As healthcare providers, we are given a privilege to care for others, and must always remember that we treat complex individuals, making choices that affect their lives, families and personal well-being. At the same time, our patients must recognize that care providers are people too– always trying to do the best they can while juggling numerous responsibilities on a daily basis and working in a system that still has too many flaws. The clinician-patient relationship is most effective when both sides meet in the middle–a “safe space” where each is able to truly see one another and achieve the mutual understanding needed to succeed as a care team.
High Reliability science is one area we are looking to for answers to systems failures in healthcare. High reliability organizations stress the importance of “Stopping the Line” when a worker senses something doesn’t feel right. The concept has been shown to help reduce harm in many high risk environments. What if something similar existed for communication concerns in the healthcare environment?
The following short video, entitled Please See Me, created by patients and caregivers for patients and caregivers, offers a possible solution. Can “Please See Me” become that safe space, where patients and family members can stop the line and share those words if they feel their needs are not being heard or addressed? At the same time, can caregivers use the same phrase when they feel they are not being understood by patients and family members?
Many of us believe the phrase “Please See Me” can be the start of something special, creating that safe space and providing a phrase that helps improve communication and understanding in every healthcare environment leading to better outcomes.
Patients and Care Teams
Working as Partners
In the Spirit of Healing and Compassion
Whether or not Tiger Woods is deserving of being called a role model, the body of work he has accumulated is worthy of admiration, especially by younger players like Rory McIlroy. What caught my attention about yet another inspiring Nike commercial, wasn’t so much the role model himself, but the reminder that others are watching and learning from the actions of those put into a leadership position–regardless of how deserving.
In healthcare, as in sport, skills and technical acumen are only part of the equation, though often they can take many onto a stage and into the spotlight exposing behavior and character far less developed. Like McIlroy, those with talent coming up the ranks in sport can often drive their own destiny with dedication and committment. Athletes can stay a safer distance from those who have gone before them than young learners and junior healthcare professionals. But these young professionals too can drive their own destiny, and shape a new set of expectations for what success looks like in healthcare. Here’s a shout out to our Telluride Alum on this Friday!
*In the event the video is pulled, you can find it on YouTube — Nike Golf, Ripple
Shark Tank billionaire Mark Cuban weighed into the healthcare conversation last week and lit up the Twitterverse. While the topic–patient engagement and ownership of health data–has been growing in magnitude and number of influential players, to have a high-profile influencer like Cuban enter into the mix and accelerate the conversation is a bit of an unexpected (or perhaps calculated?) gift. For those who didn’t see Cuban’s three tweets that engaged @Eric_Topol, @charlesornstein, @danmunro and more, here is what started it all:
We need more innovators with the resources of Mark Cuban to jump into the conversation around engaging patients in their health and changing healthcare for the better. To have those ready and willing to invest in validating the value of being empowered by owning our own data is priceless. Waiting for the traditional pathways to decide how we will do so is taking too long. With technology exploding around the ensconced world that is traditional medicine there are far too many viable options available. Theranos, created by Stanford dropout Elizabeth Holmes, is one such innovative company now said to be valued at $9B. Holmes is brilliant and is trying to democratize medicine — to make it affordable and less painful and scary for every person to have their blood drawn, and as a result, better understand their own health. My hunch is that Cuban has a stake in Theranos, and more power to them both. This is access to care and innovation without the roadblocks of the traditional route.
Funny how sometimes the house of cards built by information fall together. Dan Munro once again beat me to the punch on this topic, as we have been talking about patient engagement versus a patient’s responsibility versus commitment to one’s health for some time in our own healthcare circles. To watch the attention this topic has pulled from the power levels of business and healthcare via social media is both exciting and validating. Patients, however, still need to be invited into the conversation and Twitter feeds, and this may just prove to be the true value in having Cuban involved. His 2.8M Twitter followers were just pulled into a conversation rarely invited or influenced to engage in.
And finally, the debate over how often or why/why not to test your blood quarterly per Cuban’s suggestion is a curious one. I understand all too well the argument for overtreatment, as colleague and author of The Treatment Trap and Wall of Silence, Rosemary Gibson, speaks of it often. But is this the same overtreatment patients need to be wary of? The trip to the cath lab when medical management will do? The shoulder or back surgery when physical therapy may prove far better? Or worse, the criminals who prescribe chemotherapy for patients that do not really have cancer?
This truly is about something else altogether–something bigger and better. This is a reminder that our world is changing quickly, and with it, our ability to know more about our bodies and our health is too. That knowledge truly is power, and why should care providers be the only ones holding the deck? When patients are engaged in their health, the research so important to those opposing Cuban’s advice shows all have better outcomes. As Cuban explains in a recent Health Care Blog conversation, he has been engaging in his own health for some time:
…What I do know is that I’m in firmer control of my day to day health…there is value when I review my results annually with my doctor , having the last 3 results to compare to. Now that I have a history of data looking at the results isnt stressful. Its the opposite. Its comforting.
