Patients and Families Can Help Prevent Diagnostic Error

Communication has been shown to be a significant key in preventing medical error, and the picture is becoming ever more clear: Patients and families have to play an active role in their care. From the front lines of healthcare delivery:

  1. Ask questions of your healthcare providers without fear
  2. Engage in the care you receive
  3. If a healthcare professional rebukes the input you provide into the care you are about to receive, take that as a sign you need to seek care elsewhere. Immediately!

It could save your life, or the life of a loved one. More to come on this, but the following video was put out by the Institute of Medicine…

Taking A Pause to Care for Caregivers After Traumatic Care: Win or Lose

Today’s Guest Author is Dr. Roger Leonard, retired cardiologist, past ACC Governor for Maryland, & previous hospital CMO, who now volunteers his time with MedStar Health’s Quality & Safety Department. Roger helps to lead MedStar’s Patient & Family Advisory Councils for Quality and Safety and participates in The Academy for Emerging Leaders in Patient Safety: The Telluride Experience

As part of our journey toward becoming a High Reliability Organization at MedStar Health, we begin every meeting with a safety moment. Recently, we shared an opinion piece in JAMA written by Dr. Marjorie Stiegler, an anesthesiologist at UNC, titled “What I learned About Adverse Events From Captain Sully: It’s Not What You Think” (JAMA, Jan 27, 2015, Vol 313, No 4, 361-362). Rather than paraphrase, let me quote Dr. Stiegler:

“The aircraft touched down in the middle of the Hudson River…no one was killed or critically injured. There was no glaring error, no misstep, no panic. By all accounts, this was an incredible save. So why did Captain Sully tell me they all had PTSD for several months thereafter? Why, if Captain Sully’s years of experience had all been a cumulative preparation for this most unlikely event, and if he did just about everything right (and quickly), could he not sleep or concentrate for three months? Why did he not return to the skies for nearly half a year.”

In medicine, we respond to life threatening emergencies regularly. Many are successful with precision teamwork, no lapses, no panic…by all accounts an incredible save. Yet, I have never observed any resuscitation team voice their emotional reaction to what they just accomplished. The thought of PTSD doesn’t exist. Is the difference between the flight crew and the medical crew simply that the former has their lives at stake? If so, then the air traffic controller at La Guardia should not have experienced PTSD as described in his testimony before Congress. Perhaps it is the frequency with which these events occur…rarely in commercial aviation and regularly in medicine. Does practice make perfect?

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Example of The Pause with Jonathan Bartel

If we seem to be immune to PTSD after saving a life, then why do we so commonly ignore our emotional response to failed emergency care? I believe that a significant explanation rests in the culture of medicine where we are taught to control our emotions supposedly for the benefit of our patients, families, and colleagues. In the process we diminish our humanity and miss comforting a family or colleague who is hurting. I am unaware of the peer-reviewed study that proves lack of trust when patients and families see healthcare professionals cry.

When critical emergencies occur in medicine, often we fail to debrief and rarely do we take health care associates off-line. If an effective debrief asks: 1) What went well?, 2) What didn’t go well?, and 3) What can we do to improve?, then I would suggest a fourth question – “What are we feeling?” In essence as a team, we are sharing our cumulative emotional intelligence.

A step in the right direction is to share The Pause.The Pause was created by Jonathan Bartels, BSN, an emergency nurse at the University of Virginia Medical Center. In the article, Bartels describes caring for a woman who had been hit by an SUV going full speed through an intersection. The 45-minute attempt by his team to revive her was both elegant and futile, and he watched his colleagues leave the room walking back into the ED readying themselves for the next trauma victim to enter. For Bartels, this “day of the young woman” was different–it marked a turning point in how he would manage the emotional aftermath of traumatic care. He says:

I remember defeat and exhaustion, but also more than that: a kind of vacancy, a space where the pull of emotion gets tamped down by time, fatigue, and grief, leaving an empty numbness in its place…There is no time for a breath, or thought or tears. A death that gives us pause as humans leaves us as clinicians with no time to pause. Maybe, I think, that’s the problem.

It was on the day of this girl’s death that I changed my response to and ceremony around death. Her death wasn’t our first, and it would not be the last, but I remember it because it did mark the end of the old way and the beginning of the new—our pause —and my determination to speak up, to ease up on the tamping down of emotion, to be brave.

When our best efforts cannot sustain life, sharing a moment of quiet reflection among the team can be powerful. As we honor the life lost, we reconnect our humanity with the patients and families we serve and reaffirm our obligation to uphold our special professional responsibilities with humility and grace. I encourage each of you to read his article. (Crit Care Nurse, Feb 2014, Vol 34, No 1, 74-75).

One of the key principles of a High Reliability Organization is the commitment to resilience. There is no single path or checklist to accomplish this. Nonetheless, it is clear that taking our emotional pulse, such as we learn from Captain Sully, and using tools such as The Pause are meaningful. They can recharge our physical and emotional batteries as we reaffirm our humanity and privileged profession.