“What’s the WORST thing it could be?”

A beautiful day, a beautiful place, and some of the finest young minds I’ve had the privilege of brainstorming with. 

Today in Telluride we dove into the deep end of tackling the problem of patient safety. Several wonderful presentations and many amazing take home points. For me the most poignant of which was the story of Lewis Blackman and meeting the patient’s mother Helen Haskell. I was so thankful for her to share her story of miscommunication and premature closure. Two things that ultimately led to the untimely passing of her 15 year old son from a completely preventable and treatable complication of an elective surgery. All too often in our healthcare culture we take sign-out or passage of patients onto our service with a diagnosis as though it is spoken gospel. If a colleague sends us a CHF patient, then we treat it as a CHF patient without question, all too often ignoring vital signs, physical exam findings, or lab findings that may point to another underlying cause.

Such was the case with the bright 15 year old boy who complained of abdominal pain which ultimately turned into a perforated bowel. Had the question “What’s the worst thing it could be?” been asked about this young man’s persistent post operative abdominal pain, then maybe this wouldn’t be a story we use to illustrate the large cultural shift that needs to happen among physicians in patient safety.  That’s not to say chase every lab or every complaint a patient has, but to truly ask ourselves as physicians, have I ruled out the WORST possible thing this patient could have?   Have I ruled out the conditions that may kill this person under my charge?  Have I taken a step back to look at this patient objectively?  Am I taking all information in and processing it, without the overhanging bias of a diagnosis I have already made?  Am I adjusting my care and investigation accordingly?  Questions that I think I may have to ask myself more often.  I am looking forward to diving much further into this world, improving a system that I will be a part of for the remainder of my life, and doing my best to make sure that no other person has to share the pain of Helen Haskell.

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