And I feel far more confident that if and when I get sick, having those numbers will make me and my doctor smarter in our decision making process.
I know that healthcare needs more Mark Cubans. So much so, that while I thought Shark Tank to be a somewhat intriguing TV concept before, I am even more inclined to watch knowing he is engaging not only in his own health so thoughtfully, but also because he may be keeping an eye out for the next Theranos.
Stay tuned to ETY as we continue to elevate the conversation around patient engagement, patient and care team partnerships and more in the coming weeks. Please share your thoughts!
Its that wonderful time of year for baseball fans when spring training is winding down and opening day of baseball is just two weeks away. If you are a baseball junkie like I am, Field of Dreams has to be an all-time favorite baseball movie. It is my favorite, and when our Telluride alumni reach out with a new patient safety program they have initiated, I can’t help but think of the classic line, “If you build it, he will come,” that encouraged lead character Ray Kinsella to plow his corn field and turn it into a baseball diamond. Our Telluride mission, generously funded through the years by The Doctors Company Foundation, COPIC, CIR and MedStar Health, has been a similar leap of faith…”If you teach them, they will lead”.
The following post is by Telluride Alumni and Guest Authors: Byron Crowe, M3, Michael Coplin, M4/MBA Candidate, and Erin Bredenberg, M4 at the Emory University School of Medicine. Their work is another wonderful example that our Telluride mission is catching fire, and that the next generation of physician leaders are making a difference by building their own patient safety baseball diamonds.
Student-driven quality improvement initiatives are growing at Emory University, and the three of us – Erin Bredenberg, Michael Coplin, and Byron Crowe, all medical students at various stages of training – are using our experiences at Telluride to guide us as we create new learning opportunities for fellow students and improve care through QI projects.
We come from diverse backgrounds; prior to medical school, Erin was a Peace Corps volunteer, Michael spent time in investment banking, and Byron worked in hospital administration. Our personal experiences with the shortcomings of our healthcare system drove a shared interest in QI and patient safety, and we each eventually found our way to Telluride at some point during the last three years.
Telluride has shaped our trajectories at Emory in unique ways.
- For Erin, now in her final year of medical school, the impact of the connections she made with other like-minded students inspired her to use the skills learned at Telluride while completing an MPH to educate others. She joined her local IHI Open School chapter as Director of Education where she organizes workshops and events to teach students key concepts in QI and patient safety, skills she honed working at the Atlanta VA hospital on a major falls prevention project.
- Michael has become a key advocate for QI education within the medical school and has been integral in pulling together faculty and students to explore developing a longitudinal QI curriculum. He is currently earning an MBA at Emory and is channeling his interest in health systems efficiency into his work on a QI project in the emergency department.
- Byron, now entering his third year, continues to lead the IHI Open School chapter at Emory and organize students around local QI projects. In the community, he is coordinating an ongoing partnership between a local safety net clinic and the Open School to improve care for diabetic patients.
We all agree that one of the most important aspects of our time at Telluride was the empowerment we felt from meeting other students who wanted to use their careers to make care safer and more effective through QI. Moreover, our experience at Telluride did not end once we returned to Emory–in addition to working together at school, we have remained connected to the amazing students we met at Telluride from other institutions.
Attending the Telluride conference taught each of us new things, whether about the healthcare system, our patients, communication, and ourselves. But it also enabled us to join a growing community of faculty and students who have attended Telluride and who share a commitment to improvement. Having a small piece of that community at Emory has been a formative and unforgettable part of our medical school experience.
The stories shared during this year’s Patient Safety Awareness Week (#PSAW2015) were inspiring! In ETY’s Why Patient Safety Week Matters, Carole Hemmelgarn, Patient Advocate, shared for one of the first times her feelings of grief related to a series of medical harm events that took her only daughter, Alyssa. She wrote that “grief is her twin”, a twin that at times brings comfort and sorrow. Thanks to the power of social media, her message was carried like a gift to many around the world. The following comment confirms yet again that our stories matter to others–and our willingness to share them when ready can ease not only our own, but another’s suffering:
Your story is so important. I never thought of my grief also bringing solace. I lost my father and thought that was bad but 10 years later I would lose my sister and mother in the same year. I have cried (for a few minutes) every weekend since August 2013 when my sister died and I thought somehow I needed to stop because this is not normal. After reading what you wrote maybe I should stop trying and just rejoice in the memory of my loved ones a few tears is a small price to pay to remember them.
And from @MichaelDFranklin:
Do we realize that such a quote, “grief is my twin” is not specific to loss from medical errors, but to life itself?
