Paperwork gone bad
“It was a system operating for its own benefit.”
This idea has come up in both of the tragic patient cases we’ve studied and is certainly something I’ve wondered about while on the wards. It often seems like very little of the paperwork in medicine serves any real end beyond the work itself. In the case of informed consent, an originally well intentioned process has been rendered useless. It is just another form.
In designing patient safety or quality improvement interventions that will add to clinicians’ workloads, it is crucial to ensure that the benefit derived outweighs the added time commitment (which when scaled across thousands of providers can be considerable). Furthermore, a system of continual re-evaluation and analysis needs to be in place to ensure that complacency and workarounds don’t ultimately render the intervention yet another hurdle in a long road of good intentions turned road blocks.
Nothing is wrong
They would act as though nothing is wrong.
I wrote this quote down on my pad during the Lewis Blackman video that was shown today because I’ve been guilty of this during rotations myself. Hellen Haskell, Lewis’ mother, was talking about the nurse taking care of her son and the fact that nursing notes ultimately revealed that she was indeed deeply concerned about the patient and his deteriorating clinical condition.
The truth is I don’t quite know how to act (maybe act is the wrong word) or rather what emotions to show around families. No one ever tells you to show a impassive face, to act as if everything is proceeding according to plan even when your team is struggling to figure out what is wrong, yet this is exactly what one learns observing the behavior of residents and attendings.
I suppose I always assumed that it was more comforting… Continue reading