It is amazing to think about the ways in which technology has propelled health care forward. Twenty years ago, my family physician had a PalmPilot with this fancy new program called Epocrates–this was cutting edge technology. Today, we all walk around with mini-computers in our hands that not only give us access to the entirety of the medical literature, but also our patients’ records at our fingertips and also the score of the Packers’ game from last night so you know what kind of mood Mr. Miller in Room 32 will be in this morning.
I am excited to see how health information technology will continue to shape the care we provide our patients, detecting real-time opportunities to prevent adverse patient outcomes. While some dismiss algorithm-driving medicine as “cookbook,” I think it frees us to do what we as physicians are trained to do–synthesize data through a filter of… Continue reading
As I imagine several other people here attending can relate, I have long been a “fixer.“ Rather, I have always wanted to be a fixer, but throughout the years I came to realize what I could and couldn’t control and where I could actually make a difference. I was intrigued by quality improvement and patient safety because it simply made sense. You assess a situation or adverse event, and you get to the root cause of everything that led up to that event before trying to create a solution. So much in medicine is unknown and our research processes are hypothesis-driven based on what we think we already know about a subject. But with QI, we have the humbling benefit of seeing the end result of a situation and being able to work backwards to understand what led to it. With that information you can test a hypothesis or intervention… Continue reading
I first applied to AELPS in 2020–yes, that 2020. I was a first-year medical student at the time, very very new to the field, and had yet to even complete a clinical rotation. I learned I was accepted to the program in March of that year, shortly before I learned that the program would be rescheduled to later in the summer, and then eventually to the following summer (and then the summer after that!)
Two years later, it seems as though the program will finally be able to occur safely. I am now at the end of my third year of medical school, with my clinical rotations nearly complete. I’m a bit more experienced and a bit more informed than I was when I first applied to this program, as I only a had semester of medical school under my belt at the time. The patient safety concepts that I… Continue reading
One of the biggest things I am coming away from today with is a better understanding of how the NTSB does their post event inspections. It makes sense, but they get to the crash site ASAP, ideally 30min – 24 hours after the event. Interviews are the main focus, and of course this is critical for getting correct and less biased information. The idea of a post event safety inspection happening 1 month after an event now sounds foolish. If you do, there’s no way you can get accurate, un-biased facts, and an honest view of the units culture
Today we heard so many instances just how pervasive medical errors still lead to patient harm. Additionally, we learned about reflective practice, and were provided prompts surrounding COVID, it caused us to reflect on something a lot of us although still very present, have not fully processed, or have hidden away, and the discussion I had with colleagues today is true across our nations healthcare system.
The reflective exercise asked for a metaphor/word etc. that reminded us of covid I thought instantly of a tornado, full of uncertainty, messy and destructive. But then I also reflected and time-value: cost opportunity came to mind. While all of us experienced the “rona-nado”, wether it be personally, professionally, educationally.
I thought of how this translates to the current hospital system and how we are set up for failure often as the system is akin to a tornado, safety and quality gives us an… Continue reading
Inspiration, emotion, altitude, and a crushed egg
- Inspiration- The story of Lewis Blackman was so powerful. It was hard watching the vital signs get worse and worse, and the pain migrating and getting worse. I wanted to teleport there to say we needed an urgent abdominal CT. I wanted the nurse to call a rapid response, and for an ICU consult immediately when blood pressure was not measurable, things that I would hope to have done if this happened today in my hospital. The strength of his mother Helen Haskell, and her desire to make a difference for Lewis to help others, inspire me.
- Inspiration #2- Such great lectures. I am hoping the powerpoints will be sent to us. I want to study and meditate on what I learned, from reflection to premature closure to confirmation bias to automatic analysis of safety events to incident analysis and so much more.… Continue reading
Thinking on the sessions we heard today there are so many I could reflect upon. Actually, the very notion of reflection warrants its own attention. Listening to Gwen’s presentation I was struck by the intentionality of reflection. This is not something that comes naturally and demands concerted effort. When I think of a typical day in the office of seeing patients, we do not really carve out time for reflection on the day or a particular patient encounter. In fact, the end of the day is more marred by wrapping up the documentation, making it in time to the karate lesson, or a million other things that we need to get work ‘over with’ so we can move on the rest of the day. But what are the consequences of not reflecting? How do trainees conduct a daily debrief to support the wellbeing of the collective?
My own personal experience… Continue reading
Although I come from a family of artists, I have little artistic talent. As I grew up, I found myself drawn to areas of expertise that I considered technical–in which there was a clear right and wrong. I guess I was a rebel. In high school, I became increasingly interested in medicine: I saw it as a wonderfully tangible application of scientific knowledge, a means of reducing human suffering. I set out to see what working in healthcare might be like. I found work in a private practice as an after-school job and spent a summer interning in a primary care medical clinic at San Francisco General.
In both of these experiences, I noticed the impact of non-scientific factors on the delivery of care. For example, at the private practice, the economic forces were clear: only patients with private insurance were accepted and I was instructed to book two patients… Continue reading
I still remember it clearly. It was the beginning of my 2nd month of intern year. An elderly gentleman was admitted with a heart failure exacerbation. We had adjusted his medications and were able to successfully diurese him back to the point where he was comfortable discharging home. Two days later he’s back on our hospital team. I went and talked with the patient and said “What happened? We had a good plan in place to keep you thriving out of the hospital?” It turns out I was the problem. I had made a mistake when reconciling his medications in preparation for discharge and he tipped back into heart failure. I was so embarrassed but my attending at the time said “You can make mistakes and still be a good doctor. But you need to go and be honest with the patient that this is on you.” So I… Continue reading