Where do I even begin when trying to summarize the discussions and ideas sparked by a mere few days at the Telluride Experience in Napa Valley? Without having stepped into a clinic as a medical student in-training, I feel like I have gained a wealth of knowledge that will frame the experiences I do have when I set foot into my first preceptorship in just a few short weeks! To really be able to translate the learning to applied practice, I found myself making a list of things to remember to do as I began my career. In no particular order, here are the 20 things I must do as I strive to work towards zero harm for my patients:
- Engage in regular reality checks. Be able to step back from the detailed task(s) I am performing and take a look at the larger picture.
- Maintain collegiality with EVERYONE. We are all equals working toward a common goal: to make the patient well. The patient and family members are included in this mutual relationship. Share a meal or drink with colleagues and get to know them – this is the safety net that will allow communication in high-stress situations and prevent errors.
- Realize the impact my personal life could have on my professional interactions. I have a duty to provide my undivided attention to my patients, regardless of what is happening in my personal life. I will rely on support networks as I need them and I will develop the ability to put any personal distractions on hold when I am with patients.
- The golden rule to fight patient safety terrorism: “See something, say something.” If it is good enough for public transportation hubs, it should work in a hospital. If something is being handled inappropriately or I see a mistake about to happen, I must voice my concern.
- I will be comfortable stating the truth and being open – to patients, supervisors, and my colleagues. Transparency leads to trust and I will disclose all my mistakes and assure patients that I am committed to delivering the best care possible.
- Follow the protocol. Like any scientist, I will familiarize myself with all steps in a procedure before I attempt to start the process. If I am unclear, I will ask for help. I will not pull that central line by myself the first time.
- Just because I have been trained to understand and use medical jargon doesn’t mean my patients and their families have. My job includes being able to explain what is happening in a way that patients/families can understand and engage in the conversation about their own care.
- Hospitals can become very high-stress, emotional, chaotic environments. I will remain calm and continue to attend to my duties as urgently as I can without contributing to panic.
- I will not forget the common purpose I share with my health care team: alleviating human suffering from disease and providing the best care for my patient while truly enjoying my profession.
- As a public health professional, I will have prevention at the forefront of my thoughts. It is much easier and cost-effective if we can prevent something instead of having to respond to it later.
- Be a smart negotiator. Tone, diction, and phrasing make all the difference whether you are questioning something or fighting for change. I will present my argument in a way that others will understand my perspective without being accusatory, presumptuous, or demeaning.
- Never have more than 50% expectation of success in any procedure. Only be expecting humans to introduce error into patient care will we be able to catch it. I will listen to that small voice within that expresses even the tiniest hint of doubt. So, I don’t care how many times someone has said the patient is not allergic to penicillin, we will check the chart one last time before we administer it.
- I will be open-minded to the opinions and ideas of others and to the realm of possibilities for a diagnosis.
- Be aware of forces inherent to any culture that pull/push/shape you and the care you can provide. Know yourself, stay true to those ideals, but be vigilant of these external forces that can change the path you try and take.
- Have a go-to phrase to use when speaking up: “I noticed that…” Take away the power from nonverbal behaviors.
- Ask for feedback and get this on paper! Specifically after a rotation, I will try to improve myself and better my clinical knowledge and skills to bring to the next rotation. Ask the following:
- What do you like that I do well?
- What would you like to see more of?
- Develop equal competence in collaboration skills and clinical skills. The job demands both.
- Remember how to communicate with the family members of a patient in the event of any medical error:
- Tell them what they want to know. Tell them the truth and answer the questions honestly about details.
- Address how you will fix it.
- Take responsibility for the error.
- Say you are sorry.
- Let the family be a part of fixing the problem.
- Focus on the facts and not judgments when making notes in medical records. Judgments can alter how other health care providers interact with the patient and hinder quality care.
- Take care of each other.
I am sure there are many more points to consider and I hope this list grows as I gain more clinical experience. As a starting point, though, it brings up things I’m not sure I would have tuned into or been aware of before I started working with other providers and patients.
To everyone involved in allowing me to create this list: thank you seems inadequate. You spent your time organizing a conference and hoping that this time spent helped with the patient safety revolution. You shared your deeply personal stories about medical errors affecting your daily lives. You synthesized years of experience into poignant stories that made an impact. You provided a network of professionals, colleagues, and like-minded revolutionaries to help. You picked me to be a part of it. Thank you will never be enough.