Redefining Reality

While completing my undergrad degree, I was a member of our school’s mock trial team. I will be honest – this was not my favorite experience, and I have rarely mentioned it since. I figured out rather quickly that law would certainly not be the career I ended up in. But I’d made the commitment, and it did do wonders for my public speaking skills. Making arguments in defense of questionable acts and making convincing accusations required learning a few lessons. Among these lessons, in addition to quips such as “fake it till you make it” (a lesson I don’t believe fits in well with medicine, for the record) was the idea that if we defined our reality strongly enough that we believed it ourselves, we could make the “judge” and “jury” believe it too. For example, when we played the side of the defense attorney standing up for a corporate toy company that had distributed a defective product resulting in an infant’s death (safety issues are everywhere!), we created a reality in which the toy company had followed all the latest safety protocol and had done everything they possibly could. My problem with this concept was obvious – this was our reality and our truth, even if factually, shortcuts had been taken. We relied on a false reality.

I thought of my mock trial experience this morning after we watched the Lewis Blackman story. I could put myself in the shoes of the medical professionals in the story. Their reality was that a 15-year-old boy, following elective surgery with an apparently less invasive procedure, would recover soon after. Their reality was that the lack of a blood pressure reading was due to defective equipment. Their reality was that patients on pain medications often suffered from painful constipation. Alternate realities just did not happen. So when the evidence indicated these realities were false, it was difficult to comprehend what was happening. These were experienced professionals, and they had lived in many deeply rooted realities for a very long time, probably because adverse events had rarely happened from relying on those particular realities. Unlike the arguments we made in mock trial, these realities were not created intentionally. They were created out of necessity after decades of operating under a system filled with damaging hierarchy, intimidation, and fatigued professionals.

As patient safety advocates have discussed for years, and as we should all continue to discuss in our respective professions, improving patient safety and thereby improving the quality of healthcare will require major cultural changes. It will require the realities of many, many medical professionals to change drastically. This is daunting. If I am being completely honest in this blog (might as well start honing my transparency skills), thinking about ways to achieve a major cultural shift is so frazzling, I want to go back to my comfy room at the Bear Creek Lodge, crawl into bed, and pretend the world’s problems don’t exist. In my defense, my feeling of being so intimidated is fleeting, and I filled up seven full pages of notes about my ideas for quality improvement during today’s sessions. I am very fortunate to be sharing this experience with a classmate of mine from Mizzou, Audra. We are already gauging our next steps in the process of improving patient safety and quality improvement education in our curriculum. We believe the major culture change required of us as medical professionals has to start with our education, and we have been disappointed in the amount of apathy and negative attitudes regarding these topics among our peers. After today’s sessions, we are able to start coming up with specific steps we can take when we return to Missouri, and we are anticipating more insight as this week progresses.

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