A resident’s perspective on the Medstar patient safety elective

When I began the Medstar patient safety elective last week I would have never thought that it would change the way I will practice medicine for the rest of my life.

What began with a basic understanding of the varying components that make up quality patient care and safety, ended with a passion and thirst for change in medicine.  I was astounded to learn the scope of medical errors in this country. In a high stakes profession built so heavily on patient trust, how is it that we have lost touch with the reality that as physicians we are human?  We make mistakes. We can offer the best medical treatments and technologies, yet we can’t save patients from ourselves. It’s time to turn the attention to the hand that is writing (or typing) the order. It’s time to slow down and focus on the person that makes up the patient. It’s simple right? It’s the golden rule. Deliver the kind of care to your patients, that you would want delivered to your closest family and friends, or, to you.  Take a patient-centered approach to medicine. Ensure that your patients are safe before you do anything to heal. It seems so easy, yet why do 100,000 people in this country still die from preventable medical errors every year? It is time to hold a critical magnifying glass to how we deliver patient care in the United States. As physicians it’s our duty to protect the patients we care for. We must take a thoughtful approach and make systems based changes in order to ensure that no one is harmed by our direct actions. We have to stir up this fire in the youngest generations of doctors in order to elicit lasting change. We have to take an honest look at the culture of medicine, eliminate hierarchy and start respecting each other. When we don’t, it’s the patients that truly suffer.

When I spoke to Helen Haskell (Lewis Blackman’s mother) during one of my phone interviews for the patient safety elective I could sense her lasting guilt and regret. She blames herself for not researching enough about the elective procedure her son underwent. She was forced to watch her 15 year-old son slowly bleed into his abdomen and die in the hospital with no one listening, with no one respecting her concerns, with nurses afraid to call or speak up to doctors, with inexperienced doctors unable to see past the diagnostic label written in Lewis’ chart. Since when has it become a patient’s responsibility to independently learn about their treatment options? Since when have we come to put more trust in a written word in the medical record than in a mother’s intuition and concern? Informed consent and shared decision-making are at the core of many harmful patient events.  It’s time we teach doctors to share information with patients rather than make decisions for them. One-paged, fill-in-the-blank informed consents should never replace meaningful conversation that involves patients in their own care. The best possible thing we can do for patients is empower them to understand their medical condition.  It will only promote adherence and respect for one another. We must be transparent and humble and recognize that mistakes happen and when they do, honesty and full disclosure is the best policy.  Improving communication skills are key. For patients, it’s not about how much you know but how you explain it to them, how you involve them and how you treat them on a personal level. I rarely hear a patient boast about how smart their doctor is. Patients talk about how much their doctor listened or how much time they spent learning about them or what a great job they did at explaining something. It’s not so much about what you do or even what you say but how you make them feel.

When I asked Helen what advice she would give to young doctors just starting out she said “Find your true professional and ethical foundation and be proud of it. You are part of a service industry that must be reliable. Remember that it takes courage to stand up to powerful sources and be transparent. Don’t help make medicine commercialized and full of propaganda. Resist the pressure to deliver high volume care, and practice thoughtful medicine.” Wow.

I have come to find that the leaders in patient safety make a small but unbelievably strong community. I can’t wait to join my enthusiastic fellow residents in Telluride this summer for the Transforming Mindsets: Patient Safety Summer School for Resident Physicians. I have no doubt it will be an unbelievable experience.