Telluride Napa: Day 2 Reflections

Day 2 started much like Day 1. Once again we were shown a video which flies in the face of everything that we are taught to do as healthcare professionals: First do no harm. The video about Michael Skolnick’s story was like watching an impending train wreck but being powerless to stop it. So many lessons to learn here….

1-As much as we learn in text books,  patients and their symptoms will not fit into a nice little box-so you always need to be open to the possibility that you are wrong, a diagnosis may change and be willing to consider/ look for other answers. For example-I have seen strange presentations for appendicitis over my career that did not include the expected RLQ pain, fever & elevated WBC. One patient I had was actually having LLQ pain, fever and elevated WBC. I was thinking diverticulitis. No one was more surprised than me when the CT results came back. Keep your mind open to the fact that your initial thought/ impressions/ differential diagnosis may be wrong. Have a plan B.

2-Michael’s symptoms were attributed to a cyst that was so small (& not obstructing) it didn’t make sense to me why it could cause his loss of consciousness-and I am no neurosurgeon. As providers if you think something doesn’t sound right and it isn’t your area of expertise-that doesn’t mean you (not the patient) can’t ask for/ recommend a second opinion either.

3-Informed consent-I sadly think that this has far too often become a box to check in most cases. I have seen so many patients who were supposedly consented admit they didn’t understand the explanation they were just given-but only after the person consenting them had left the room. This should never happen. If we truly want patients to be educated & informed, this can’t be rushed.  It almost seems like consenting has become a mundane task for some healthcare professionals-it is far too important to be looked at this way. Think about all of the things we do consent patients for-procedures, surgeries and even vaccines. Do the patients really understand that all of these things I mentioned include some modicum of risk and potential for harm? Most likely not unless that consent has been done properly. I also wonder if we do not use informed consent enough. What about other tests like CT scans? Should we consent for that? CT scans by themselves-maybe not. What if we give IV contrast? There is a risk of a reaction to it.  Does anyone even tell patients this? Even where consent is not mandated, we need to be sure to explain things to patients/ families in detail and communicate adequately in order to build and maintain trust.

4-In Michael’s case-that was one of the worst “consents” I have ever seen. He was under the influence of mind altering medications, never really given any option other than surgery and never understood that any surgery has risks inherent to it. His parents should have been present too. It really seemed like they were just railroaded into the surgery. It was a travesty. Why didn’t anyone else question this? Where was the nurse? If Michael was his/ her patient-they should have known the medication was given and that he was not in a position to agree to anything.

5- As healthcare providers, we need to always support a patient’s right to make whatever treatment decision they wish. It is not necessary that we agree with them. It’s not about us. It’s not our body. It’s not our life. Parents as well have the ability to consent and decide for their kids. I have read horror stories recently where (when the medical staff does not agree with the parents’ choices) they get Child Protective Services involved and have had cases where the child is removed from the home for not agreeing with the treatment plan. This is such a violation of the provider-patient-family relationship and a form of bullying. At the end of the day, you can present someone with all of the options, but the choice is theirs. There are some things we cannot control. Learn that now. It will save you some angst later.

Communication is the root of so many of these safety issues. Why on earth do we make is so much harder than it needs to be?

This was a good day. Lots of info. I am encouraged when I see my physician and soon to be physician colleagues embracing this material and their willingness to work with the nurses who are here.  They have been very insightful and open to conversation and listening to other points of view. This is how it should be. We are all on the same team after all-the patient’s.

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