New friends, new tricks

Today was enlightening. Never before have I heard terms such as “early closure” and “normalization of deviance”, words that define the daily flaws of medical care. Narcissism and mindfullness are concepts that I’ve always associated with people I know but never thought of in relation to medicine

At the core of all the activities today was the concept of open and honest communication. The team caring for Louis Blackman had many opportunities to admit that they didn’t know the cause of his symptoms. However, they chose to downplay his symptoms and close the case wothout a clear diagnosis. Narcissism was at play with senior residents, who did not involve their attendings at critical moments.

In medical school we are expected to answer multiple choice questions to demonstrate our knowledge. However patients don’t come in with A through E on their forehead. Its critically important to know that you don’t know. That you have to ask a senior or attending. There is no “grade” on your transcript to strive for. The only thing to achieve is safe compassionate care. Once you admit to yourself that you are human and fallible then you can privide honest, non-narcissistic, mindful, high quality and safe care.

You might have to negotiate with the powers that be to allow for safer care given the constraints of being “only human.” Sometimes there is simply no way to provide safe care for every patient with the human/ technological resources that are at hand. If you are the first to set the price (ie increased support staff for safe care) the administration might “anchor” to those terms and act favorably towards the goal of patient safety.

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