Dave Mayer’s ETY post, Caring for Caregivers…, later in the week, served as insight into the grief felt by those administering care–even when that care goes as planned. He referred to an opinion piece in JAMA entitled, “What I Learned About Adverse Events From Captain Sully – It’s Not What You Think,” that discussed the stress involved in caring for others requires many to side-step a recovery process for the self that could revive and encourage positive coping skills for future stressful events. Caregivers are often expected to jump back into the next case without taking time to recover. This equaling of the patient-caregiver grief playing field reflects the silent suffering that can be occurring on both sides of the healthcare encounter when a simple conversation could be the bridge to healing. Grief multiplies in isolation–it can be lessened in the right company when ready. And as Carole did last week, the sharing of our own grief can also be a gift to a complete stranger. How beautiful is that?
How can we help multiply these gifts; stories of our selves by both patient and healthcare professional? Especially when medical training has only begun to consider the healing power of listening with the heart, as well as the head. This winter, I had the pleasure of hearing Atul Gawande speak at the IHI Forum where he shared insights gained while working on his latest tome of wisdom, Being Mortal. Of all the thoughts he shared that day, the one that has stuck with me four months later is the differing views he and his wife hold for end of life comfort. Atul said he is “down with Stephen Hawking”, and if he is simply “a brain in a jar and we can still extract his thoughts” let him live on! His wife on the other hand (and I summarize) has shared that if she even looks as though she can no longer enjoy life or share in the moment, pull the plug. This take home message is a reminder that individual choices related to how we live and die can be very different, even from those we love most. Unless we choose to talk about those choices–with one another, and with our healthcare teams–we remain a mystery to one another.
In the introduction to Being Mortal, Gawande reflects on how far our current approach to care as we age is from where we once were, or even where so many will find real comfort, including those delivering care. He writes:
I learned a lot of things in medical school but mortality wasn’t one of them…our textbooks had almost nothing on aging, or frailty, or dying…when I came to experience surgical training and practice, I encountered patients forced to confront the realities of decline and mortality, and it did not take long to realize how unready I was to help them.
There are many in healthcare–patients and caregivers–who also understand there is a better way. I recently found out that a good friend’s Mom was given 6-12 months to live at the younger-every-day age of 71. The choices she made throughout her life most likely have influenced the way it will end, but they are hers. She has found a doctor she likes to see her through treatment, and he is encouraging her to continue to make the choices that bring her comfort and as much joy in the remaining time she has with friends and family. She has found a healer, as well as a physician–someone who can sit with her and listen, hear with the heart and share experiences that might prove healing even though he cannot treat the disease itself.
Atul Gawande is on to something in Being Mortal. In fact, it could be one of his most important works to date. The suggestion that instead of being taught to diagnose, to treat, and to protect the hospital assets, a greater amount of time could be spent teaching healthcare professionals how to share in grief, to share stories of the self and to explore more deeply what is truly meant by the art of healing is an idea that each of us–patient or caregiver–can carry with us into care environments if we choose.
2015 is well under way and our friends at the Josie King Foundation are determined to increase awareness and action around their mission of keeping patients, and providers, safe from medical harm. So determined, in fact, that Sorrel King is sacrificing her joints to run the Boston Marathon in April to raise awareness and funding for the cause. If you are going to be in the Boston area on Monday, April 20th — or running yourself — be sure to reach out and join the mission.
For more information or to make a donation, you can go directly to the Josie King Foundation website, or click below to read more!
Over the last few years, we have written about the vital importance of Care-for-the-Caregiver programs when unintended patient harm occurs from a medical error. As caregivers, the willingness to admit our humanness, as well as our ability to make an error, helps us reframe the recovery and learning process when these events tragically occur. All too often, we have turned away from our fellow colleagues, or worse, blamed them at a time when they needed our support the most. We all know of stories where good, caring healthcare professionals have taken their own lives after unintentionally harming a patient. As a profession, we need to do better.
I encourage everyone to read an outstanding two-page opinion piece in JAMA titled “What I Learned About Adverse Events From Captain Sully – It’s Not What You Think”. Written by Marjorie Podraza Steigler, a fellow anesthesiologist, the article should cause all of us to stop and rethink this important question. An emotional toll on physicians and nurses may occur even when no error was made, and the care team responded with precision during a major patient care crisis. As a cardiac anesthesiologist, I think of emergent, high-risk cases that went for hours, and while the outcome may have been good, the team was physically and emotionally drained afterwards. All of us, however, were usually expected to immediately return to the operating room for the next case often without time to process what had just occurred.
As Dr. Steigler correctly points out:
The contrast between the immediate removal from duty for those involved in the Miracle on the Hudson and the expectation that permeates our hospitals is stark. In both cases, the safe care of the next “customers,” whether they be travelers or patients, is at stake.
We have to do better for ourselves if we ever expect to do better for our patients.