Day One: Thoughts/Observations

1. Need to be careful to avoid framing patient safety as a professional responsibility/advantage instead of a moral imperative. Watch and examine the language we use. There is an importance to realistic ideas of “cost efficiency” but patient safety is much more than that.

2. In the video on Lewis Blackman, there is a plea for medical professionals to frame clinical decisions by asking “what’s the worst it could be”
How do we realistically do this in an era of rationed healthcare? We can’t guarantee basic preventive care to citizens, how do we make new standards of care that demand us to consider the worst, especially considering a medical culture of over treatment where more tests and procedures create further opportunities for medial mistakes, harm, waste, inefficiency, and overuse.
What side of the seesaw do you begin on?
How do we balance?

3. In a discussion after the video, Dr. David Mayer said, “The system is working to do exactly what it was designed to do.” It’s so interesting, this echoes an article I read from the Harvard Kennedy school on Public Policy I read recently in my research on the Prison Industrial Complex. How are American institutions working and functioning as they were meant to, and causing people to quite literally lose their lives and livelihood in the process? How are American institutions culpable in “doing harm” and how do we begin to combat muscular structures as individual people, as young medical students?

4. “Every adverse event is subject to litigation; the standard of care becomes defensive medicine.” – Richard Anderson
I’ve been thinking a lot about this statement. How do we praise “Standard of Care” in the era of evidenced-based medicine as a way to reduce variability. In conglomerating data, however, we reduce the individualization of “patient-centered care” which we claim to also want to maximize. Standard of care becomes attached to statistical majority, to “cookbook medicine,” to guidelines in which diversion invites litigation and predisposes the physician to blame. How does a Standard of Care (medical protocol) legitimize and reify the sense that “there is a right answer and you should know it” that we’ve discussed is so critically harmful in the conversation about how clear and honest communication is difficult in the face of expectation towards perfection. Are the benefits of a “Standard of Care” mitigated when it perpetuates an expectation that we’ve decided acts as a barrier to patient safety? How do we talk about it and use it to achieve our goals instead of finding them hindered. I also wonder how this lies in connection to the first video we opened with of professionals getting stuck on an escalator and forgetting they can simply walk off. How technology can be a pair of handcuffs in itself. Will my best tool as medical student be not my clinical judgment, empathy, preparation, but rather Up to Date? In the face of standard protocol and the responsibility for infinite facets of medical knowledge, do we render up to date the statistically but not qualitatively the best chance we have at achieving maleficence?