No decisions about me, without me

Aside from the gorgeous hike that we went on this morning, the conversations that stood out most to me to day were those about informed consent and high reliability organizations. I think that the statement in the title of this post can be applied to both.

Hearing the stories of Lewis Blackman and Michael Skolnik have motivated me to do better in ways that very few things are capable of doing. I want to do better for my patients, their families, and my colleagues. At the core of the Michael Skolnik case was the ineffective/absent process of informed consent. The presumption that patients and their families are as knowledgable of their disease and options as we clinicians are, without a carefully crafted and in-depth conversation, is deeply troubling. We have to find a way as clinicians to make time for these conversations, respect and involve patients and their families, and do our best to help those we serve be their own advocates in medical decision making. All week we’ve discussed the danger of making assumptions, and assuming that patients know what questions to ask and fully comprehend the massive amounts of information we pass along to them is just another example. We must involve them in making this process better and in making medical choices. No decisions about me, without me.

I was also excited by the conversation about HROs, and cannot wait to put some of the tools we discussed into practice. One of the things that I took away both from the HRO discussion today and from our previous days in Telluride, is that this cultural shift toward focusing on patient safety must involve every single person at the institution. From planning to training, implementation, and evaluation, these individuals have to be brought to the table in order for the organization to truly become reliable. The people actually doing the work and carrying out the policies need to be involved in their inception order to reinforce the concepts, increase buy-in, and ultimately foster a culture that supports patient safety. Again, no decisions about me, without me.