By Aaron Cantor, BS, ENS, MC, USNR, MSII Pennsylvania State College of Medicine
On my way back home from Telluride, I happened to pick up a copy of USA Today from 20 June. I was pleasantly surprised to see that the front page featured a special report, “When Health Care Makes You Sick: Under the knife for nothing.”
Although the article highlights medical errors, interviews Lucian Leape and Rosemary Gibson, and even mentions the story of Michael Skolnik, its tone perpetuates acceptance of medical errors and withholding of valuable information: there is a way to know the total number of cases in which people got surgery that wasn’t needed if honest disclosure is practiced; hospitals are required to report infection and surgical errors to a governing body, but reporting to the patient and family (those who are most affected) may not be required. The article goes on to describe several other instances in which reports of complications are too difficult to obtain, doctors are pressured into performing more surgeries to generate more revenue in a fee-for-service model, or people are rushed into procedures without being recommended to obtain a second opinion. The article also places most of the burden of preventing unnecessary surgeries on the patient, promotes a doctor-patient antagonism, and erodes trust in the healthcare system. Stories and methods of overcoming these barriers to safe and effective healthcare are not described, which maintains a negative attitude against healthcare and sensationalizes only poor outcomes.
Fortunately, an important comment from Gibson is included in the article but it is not further explained. She states that “the system, in my opinion, doesn’t want to know about the problem [of unnecessary surgeries].” As we discussed during our meetings, most of the healthcare system is perfectly designed to the results it gets…so let’s focus on how the system promotes, say, unnecessary surgeries and work towards changing that system. The past few days in Telluride with our awesome group allowed me to meet agents of this change and learn about techniques for both enacting system changes and promoting awareness of system faults. For instance, Tim explained the new Clinical Learning Environment Review (CLER) Program, which assesses the graduate medical education learning environment and focuses on patient safety and quality improvement among six focus areas. This is great ammo with which to convince administrators to more carefully consider the culture and systems in place at your institution and support a project you are planning that aims to reduce errors.
But as Garrett and Suresh describe in their most recent posts on 21 and 23 June, respectively, these types of changes and patient safety training often receive too little emphasis from top administrators all the way down to residents and senior medical students. I think at least two activities can help encourage students to support system changes towards greater transparency. One method is experiential learning; if students personally experience outcomes of a common procedure or medication, then they are more likely to understand the patient experience and be better equipped to describe, say, what to expect during an MRI or nasogastric tube insertion and maintenance. Understanding the patient experience translates to greater honesty and a higher degree of care and mutual trust. Reminding students to pause and think about the patient as if that person were a family member may also influence students to act more cautiously and disclose all relevant information.
Another activity is following consenting patients with chronic conditions during their normal activities of daily living. This affords students the opportunity to experience how illness affects people and their families outside of the medical environment and further enhances empathy, all of which encourage greater transparency in healthcare. An example of this activity is below.
The caliber of all Telluriders was phenomenal as well as inspirational, since each of us will have to overcome an ingrained healthcare culture at some point in our careers if not done so already. I look forward to learning about the results from ongoing and developing projects as well as the sharing of ideas that emerge from our meeting.