The Paradox of Modern Health Care

My journey to medicine was not catalyzed by the admiration of a family doctor or brilliant surgeon. Rather, it was quite the opposite. Growing up, I never had a relationship with a physician. In fact, I was scared of going to the doctor. With my mother legally disabled and my father a traveling salesman, our lack of insurance often meant that a doctor’s visit put less food on our table. At fourteen I witnessed the effect of withholding care firsthand. My father, delaying a visit to the dentist, suffered from a badly infected tooth abscess. His infection ultimately spread to his blood, where he came within inches of death. Despite being a veteran and attending yearly appointments at our local VA Hospital, having previous dental care, and working hard to maintain good health, he found himself at the brink of what could have been the end of his life.

My… Continue reading

Pre-Telluride Thoughts

Here is one example of a patient story that got me interested in quality improvement and patient safety. My patient, Mrs. J, was finally going home after being admitted to my hospital for pneumonia. A stroke had rendered her unable to swallow, so we were administering liquid food through her feeding tube to effect weight gain. The good news was short-lived as we realized after several phone calls that her insurance would not cover it without submission of paperwork that could take up to 14 days to process. Expedited processing would still take 3+ business days, which paired with the Christmas holiday meant that Mrs. J would have to stay in the hospital six extra days because her insurance needed time to decide if feeding her was appropriate. Mrs. J’s situation is a prime example of the terrible inefficiencies of our current healthcare system. Not only is this roadblock detrimental… Continue reading

Bumper Stickers for Patient Safety

At our Telluride Napa session, attendees were instructed to cull their most important patient safety learning from the week, and transform it into a bumper-sticker-sized message. Here are just a few examples of what these future healthcare leaders came up with!


Pre-Telluride Thoughts – Maryland

Attending the Telluride Experience is important to me because, as a medical student, I sit in lecture halls for the majority of the first two years of school, learning all there is to know about the body and all of the diseases that can plague it all in preparation for the Step 1 exam. I learn the presenting symptoms, the pathogenic mechanisms of the disease, and the treatment. While this seems great in theory, we are never taught how to ensure patient safety during these first two years. We are given very straightforward knowledge of the disease and the theoretical treatment but are very rarely given real-life examples of patients. Instead, we learn these things through hands-on training in third year rotations, where we are adjusting to a new environment, applying clinical knowledge for the first time, and simultaneously preparing for Step 2. Patient safety is something that should be… Continue reading

Thoughts Pre-TTE Maryland

Earlier in my life, before I started my training to become a physician, before I even knew I wanted to be a doctor, back when I still considered pursuing a graduate degree in history, I viewed hospitals in the same way the average American does – an extremely safe place. Yes, many individuals may spend their last days in a hospital, but they are receiving the best care possible. Yes, modern medicine is not a panacea, but individuals, for the most part, do not go to the hospital to get sicker. If they do, it is a result of their disease process’ ability to continue to progress despite the staff’s best intentions and efforts. Even at that point in my life, however, I was not naive enough to think that mistakes never happen, but I believed that the rate of these mistakes had to be exceedingly low – after all… Continue reading

Toasters and Teamwork

Yesterday morning while waiting in line at breakfast, I encountered a man by the toaster who was toasting 3 slices of bread. He was reaching to grab in one piece of bread and accidentally dropped the toasted piece onto the floor; he quickly bent over to grab it and looked at me and said “10 second rule, right?” and put it back in the toaster. Well, clearly I didn’t say anything (to be fair I was just having my first sip or two of coffee) and then he put the piece of toast back into the toaster. So now everyone after him who used the toaster has unknowingly accepted that same decision, and that will be true at least until the machine gets washed.

While this seems like a trivial incident, I think it’s almost a metaphor for complacency sort of like the story that David was telling about his… Continue reading

Some thoughts before Turf Valley

Having recently finished reading ‘Why Hospitals Should Fly?,’ I cannot help but feel a lot of the initial skepticism that Will had when visiting the fictional St. Michael’s. It seems intuitive that a top-down approach to massive cultural change cannot be as strong as one that emerges from the frontlines. However, one of the concepts that I empathize with as a GI fellow and former Medicine resident is the amount of cultural inertia there can be in a hospital or a hospital system. That inertia is often either met with jadedness/frustration vs resign/burn-out by house staff who may feel that they have little influence or say in the matter.

Furthermore, as someone still in training, I have already witnessed or have been a part of medical errors, some small and some big. I have mistakenly written for the wrong medications or doses in the past, I have lost patients due… Continue reading

Leaving Telluride

I left Telluride in a daze today. It seemed strange to board the same shuttle that brought me to Napa 5 days ago to head back into the Bay, where I would soon return back to my normal life. There are so many lessons I’ve learned from Telluride that if I were to blog about it, I would most likely end up writing the sequel to Shattering the Wall. Therefore, in an effort to keep it succinct, I wanted to list some of my favorite quotes from Telluride:

“If a doctor gives an order in the forest, does anyone hear it?” (honestly one of my personal favorites, Dr. Nance is fantastic!!)

“Professionalism is not a divorcement from human nature; it is an understanding of human nature.”

“Lewis died because he was in the hospital room. He would be alive if he were anywhere else.”

“We look for vital… Continue reading

Patient, not Person-Centered Care

I remember the first day I interviewed a standardized patient in medical school we were given a sheet of paper with a checklist of questions we needed to ask our patients. “Where is the pain? Does it radiate? What does it feel like? On a scale of 1-10, with 1 being no pain and 10 being the worst pain you’ve ever felt, how does your pain feel?” There was a total of 23 questions on our checklist, a number that seemed daunting to someone who just learned how to properly introduce herself. Question #10 on our checklist read, “Patient’s perspective.” I wasn’t really sure what that meant, and for the first couple of sessions with a standardized patient I glazed over it, focused more on getting the chief complaint and getting the dosages and names of drugs that patients took correctly. After each session, I always got the same comment:… Continue reading

The Telluride Experience Day 4

I felt an emotional withdrawal on our last day of the event due to fact that I became so attached to everyone and we have learned so much from the past four days together as a team, together as a family. Thinking about the activities that we played, the discussion sessions, the numerous lectures, and the inspirational videos will all be missed. I was amazed how the center of every activity, every informational session revolved around patient safety through teamwork and eliminated system errors not punishing patient error. I just want to personally thank the staff for everything that they have done, and I promise to not let any of their efforts go waste.