Open Honest Communication

Reflections Day 1: Intern vs Senior Resident

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

Telluride Day One

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

Changing My Practice After Telluride

After my time at Telluride, I only had one day to process everything we learned, and then got right back on the horse and went back to work in the Emergency Department. I truly felt like I was seeing my clinical practice from a new angle. Rather than completing tasks and checking boxes, I found myself thinking through clinical situations and inviting patients and family into conversation about their care.

Of everything that we experienced at Telluride, I am most thankful for the opportunity to learn from the Blackman and Skolnick families. My heart is broke for these two young men and their families, who put their faith in healthcare members, who they should have been able to trust. I learned from their stories that open and honest communication with patients and families, from the very beginning (in my case, the ED waiting room) … Continue reading

That Creeping Feeling…

First of all, I want to say that Richard’s presentation was so phenomenal today. I distinctly remember hiking up the San Juan mountains in Colorado at last summer’s Telluride conference after a great session the day before thinking, “I’ve found my people.” It really is a special thing. I still see one of the other alums every now and then at hospital meetings and it literally warms my heart to hear his name and that he is doing great things at his home institution.

We talked a lot about informed consent and a patient’s understanding of their own experience in the healthcare system. As a primary care physician, I couldn’t help but wonder how Patty’s son’s primary care doctor felt about the horrific outcomes of his patient at the hands of a surgeon who probably didn’t need to operate in the first place, someone he tried to… Continue reading

I Have A Question…Is That OK?

Throughout today’s discussion various moments truly hit home to me, especially in regards to communicating with patients and families. People come to hospitals often in their most dire time of need, not to simply chat and sip coffee. Stress, fear, anger, and uncertainty mar the face of these individuals, leaving them to appear disfigured in comparison to their standard facade…leaving them at their most vulnerable. As healthcare workers it is our duty to identify that these people are hurting and understand that communication can assist in stopping the hemorrhage of “what if’s” and begin to help with the healing process.

Bringing to light that it is normal for individuals to have questions, I feel, is so important. As it was examined today, asking patients and families “what concerns you?” or “what bothers you about this?” truly provides an opportunity for individuals to stand up for themselves without feeling the pressures… Continue reading

Premature Closure – Not Fighting Back

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

Day 2 Reflection: Michael Skolnik and the problems we have with the process of obtaining informed consent

Today we discussed Michael Skolnik’s story and really touched on the process of informed consent. As a nurse I am a witness of informed consent and I have been identified by some as to “who not to ask to be a witness to an informed consent” form by some physicians in my practice. Often times, as many of the residents in the program identified, informed consent is one of the many tasks that physicians have to check off their list throughout the day. First off, I will not sign an informed consent if I was not in the room during the process of obtaining an informed consent. I also want to make sure the patient’s, or their families/POA, are able to state the procedure in their own terms, and every risk or benefit that accompany each procedure. If they cannot, I will have the physician restate or rephrase whatever part… Continue reading

Interchangeable Parts or Empowered Actors?

During the debrief following the video on our first day, we discussed the importance of everyone stepping up. We identified this work in medicine as a “team sport,” where all members must work together, communicating clearly, and having the power to take ownership of the tasks ahead. This is crucial in the provision of effective patient care, and it is unfortunate that these often-considered “soft skills” are minimized or absent from medical education and practice.

We also highlighted industries such as military and aviation, where teams also taking on high-risk yet different scenarios must work together and do so effectively. They minimize risk, keep clients safe, and experience nearly no adverse effects. In these industries, members of teams are conceptualized as interchangeable parts – cogs in the machine/part of the assembly line – yet also intelligent actors with capacity and power to step up.

Our conversations hinted at this idea… Continue reading

Crying Wolf

This post is a day late in coming, but it’s still a relevant concern of mine.

Yesterday was the first day of our patient safety camp/conference, and we spent a lot of time talking about communication and speaking up if you see something going wrong, especially if you’re lower down the hospital hierarchy.  As a medical student, I imagine this scenario as a med student or a resident doing rotations in the hospital.  Being the med student who doesn’t know anything or the new resident who’s green, I can easily imagine situations where I might think something’s off with our diagnosis or treatment plan for a patient, and my concerns are brushed aside as the concerns of an inexperienced learner.  At some point, hopefully, I’ll be lucky enough to work with an attending who does listen to me when I raise a concern, but the tricky thing… Continue reading

Day 1 Telluride Reflection:

What a way to start a week! I had an idea of what this week would be like, but not to the extent of the material in which it would encompass. First thing this morning, we touched on a subject that hit so close to home: the difference between the thought processes and communication processes between nurses and physicians. The first activity of the day included a video of the Lewis Blackman story. There are so many events/problems that occurred between all interdisciplinary members of the team. One of the issues being that Lewis was not admitted post op to a medical-surgical floor for post-op management/observation; rather he was transferred to an oncology unit. No matter how we are trained, if we don’t regularly treat and manage a certain population, we need refreshers on what we should be looking for, and how to manage their care.

In the video we… Continue reading

Telluride Experience 2021 Dates

BRECKENRIDGE, CO:
CMF Session One*: 6/7 – 6/10
Bennathan Session Two: 6/14 – 6/17
Session Three: 6/21 – 6/24

*Session exclusive to the COPIC Medical Foundation Residents.
 
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