Day 1 Reflection: Premature Closure

This first day has been incredible! Meeting nurses, residents, and other medical students has been an amazing way to discuss patient safety issues. With so many different perspectives, we are able to piece together a much clearer picture of patient safety issues that can occur on a day-to-day basis. During our discussion of Lewis Blackman’s heartbreaking story, I learned the term “premature closure”. The term refers to a diagnostic error made when a medical professional makes a diagnosis without completely analyzing everything on the differential. I realized that premature closure could cause two very serious issues.

If an attending or other senior member of the team announces a diagnosis, everyone else on the team feels like they can stop going through the differential in their heads. It is so important that we constantly have a voice in the back of our heads asking, “What’s the worst that can happen?” rather than settling for the easiest answer.

The other issue is that premature closure can make it harder for someone else to speak up if she/he doesn’t agree, because no one wants to defy the group. In fact, this concept reminded me of the Asch conformity experiments. A hallmark of every introductory psychology course, the Asch experiments had participants sit in a room with confederates who were purposely getting obvious facts wrong. However, if the majority of a group were saying the wrong answer, the participant would also say the wrong answer, despite his/her internal belief that the answer was wrong. Premature closure becomes more dangerous because it can silence other people on a team who would’ve readily caught that mistake.

As a medical student just starting my foray into this world, I thought that it would be next to impossible to speak up in these situations. However, other students had a great suggestion to frame your concerns as questions rather than attacks. Everyone also agreed that a simple statement, such as “I am concerned/This feels unsafe” can send a quick warning to pause and rethink the process. I am looking forward to learning more from my colleagues as the conference continues.