When Transparency Matters

Academy for Emerging Leaders in Patient Safety – Day 2 – June 9, 2015

Sentences that stuck:

  • “Patients want to hear recognition, a plan for investigation, the truth, regret, how we will prevent similar harm to others, and remedy.”
  • “In the state of Florida, if you are involved in 3 adverse events, you lose your license. Remarkably, their hospitals have no errors!”
  • “Negotiation is a means of advancing the full set of your interest by jointly decided action.”
  • “Around 440,000 patients per year die due to unnecessary harm by health services. That’s three and a half 747’s crashing per day.”
  • “Patient safety shouldn’t be a priority, but a core value.”
  • “A true leader creates an environment in which any member of the team does not hesitate to speak up.”
  • “Our hand-washing rates are up to 81%!” “Great! That means only 19% of your patients are at risk for dangerous infection”
  • “A culture change is never complete until there is nobody left who remembers how it used to be.”

We discussed many important topics today, but the one that is most relatable as a 2nd year medical student involved “transparency”. A couple stories…

A family friend with chronic back pain went in to get surgery, and came out with meningitis. Thankfully, she recovered, but because her doctor never really explained what went wrong and how the surgery went, she assumed the worst. She calls me, confused and furious, insisting that her doctor partly severed her spinal cord. I tried to explain the little anatomy I knew, and that the doctor most likely did not cut her spinal cord, and that infection is a risk of every surgery. A year later, I still get occasional texts from her in the middle of the night, asking questions about her care. Two things about this situation bother me the most: 1. Uncertainty and mistrust about her care still keeps her up at night, and 2. she trusts the words of a 2nd year med student more than her own surgeon. Now, I recognize this instance as an obvious lack of communication and transparency from her physician and within the hospital system as a whole.

For the past few months I have volunteered as a case manager for our student-run free health clinic. I was assigned to a patient who is an undocumented immigrant, speaks mainly Spanish, and has been diagnosed with stage 4 chronic kidney disease. I researched his conditions and the appropriate treatments, though I was well aware that the best approach to his illness would be impossible to pursue due to his undocumented status. I met with him for the first time, focusing on introductions and aligning our understanding of his current health. In preparation for the worst case scenario, I mentioned the possibility of him needing to go to the hospital for emergency dialysis in the future. He looked confused, and his fiancé, who had previously worked in a dialysis clinic, started to cry. After the appointment I called the doctor that was assigned to his case: “Why did this patient and his fiancé not know about these risks?” It turns out she had decided not to mention dialysis, since it was not available to undocumented immigrants unless in an emergency acute kidney failure situation. Though I have a great amount of respect for this physician, I strongly disagreed with this decision. I feel that my patient should know about the care he should be getting, the seriousness of his condition, and what symptoms to watch out for that would signal him to go to the hospital. It’s a shame that I can’t give him the best possible care, but I can try to come as close to it as possible. In a student-patient relationship that is already challenged by a lack of insurance and differing native languages, I believe transparency is that much more important.