It is already a very emotional first day at Telluride as I re-watched Lewis Blackman’s story as a senior resident. Two years ago, prior to any patient encounters, I first watched it as an intern, incredulous at the turn of events. At that time it baffled me how health care professionals could diminish patient and parental concerns so callously, and how so many errors could pile up to lead to a tragic outcome. As an intern I vowed to never allow such reckless practice to occur under my watch. As a senior I reflect on how many vital sign abnormalities I let go, errors I let happen, and lives I let slip through my fingers.
As an ER resident, the acuity of illness is higher than other specialties and inherently the potential for medical errors. Two years ago, my naive intern-self entered residency with the goal of committing no preventable… Continue reading
As I reflect back on today, what struck me the most was the video we watched covering the tragic case of Lewis Blackman. This will likely always stay with me because I met Helen, Lewis’s mother. As she shared his life and legacy with our group, I could feel the raw emotion and pain that she had endured. No one should have to experience what she did. The tragedy is that I could see this happening again. Too often healthcare providers dismiss our patients – I was shocked and upset to learn that a nurse had rolled her eyes at Helen when she explained her concerns. Are patients ever wrong? NO! This is so obvious to me, but a lot of healthcare providers clearly don’t agree. Even if patients may not be correct in the medical sense, this is due to a lack of clear, concise patient education on the… Continue reading
Within my short time as a nurse there have been few cases that have truly stuck with me…but one in particular ate away at every ounce of my moral conscious…encompassing my thoughts for more than three months after my brief interaction with the patient. And the worst part was that for the longest time I thought I was one of the only nurses who did not stand up for what was right based on a gut feeling.
A 24 yr old male presented with acute confusion and fevers; otherwise healthy. The doctor…one whom was new to our unit but with many years of practice…immediately dismissed the case as being polysubstance abuse with instruction to re-hydrate, obtain a toxicology screen, and discharge. My gut told me otherwise, but I deferred and followed the idea of poly-substance abuse…until the tox came back negative. At that point I tried to advocate…convinced the doctor… Continue reading
Yesterday we began the morning by watching a film about Michael Skolnik, a young man who died from the aftermath of an unnecessarily aggressive brain surgery for what was ultimately an incidental imaging finding. This case highlighted several errors in the delivery of his care, but the most obvious was the absence of shared decision making. The Skolnik family was not given a complete picture of the risks of their son’s surgery as well as the alternatives available to them. Following the film we discussed several problems with the existing informed consent process. Many people noted that the current function of informed consent documents is to provide legal protection to the hospital and providers rather than truly inform the patient or obtain their consent in any meaningful sense of the word. Others noted the inherent conflict of interests that underlie the process: when hospitals and proceduralists rely on volume to… Continue reading
Similar to the previous day, I found myself incredibly moved by the film presented regarding Michael Skolnik’s experience and subsequent death. While I was shocked to learn of the neurosurgeon’s actions and attitude during the whole ordeal and resulting consequences, I was truly surprised by the number of conference participants who could identify an instance when they had encountered or interacted with a similar physician. It seems like common sense that in a field dedicated to improving people’s health, all of the members in the profession would require basic traits such as compassion and empathy to succeed. Yet, I am instead hearing of countless examples where the opposite is true, and it leaves me dumbfounded.
The paternalistic model of patient-doctor communication has allowed the past generation of physicians to build an exaggerated sense of self-worth and importance, given the authority to quite literally dictate the lives… Continue reading
Just before coming to the AELPS conference in Napa Valley, I upgraded my cell phone. As I was setting up my phone, I hastily clicked through the buttons, checking the box to note that I had “read” the Terms and Conditions. Companies have gotten so used to their customers not reading these long Terms and Conditions that they don’t even show it to you during the main set-up; rather, you have to click on a link that takes you to a separate page to read them. Both the customer and company just go through this charade without a second thought.
While watching the film about Michael Skolnik, I realized that the “charade” feeling has permeated into our informed consent process. If healthcare workers minimize the process of informed consent to a mere formality, our patients will not be able to use that time to truly think about the risks, benefits,… Continue reading
Our group had a really great discussion about informed consent after watching “The Faces of Medical Errors… From Tears to Transparency: The Story of Michael Skolnik”.
Even though all of us agreed that the importance of informed consent has been appropriately emphasized throughout our education, many of us were unclear on the practical aspects of the “ideal” version of informed consent. A distinction that was highlighted by the film is that informed consent is a dynamic process, not a singular event, and does not merely end with the patient’s signature on the consent form. One conversation would not suffice regardless of how comprehensive it might be.
The consideration that, at any point in time, circumstances driving the patients’ decisions can change and they can withdraw their consent should remain at the forefront of caregivers’ minds.
Not only does maintaining this collaborative process prevent harmful outcomes, but it improves patient satisfaction… Continue reading
As medical students we are often made to feel like an annoyance to everyone: the attending who can’t be bothered to teach yet another new batch of newbies, the nurse who wishes we would get out of their way so he/she can do their job, the resident who is post call and just wants a bed, and yes, even sometimes the patient who at times view us as yet another person who will do the same thing to them that 3 other people had already done that day. However, after having heard the stories and discussed with fellow colleagues at the camp today, I realize that I should not let anyone make me feel like a hassle. I should take ownership of my assigned patient and do my absolute best to help them. I need to not be kept in the sidelines, but to be in the trenches with the… Continue reading
I told a colleague I would be out for a week to attend a patient safety conference, and her first comment was, “Oh, is that a particular interest for you? Patient safety?” As a student training to work with patients as a career, I couldn’t understand how any topic with the word ‘patient’ in it had the option of being an interest. Whether I liked it or not, I needed to know it and figure out how to make it an interest because it would be the main focus of my career.
From the opening remarks of the Telluride Experience, it was clear that whatever level of interest I had in patient safety prior to the conference would be exceeded as it has now consumed my thinking. It was the perfect riddle. Everything seemed to contribute to it and lack of something reduced it. Everyone needed to be aware of… Continue reading
By Mary Blackwell, Nursing Student, UPenn
By the end of day three my mind is saturated and I feel so lucky to have the opportunity to be here at the Telluride East Conference. Aside from the twins in utero, as a rising senior in UPenn’s undergraduate nursing program I am certainly the youngest conference attendee. As a student, and a nursing student at that, in the hospital I often feel like the lowest on the food chain. But in this environment of open communication the medical hierarchy collapses and it amazes me to see various healthcare professionals come together for the betterment of patient outcomes. Never before have I had personal connections or meaningful conversations with interdisciplinary healthcare students surrounding issues in healthcare. Because it is so clearly valuable to have these types of conversations, I wonder why academic programs don’t put a larger effort into connecting various healthcare students… Continue reading