In my return to Telluride 6 years later, not a lot has changed. The people here are still as friendly as ever and the best taco stand I have ever found is still making the same mouth-watering burritos (pictures to come). However, my journey here is far different than before. This week I have been exposed to a wide variety of people involved in the health care community all wanting to hone in on issues surrounding patient safety.
The discussions that are taking place will one day shape the future of healthcare as patient quality and safety continues to evolve. Ideas are being bounced around and discussed around the clock. I think so far the most profound stories for me were the videos of Lewis Blackman and Michael Skolnik. It is hard to see how easily the medical system can fail so easily, but these stories and those of… Continue reading
As day two neared a close, a spontaneous conversation amongst roommates touched on two topics relevant to our discussions today.
1. “Informed” Consent
The goal of informed consent is simple: to provide the necessary information that allows the patient to reach a decision regarding his or her health. Today we discussed the pitfalls that have led me to view the word informed in a different light. From obtaining consent in less-than-ideal situations to forms filled with complicated jargon, it seems to me that the current consent process requires the patient to be vigilant. In many ways it seems that the burden of responsibility to understand the decision-at-hand has been placed on the patient. Is a system where the burden of responsibility is placed on the patient safe?
2. Value in Walking the Line?
In various activities yesterday and today, the theme of self-evaluation has… 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
Its been a incredible experience – whether it was bonding while taking our 3 mile hike or bonding during the picnic or in casual get togethers amongst friends at picnics and barbecues; we exchanged thoughts and imagined a system committed to bold, new ways of thinking of health care and the relationships between doctors and other care providers. Today we heard a touching story about a child that experienced an adverse outcome that highlighted the value of strong communication and truly understanding the environment/mood before making inappropriate diagnosis of patients especially kids who may try to naively consolidate multiple emotions and be more scared based on what they read/watched on TV. As I leave this round table – I think about what I can take back to my home institution and implement. Some of my thoughts include creating a difficult patient encounter in Clinical Skills where an individual has… Continue reading
Thanks to everyone’s participation on the blog, facebook and Twitter, the Transparent Health blog hit an all-time high number of page views today with 241 hits to the blog. Thanks so much for sharing your wonderfully creative insights and thoughts on how healthcare can become safer for all of us.
Let’s keep the conversation going–and not let up. As you all learned today, a conversation can change an outcome. The more noise out in the Twitterverse, the blogosphere and whatever “they” call Facebook-land–the more likely the Telluride Summer Camp messages of: transparency, open/honest communication, patient-centered care, creation of a just culture in medicine, respect and joy in the workplace and building of high reliability organizations that drive preventable medical error to zero will catch fire–in a good way. Keep the momentum going even after heading… Continue reading
What an incredible first 24 hours in Telluride, not only did I meet some incredible people, but I also began to look at healthcare beyond 1 person and 1 family to one community and one city. Hospitals have incredible abilities to transform communities and touch the lives of many. We have a commitment as physicians to provide high quality care although there are many opportunities to make mistakes all the time. Amid all the distractions that surround us, we must try to stay focused for the subtle signs and rely closely on the physical exam to provide high quality care for patients. At the same time, we must do more to ensure mistakes aren’t repeated at different hospitals across the country. It seems that knowledge in hospitals is highly institutionalized and we must try to take the knowledge and apply it across institutions and state lines. I think this is… Continue reading
While I am spending a week surrounded by some of the most gorgeous mountains, the Hide Park wildfires continue to ravage northern Colorado. Despite some of the best efforts of firefighters, the wildfires have consumed more than 58,7000 acres, have forced thousands to evacuate, and have destroyed more than 180 homes in nine days. With continued hot weather and winds, the goal is to contain the fire and minimize as much damage as possible.
With news about the fire on a nearly continuous feed on local news channels, I am reminded of Dr. Don Berwick’s famous 1999 National Forum Speech, “Escape Fire.” In the speech, he describes the 1949 wildfire that broke out on a Montana hillside and how it changed the way firefighting was managed in the United States through the use of an “escape fire.” Dr. Berwick draws the powerful analogy that our health care system is in… Continue reading
A soldier cannot run from battle because there are guns trained on his back in both directions.
This is not so in other occupations. As medical students and professionals, we constantly have to choose how to react to new information and whether to take action or to sit on the sidelines. Soldiers don’t have the luxury of these options. So in a way, because we must make difficult choices, we also need to muster more courage to perform in the battlefield.
Patient safety improvement takes a lot of guts. It means challenging the status quo, confronting established traditions, risking your job or grades, and most of all, dealing with recalcitrant people….who may be your seniors.
Today I was confronted about my experience shadowing a preceptor who does not wash his hands before he sees patients. I have commented on this directly to the physician by saying, “I notice that you… Continue reading
Today’s student discussions about the Lewis Blackman case focused on ways that students might be able to affect change or address safety concerns as members of a clinical team. Drawing on our various clinical experiences, we offered suggestions on how to ask an innocent (but important!) question or standardize hand-offs.
In reflecting on today’s discussions, I can’t help but remember my dad telling my eight-year-old self: “KISS: Keep It Simple, Sir”. Healthcare immerses us in complexity, whether through patients with multiple comorbidities or new technological tools. Caught up in the whirlwind of elaborate innovation, we sometimes lose sight of the most elementary tools that can improve patient care. Today, students offered simple ideas: a pad and paper for patient questions, a photo directory of the clinical team posted in a patient’s room, a common form for daily hand-offs. Such tools neither require tremendous financial… Continue reading
Isn’t it appropriate that after 7hrs of flying and a 1.5hr windy car ride I find myself in Telluride, CO at an elevation of over 10,000ft to spend a week participating in the 8th Annual Telluride Interdisciplinary Patient Safety Roundtable?
My third year of medical school has been nothing short of transformative. While my classmates and I have grown tremendously in translating our theoretical knowledge into clinical skills, what has also grown is an increasing awareness of the plight of our patients. Many of our patients are already in a vulnerable position given their medical conditions. What does the health care system do to help them regain their health? We force them to navigate the rough seas of a fragmented health care system.
Out of frustration for one of my patient’s experiences while on my Family Medicine clerkship, I wrote this welcome message that satirizes the typical patient experience… Continue reading