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
I dont think that I’ve ever thought so much about informed consent as I did today. I’ve always had the self-perception that I communicate well with patients, especially around planned procedures in the emergency department where I work. After today’s discussion, I recognize that I am doing a fine job, but I can also do so much better.
Informed consent is a shared decision making opportunity between patient and physician. At its core, informed consent is a conversation with the goal of allowing the patient to ask questions and hopefully come away with a clear understanding of the procedure to be performed, as well and the risks and benefits of the procedure. Procedures, diagnostic tests, and medications can all be conversations that are pursued with patients under the vigilance of informed consent.
While the conversation is the essential element of informed consent, the informed consent paperwork can serve… Continue reading
Our second day in Telluride finished with the residents watching the award-winning film The Faces of Medical Error…From Tears to Transparency: The Story of Michael Skolnik”. The educational film addresses the importance of informed consent versus shared decision-making conversations – an important aspect of open and honest communication in healthcare that is still lacking in many health systems. The film asks the question – Can a conversation change an outcome? Can a conversation save a life?”
After the film, the residents engaged in a two-hour conversation with faculty and safety leaders on issues related to informed consent and shared decision making. When Paul Levy asked the residents how much training they get on this topic, every resident in the room acknowledged this three-hour session on informed consent/shared decision making was more education than they have received during… Continue reading
What are the transforming concepts that need to be developed by a health care organization in order to instill a safe culture?
According to Lucian Leape MD, Adjunct Professor of Health Policy at Harvard University, who came to Telluride to share his wealth of knowledge and experience related to patient safety, there are five core concepts that need to be explored and implemented in order to first create a culture of respect. Those concepts are: 1) Reform medical education; 2) Integrate health care; 3) Find joy and meaning in work; 4) Engage consumers/patients; and 5) Adopt a transparent culture.
Dr. Leape’s challenge to our group — How do we motivate CEOs of health care organizations to make a culture of respect the priority? How do we develop awareness of the problem so that there is pressure for action? What can you do “from the bottom up?”
What an amazing and invigorating second day of discovery and consensus building at our Telluride Roundtable on “Open and Honest Communication Skills in Healthcare”. The high altitude and beautiful mountain valley scenery have ways of opening up creative thought processes that lead to amazing new ideas. Some reflections from day two: