Over the course of the past two days, in which I have had the privilege to learn from the wonderful faculty and colleagues at the Telluride Experience: Napa, many ideas, thoughts, and emotions have come to my mind, and I would like to share them with you through this post.
Prior to the Telluride Experience, I have learned about quality improvement and patient safety while working on a hospital process improvement team and while attending a series of interprofessional workshops in medical school. Consequently, coming into this experience, I felt that I had a grasp of the important principles within the realm of patient safety such as communication, just culture, teamwork, medical systems, and more. However, in just these past two days, my experience here in Napa has taken these concepts beyond what I ever thought I knew. The stories and activities have added tremendous depth and context to my previously superficial understanding of the seemingly simple yet important aspects of safe patient care. Next, I would like to take the opportunity to reflect on three topics that I have found particularly thought provoking: communication, errors and the medical system, and hierarchy.
Communication. Although we learn a lot about communication in medical school, the communication that we learn is generally confined to the interactions that we have with patients about their medical care, for example taking a patient history. However, my experience at Telluride has highlighted some important yet crucial aspects of communication that are inherent in patient safety but often forgotten in our training to become doctors. For example, in medical school, we all learn how to conduct a history in order to come up with a differential diagnosis to treat a patient. However, we are not often taught how to safely and respectfully communicate this information with colleagues during shift changes or to safely communicate with primary care providers after patients are discharged. Next, although we learn how to take a social history and how to build rapport with the patient, we do not learn about the importance of taking the time to sit next to the patient and the importance of resisting two urges that plague the medical profession: interrupting the patient within twenty seconds in order to speed up the appointment and staring at the computer screen. But one aspect of communication that I have learned in the past two days at Telluride has struck me deeply, and that is the language that we sometimes use in health care to describe our patients. Although the language that we use may be more efficient or simply ingrained in our medical culture, this language can not only disrespectful, but also harmful. For example, rather than saying that “Mr. Smith is complaining of chest pain”, we should say that “Mr. Smith is concerned with chest pain”. The changing of the word from “complain” to “concern” paints two very different pictures. Next, rather than saying that a young child who was just admitted into the hospital as “anxious”, we should not jump to conclusions and label a patient, because anxiety is a clinical problem that can have medical consequences. I confess that I have used this language in the past. However, I now know that words have power and labeling is for jars, not for people.
Medical errors and the system. As a medical student and future physician, my biggest fear is making a mistake. I chose this profession because I wanted to help people, and the thought of making a medical error scares me tremendously. However, what I have learned over the past few days has given me much reassurance. No one ever wants to make an error. However, I have learned that we are human, and humans, no matter how perfect we believe we are, make mistakes. I have always considered myself as the “perfectionist” type when it comes to my work, and not only is it tiring to always be perfect, but it is also stressful. However, today I learned something that I will always remember and that is we cannot expect perfection. Instead, we must anticipate that we will make mistakes. With this thinking, it helps us design our health care system to catch these mistakes before they can appear. As John Nance, a faculty member at Telluride and author of “Why Hospitals Should Fly” stated very clearly, 440,000 individuals die every year from medical errors and this is inexcusable. Therefore, rather than viewing errors as moments to blame individuals for their incompetence, I have learned that we should view errors as opportunities for learning. This is how we can change the culture about patient safety and this is how we can motivate providers to not be afraid of errors, but to be cognizant of how we can use these opportunities to learn and to improve the system.
The last point that I would like to reflect upon is hierarchy. Ever since my first experience volunteering in a hospital during high school, I have experienced the innate hierarchies that are embedded between and within health care professions. Before Telluride, I naively accepted these hierarchies while trying to remain respectful towards my colleagues of every field. But three stories from the Telluride Experience: Napa have challenged my previous understanding. The first is the story of Lewis Blackman and the second is the story of Alyssa. In both of these stories, providers failed to listen to the patient and the family, who were actively voicing their concerns as well as the nurses and residents. As providers, we are constantly worried about what the attending physician or nurse manager may think as well as who is the one taking responsibility for the patient. However, we fail to acknowledge and trust the voices of our nurses and interns and most importantly, the patients and their families, who should be at the very top of this hierarchy. Patients know themselves the most and their experiences should not be ignored. This needs to change. The third story that I would like to highlight is John Nance’s story of the young, inexperienced airman who alerted John, who was the airline captain, about an error in the approved cruising altitude of a military plane. Had the airman not spoken and alerted John of the approved cruising altitude, the military plane would have crashed into a large commercial jet flying immediately above, and this would have been the second deadliest airline crash in aviation history. In the medical culture, students are too often afraid to speak up because they are worried about being wrong. I, myself, have been in multiple similar situations, but the Telluride Experience: Napa has inspired me to change. Even if the medical culture has not yet embraced the full concept of teamwork within and between hierarchies, we all have the same goal and that is to care for the patient. Hierarchies should not be barriers in the effort to reach this goal and everyone must feel empowered to speak up, even if they may be wrong. As one of the faculty members mentioned, if one is wrong, thanks should still be afforded because this acknowledges the effort of speaking up and helps continue this culture, which may prevent a future error.
Communication, error and the medical system, and hierarchy are only three of many important topics that I have learned in the past two days, and the thoughts that I have shared are only a few that are currently swirling in my mind. I am truly inspired by what I have learned so far, and I am grateful for the opportunity to gain this knowledge as it will help me become a better doctor and human being.