More #meded Reflections from Telluride Patient Safety Roundtable #TPSER9

DSC_0905Reflections from students across all areas of the health sciences continue to come in after two pivotal weeks of education in Telluride, CO. The following reflection is by Quyen Nguyen, a University of Illinois-Chicago Pharmacy student. Additional reflections can be found here.


One of the most important lessons I have learned from the past three days is the urgency in which we need to act to bring ethics back to the forefront of healthcare systems. Too often the best interests of the patients and their families are put behind financial, legal, and personal factors. It may never be possible to prevent every error, but we have a professional duty to take responsibility and put patients’ and their families’ needs first in the aftermath of a medical error. I wish to express a sincere thank-you to Carole for your courage in sharing your personal story so that future healthcare professionals can learn from it. I hope that each of us will continue this conversation of patient safety to make a difference in patient care when we return to our institutions.

Today I also learned about the concept of anchoring. Anchoring is a practice in which a person’s perspective is biased by the first information given. The tendency of anchoring increases significantly when one becomes tired, fatigued or distracted by any other human factors. The heartbreaking tragedy we have seen in Carole’s and Helen’s stories stems from anchoring bias. As a caregiver, we have to be mindful and avoid bias when dealing with patients. However, after several talks with several medical students and nursing students, I learned that many residents may have to work up to 80 hours/week on average and many times they have to work more than 8 hours in a shift (please correct me if I am wrong). I wonder whether it is possible for one to maintain a clear mind with an objective perspective under these working conditions. Should there be a change to reduce such long working hours in residency programs?

Yesterday, I went shopping and talked to a cashier in a souvenir shop in downtown Telluride. After I asked her whether she offered any discount for Telluride scientists, we started having an interesting conversation. On being asked what I was there for, I shared with her that I was in a 4-day summer school with medical students, nursing students, and pharmacy students to learn more about patient safety and how to improve healthcare quality. She then told me that since we were learning about patient safety, we should make sure that nursing school teaches nurses how to take blood sample of a patient without pricking her patient five or six times. She suggested that doctors should invent some kind of X-ray imaging on a patient’s arm so that they can test the blood without pricking a patient. We both laughed and I said, “Yeah, why not?” Such an invention may be possible in the future and it would increase the ability to deliver high quality patient care. I thought this is an interesting anecdote of those outside the medical profession on how they perceive those inside.

Sitting Down with Patients

This past weekend, I had the wonderful opportunity to give the welcoming remarks at the Annual Recent Advances in Obstetrical Care conference in Baltimore, MD. Being an anesthesiologist, I have worked closely through the years with many obstetrical caregivers in the labor and delivery suite, and I am always honored when asked to share a few thoughts on healthcare today. A few attendees who knew of our blog asked if I would post my opening remarks on Educate the Young. Following is an excerpt sharing my comments on the increasing demands for transparency and the true value of patient partnerships:

What types of transparency are now being asked of us by our patients?

They want Transparency in outcomes. I have heard Peter Pronovost say, “consumers can get more information about the toothpaste they buy than about the care they will receive”. Patients want information on healthcare similar to the information they can obtain and review before buying a new car, choosing a hotel for a vacation, or selecting a restaurant for dinner. They want to be able to make more educated choices about their care options.

They want Transparency in shared decision-making. Informed consent doesn’t cut it anymore. More and more patients want their caregivers to fully understand their values, preferences, needs and goals before any discussions on care options, risks, benefits and alternatives begin. They want information on the hospital and their physician’s experience related to the procedure they will undergo–more succinctly–how many similar procedures have we performed, and how well have we done? They want to know our infection and complication rates. And more and more patients also want to understand the costs related to different treatment options.

And they want Transparency related to medical errors when that error has led to personal harm or loss. They are understandably frustrated and angry when traditional “deny and defend” approaches to unintentional patient harm are used because of medical malpractice fears, or when they are “passed off” to administrators and lawyers when trying to get basic questions answered about their care and possible follow-up treatment needs.

It is my opinion these new patient demands for transparency have been long overdue, are badly needed, and will help move us to a more cost-effective, higher quality, lower risk patient care model. It will be a new and better healthcare system, but history has taught us change will not come easily or quickly.

As you begin your educational meeting today, I want to leave you with one “take-home” suggestion – truly engage and partner with your patients. Many of us who work in quality and safety have learned so much from our patients and family members through the years. For me, one example of this valuable partnership is what I have learned through Carole Hemmelgarn, an amazing woman and patient advocate who taught me the following important communication skill.

When you enter a patient’s room, instead of standing at the foot or side of the bed (as I had done for so many years) pull up a chair, sit down and have a true conversation with them. Research has shown that patients perceive caregivers who did this to have spent twice as much time in the room with them, versus a comparison group of physicians, who actually spent the same amount of time with the patient, but stood at the foot of the bed while talking to them.