By Nicole T. Jiam, Johns Hopkins University School of Medicine
About a month ago, I was sitting in on a clinical correlation led by an aneurysm neurosurgeon and his patient at the Johns Hopkins Hospital. These clinical correlations are incredible opportunities for medical school students to learn directly from the patients themselves by hearing their story and then asking them questions.
During this particular clinical correlation, the neurosurgeon discussed the importance of informed consent and the decision making process that stretches over several weeks. The decision to undergo a surgery and which neurosurgeon requires deliberation and time.
At one of the meetings prior to the operation, the Johns Hopkins neurosurgeon candidly told his patient: “One of the most important ways of evaluating physician competency is case volume. You want to pick a surgeon that has a huge wealth of experience doing this procedure.”
To which the patient… Continue reading
I just returned from an amazing week in Telluride where I not only learned a lot but was also inspired and reinvigorated by the group of colleagues and faculty I met. One of the most surprising things about the week was that despite our varied backgrounds and geography, we all came together with a common set of interests and experiences (sometimes bad ones) determined to make changes moving forward in our practice. Thank you to everyone I met this week.
Here are the main lessons I learned during the week as well as some fantastic quotes from the group…
1.) Start every meeting with a story (it’s all about the patient!)
2.) The way we treat nurses when they bring a concern to us that ends up being wrong, is often more important than when they bring a concern that ends up being right (respect and appreciation are… Continue reading
Day Two At Telluride Patient Safety Summer Camp
Today’s final discussions revolved around what three tangible things we as residents can do when we return to our respective programs to improve shared decision-making and improve our ability to communicate in the case of patient harm. I was very encouraged that there was actually very little variation from each of the breakout small groups. We all seemed polarized to some very clearly defined, and what seemed like obvious, solutions to improved patient safety in our respective corners of the world.
The opportunity that I see after completing this exercise is that although we can all make small incremental changes in our respective practices, how can we reshape the practice of medicine to make our small individual changes part of a bigger and more permanent cultural change? If all 28 of the scholars would communicate with 10 colleagues about the importance of… Continue reading
This experience has redefined medicine for me. In so many ways we strive to do the best for our patients, but the system fails us. These failures effect our patients, sometimes in terrible ways, but they also effect us as practitioners. We beat ourselves up when we have bad outcomes, we cry, we question our motivations, abilities, and knowledge base- but now we are questioning the system. Learning how we can affect change to improve the experience of our patients, and thereby improve our own experience is groundbreaking. Understanding how change can work, as demonstrated by other industries (defense, airline) makes me feel its possible. Meeting so many inspirational people that believe we can do this, makes me feel I can do it too. My brain and notebook are brimming with ideas to bring back to my own hospital, clinic and patients.… Continue reading
There is nothing more powerful than a personal experience. Helen Haskell represented this at the Telluride Patient Safety Roundtable. Her son, Lewis, died of medical misdiagnosis which inhibited the team from providing appropriate life saving treatment, his story was recounted in a video produced by Drs. Mayer, McDonald and the team at Solid Line Media. The story and the courage Helen has to continually attend the conference and provide a first-hand experience of an unsafe medical system was by far the most memorable things about the week. There were lots of memorable things about the week, including the views from the gondola required to scale the mountains and the dedication of the faculty members, but Helen’s story will continue to stay with me. I am hoping that her son’s memory can act as a guiding force for all of us. A memory we can return to when we have lost… Continue reading
There’s an old adage in medical education “see one, do one, teach one.” I don’t particularly subscribe to it in a literal sense because I think training requires a more intensive learning process than that. But sometimes it does apply quite nicely. A perfect example of this was on Wednesday when I helped run a session about shared decision making and informed consent at our new house staff orientation. The session consisted of a viewing of the video of Michael Skolnik’s story followed by a moderated discussion with the house staff. The idea came out of a casual conversation with my hospital’s Associate Vice President for Academic Affairs. I thought it would be a helpful to new residents to think about these important issues before they really start on the wards and she let me run with it. Just two weeks out… Continue reading
The theme for Day Two in Telluride brought home the value of conversation and communication. Shared decision-making and the process of informed consent once again provided fuel for a robust conversation following Day Two’s viewing of the educational documentary film, From Tears to Transparency–The Story of Michael Skolnik. One student’s comment, “We can’t expect the patient’s family to know they need to be informed,” was a good reminder that keeping patients and families at the center of the solutions being generated in Telluride is again why we are all here.
A second student commented that after the group’s conversation, she now feels “unqualified to get an informed consent,” sharing that she always refers to the risks and benefits of a procedure, but has never discussed alternatives to the procedure. Like the family, unaware of what they need to be informed about, how will medical students know what the informed… Continue reading
In an unprecedented way the Telluride Roundtable enters its third straight week of engaging learners in the importance of open, honest, and effective communication in health care. With students and faculty gathered from all over the country, this week’s activities hope to build on the two previous, very successful weeks here in the San Juan Mountains! Under brilliant blue skies and with near perfect weather conditions, the conversations will center on ways these futures leaders in health care can champion change within their own hospitals and clinics and beyond.
Unique to this week’s attendee roster: Students of Pharmacy and Law will join the Medical Students in the learning process. From the Patient Advocacy perspective, Helen Haskell – founder of Mothers Against Medical Error – will share her perspectives on patient safety, patient and family-centered care, and the critical importance of honesty during the informed consent process, as well as when… Continue reading
“If they haven’t learned it, you haven’t taught it.” This was a Woodenism oft quoted at the Resident Summer Camp in Telluride by special guest faculty, Paul Levy. Wooden and Levy are both coaches and teachers in their respective fields–one hospital administration and the other NCAA Men’s Basketball. With that statement, they both take responsibility to the fullest extent for successfully transferring knowledge to those they themselves are charged with educating. As I reflect on that week, this message rang especially true during the group’s conversation on informed consent and shared decision-making.
One of the residents had mentioned how surprised he was at an intelligent patient’s off-the-mark retelling of the information he had just conveyed. “It was like apples and orange,” he said, as John Wooden’s words rang loud and clear in my head. It was also becoming clear that as care providers, the role also encompasses educator… Continue reading
As I reflect on last week in Telluride, I keep returning to the exchange on informed consent and shared decision-making that was stimulated by watching Michael Skolnik’s story on film. The group concurred that their training around informed consent was all but non-existent during medical school and residency. As the conversation continued, it became clear that true patient-centered care would include this often missed opportunity to better understand a patient’s needs, values, preferences and goals as they relate to the risks and benefits of any (and every) procedure. What is successful hand surgery to a painter? Or knee surgery to a prima ballerina? Or heart surgery to a seventy-five year old grandfather who just wants to dance at his granddaughter’s wedding? How does that compare to a successful outcome for the surgeon? And perhaps just as important, does the surgeon know if her patient is painter? A dancer? A grandfather?… Continue reading