How Soon Should Students Learn to Care for the Caregiver-Part Two

As with all of our patient safety teachings, we used real cases – both internal and external — to reinforce the educational messages taught throughout our Patient Safety curriculum, and hopefully, to keep the knowledge fresh. Two cases that always generated intense discussion included: (1) a Seattle Children’s Hospital nurse who committed suicide after making the only recorded medical mistake in her 24-year career, and (2) the Julie Thao Wisconsin case, which Bob Wachter described on his blog back in 2007 – When is a Medical Error a Crime? on November 5, 2007.

Medical errors can have a profound impact not only on the caregivers involved, but entire health systems. Charles Kenney eloquently tells the story of how one patient’s death due to a medical error impacted the Virginia Mason Medical Center in Seattle. In his book, Transforming Health Care – Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience, Kenney retells this experience through the eyes of those involved, beginning on page 58. It is the sharing of cases, and stories like these–told from the hearts of those involved–that provide healing to others across the country. Students need to know that by choosing to take on a responsibility so noble and great as to care for another human being, that this does not make them super-human and infallible. It makes them people who care deeply about others, very human and fully capable of making mistakes without strategic system’s safeguards in place.

Over the course of the four years, we tried to expose our students to as many of the complexities of patient care as possible, which included the unfortunate instance of patient harm. As such, we hoped our students left the program armed to face, and openly discuss, one of the two fears they consistently voiced on their first day of medical school–hurting a patient they would vow to care for and protect. And they also moved forth knowing there should be support available in the event they themselves became a “second patient”. Ideally, students should be prepared to ask questions of leadership, residency program directors and future employers before they choose to work in a given healthcare system. Questions such as: 1) What are your serious safety event numbers? 2) What programs do you have in place to manage a serious safety event when it occurs? 3) How do you respond to patients and families when an unintentional error causes patient harm? and 4) Who manages your Care for the Caregiver program, and how long has it been in place?–all should be received well, and openly discussed by those involved in the interviewing and hiring process. If not, students should think twice about ranking those programs in the match, and residents should hesitate when thinking about signing a faculty contract at that institution.

Admittedly, barriers still exist to this curricular approach, but those “Walls of Silence” are coming down, and those barriers are slowly being removed. Many medical malpractice insurance carriers now endorse disclosure and apology when appropriate, as they see the value these programs have on the system as a whole. The Doctors Company (TDC), COPIC and the Committee of Interns and Residents (CIR) provided scholarships so that 70 students and residents could attend this year’s Telluride Patient Safety Roundtable and Summer Camps on Open and Honest Communication (which incorporates many components of the UIC disclosure curriculum) so the next generation of caregivers learns how to do it right. We have to continue spreading the word, and build programs that teach not only “how to” keep patients safe, but caregivers as well.

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