Resident Reflections: Day Two in Telluride #TPSER9

Telluride 2013 Resident Scholars
Telluride 2013 Resident Scholars

By Elizabeth Columbo MD

This experience has redefined medicine for me. In so many ways we strive to do the best for our patients, but the system fails us. These failures effect our patients, sometimes in terrible ways, but they also effect us as practitioners. We beat ourselves up when we have bad outcomes, we cry, we question our motivations, abilities, and knowledge base- but now we are questioning the system. Learning how we can affect change to improve the experience of our patients, and thereby improve our own experience is groundbreaking. Understanding how change can work, as demonstrated by other industries (defense, airline) makes me feel its possible. Meeting so many inspirational people that believe we can do this, makes me feel I can do it too. My brain and notebook are brimming with ideas to bring back to my own hospital, clinic and patients. Without a doubt, this is a defining experience in my medical career. Telluride has been amazing…

By Michelle Espinoza MD

As physicians, many times we do not fully understand the power of our words. Our words, can help build relationships  or destroy  them. This reality,  I have learned, is especially true with our patients. The origin of the word “patient” means “one who suffers”. Today, in learning of the events that have forever changed the lives of the Skolnik family, I realized the impact our words can have both spoken and unspoken. Many times I have been afraid to speak out or intervene in a situation that I know or feel is morally wrong to not “upset/disturb the peace”. I have also learned the hard way that deciding to not use the power of my words can lead to devastating tragedy. Michael’s story will be forever ingrained in my heart and in my mind. Never again will my decision to maintain my silence be taken lightly, for as I learned today that conversation may actually save a life…

By Olamide Kolade MD

I am enthralled at the concept of ” shared decision making ” because it puts back the patient at the center of the medical universe. Sometimes there is a tendency to be paternalistic either consciously or unconsciously when dealing with patients. This is a pearl of wisdom that I will be taking away from Telluride. It enhances patient care, empowers the patient and protects the physician to some degree. It is win- win situation for all parties involved.

By Jessica Hurst MD

After this afternoon’s discussion about shared decision-making, I wanted to share my list of three things I plan to do when I get back to Boston next week to improve the shared decision-making process for my patients.

  1. Patient-centered rounds on the wards: This approach to rounds encompasses a lot of the simple yet brilliant concepts we discussed such as: introducing yourself, your team, your roles, and the purpose of the encounter. Presenting at the bedside to allow the patient to correct mistakes or add to the story. Discussing the differential and the plan at the bedside, which allows you to communicate this not only to the patient but also to the other team members.
  2. Carry the marker: I shared with my small group that there is a whiteboard in each of our patient rooms with a fill-in-the-blank “My goal for today is___.” How many patients use it? None. Why? Barrier #1 is the complete lack of markers in the rooms. There are probably numerous reasons for this, but there’s nothing stopping me from bringing my own marker in my white coat on rounds to allow my patients to not only voice but also record their goal for the day.
  3. Identify and advocate for the high risk patient: The principles we discussed today apply to all of our patients, but we all know that there are especially vulnerable patients who may get lost in our healthcare system, or even worse, might get harmed and not even realize it. The 80 year old slightly demented, deaf, non-English-speaking Cape Verdean woman who doesn’t read and lives alone. The 30 year old man with a history of opioid dependence recently released from prison, now homeless, jobless and without social support. These are the patients for whom we as residents, primary care providers, and as patient-safety champions need to act as advocates when no one else will.

I hope by sharing this list I will feel even more accountability to make these changes and that maybe some of you will also be inspired to share your list too!

By Say Salomón MD

Wow today I got my money’s worth!!!! (Not taking anything away from day 1)

Getting to discuss the concept of High Reliability Organizations: What blew me away is the fact that the health care industry is so far behind when compared to aviation. With 36,000 flights per day, 2 million passengers and no adverse events versus in healthcare where 20 – 33% of patients admitted to US hospitals being harmed during their stay. For an industry that spends ~$2.7trillions dollars a year and wastes ~$750 billion we should do better. Let’s face it–we definitely have the resources to implement systems that would decrease harm, as well as the commitment, passion and desire to do so. So why can we get it? That is the million dollar question. But I feel confident that initiatives like the Telluride Patient Safety Roundtable will provide and empower us with the tools we need to achieve our common goal to decrease harm and provide quality and sustainable care for generations to come.  The Roundtable will also help us to become the educator and advocates our patients need.

Today, watching The Story of Michael Skolnik was both heartbreaking and devastating. I was ashamed to be called a doctor and would never think that a physician who takes the Hippocratic Oath would practice like Michael’s physician. The film established the importance of disclosure and transparency in our practice when obtaining informed consent. I will definitely take this story back to my colleagues, using it as a tool to educate. The most important take home message, however, was “Can a conversation change an outcome; can a conversation safe a life” and the answer is YES!!!!!!!; I will never forget this…

Our photo session was fabulous. We spent time in the good outdoors of Colorado, played some 3-on-3 basketball which was awesome, and our team building exercise was eye-opening. It was good for loosening people up, building basic trust, and creating an effective process to prevent harm to our egg-headed patients.

Finally we were divided into groups to discuss what would we do to improve shared decision-making, and what we can do to improve the conversation related to harm. All groups had an excellent perspective about changing and improving both aspects of patient care. We were all on the same page  and this makes me so optimistic that there is light at the end of tunnel for the safety of our patients. This roundtable changes mindsets. It has definitely changed mine and we are only into the first half. I can’t wait for the second half of this life changing experience.

Shout out for the Committee of Interns and Residents for the opportunity and to the Faculty of the Telluride Patient Safety Roundtable for this enlightening experience.

By Shea Welsh MD

Another solid day at the conference.  As the residents and guests have gotten to know each other and become more comfortable, we have become more engaged in serious conversations about patient safety.  Very sobering, yet eye-opening video about Michael Skolnik this morning that initiated some good discussion for the rest of the day.  As I watched, I couldn’t help but find it interesting how the viewer sees it easy to blame, and even villainize, the neurosurgeon who performed the consult. Yet so many, including myself, have had flawed experiences with consent.  Our culture makes it so easy to make these mistakes and get away with it. Honestly, we can all relate to some form of that physicians actions during the case.

On that note, I am planning on taking many of the ideas discussed in the small groups back to my program.  Common themes included transparency and empathy throughout the process.  One topic I find myself continuing to ponder regards the follow-up with a patient after a mistake has been made.  Being a family medicine doctor myself, I wonder if it is my responsibility as the PCP to play this role.  Then again, what if I am not the one who made the error in the hospital and had nothing to do with the adverse event?  Overall, a great, productive day and I am looking forward to Wednesday!