in the hospital, many of whom I have had the opportunity to get to know very well and understand how they think and what is important to them. If we consider informed consent more of a process or a dialogue, it seems that the patients PCP would be an important contributor, almost an advocate for the patient who can act… Continue reading →

I thought the story about Lewis Blackman was very eye-opening to me as a first year resident. The idea of premature closure and anchoring to a diagnosis that seems likely and easy is scary but real. It is simple to make a quick assumption, but it is necessary to ask what the worst case scenario in a particular case is, when symptoms are not responding to your initial assumption. When the case is then passed from one resident to the next, we lose the continuity of the case and the line of thinking, if we do not communicate well and hand the patient off properly to the next physician in line. When we look back on a case like this, it is easy to see where the breakdowns happened and quickly point out the mistakes made. It is also apparent that this scenario would be easy to repeat if we… Continue reading →