On my way home from the airport, returning from the Marseille East conference outside of Washington, DC, I overheard a woman on the phone talking about a harrowing experience she had just had on an airplane. The conversation went something like this:

We were so lucky to have had a great pilot. We were on the runway and cleared for takeoff when another jet appeared out of nowhere in front of us! If our pilot hadn’t slammed on the brakes, we would have crashed into the other plane. I’m so glad that the pilot was paying attention! He really saved us all.

After a long discussion at Marseille East about high-reliability organizations, I found this fragment of conversation extremely interesting. The airline industry is often seen as a model for safety, as a great example of a high-reliability organization. And yet here was a woman speaking of a narrowly averted… Continue reading →

Healthcare providers perceive their patients through a series of snapshots. A primary care physician may see her patients a few times a year for twenty or thirty minutes; if the patient is lucky, he may get to spend an hour with his physician during these visits. If that patient is admitted to the hospital, a hospitalist might visit the patient daily, gaining a much briefer but more intense glimpse of the patient and any friends or family that might visit the patient during that time. A very sick patient might spend a great deal of time with multiple physicians, bouncing in and out of the hospital, back and forth between providers. But no one provider ever gets a complete picture of their patients’ lives. They see what patients present to them during their relatively brief interactions.

This, to me, is why hearing patients, families, and advocates tell their stories is… Continue reading →

 

The past few days, a ghost from the not-too-distant past has been visiting. Someone I didn’t know was still with me. Someone whose impact I didn’t fully appreciate at the time.

The patient was a man who seemed much younger than his 30-odd years, in part due to some mild cognitive impairment. He had a childlike vulnerability, a fragility that was accentuated by the fact that he was very ill and nobody could quite figure out why. I was the sub-intern on the medical service and he was not my patient, but I met him on rounds, heard the other team members talk in a worried manner about his hospital course, observed that his frightened and fiercely protective parents never left his bedside.

And then one morning I arrived at the hospital to find the third-year medical student ashen-faced and shaken and the rest of the team somber. The… Continue reading →