Resident Physicians Share Their Stories at Telluride Experience 2016

Ah_Haa_School_Trees_on_CreekFollowing are leads from Resident Physician reflections after attending the first 2016 session of the Telluride Experience. Links are included back to the original posting on the Telluride Experience blog. Thanks to all who so courageously offered their stories from the front lines of care so that others can learn through them. It is by sharing our stories that we free another to tell theirs as well.

The Magic In Transparency

This phrase struck me as the perfect way to describe an experience I had my intern year. My first continuity ob patient had a fetal demise at 34 weeks.  She was the first patient I had followed from the beginning of her pregnancy.  I performed her dating ultrasound at 9 weeks.  Unlike many of my patients, she and her husband faithfully came to every prenatal visit.  She did not smoke, use drugs and followed the dietary guidelines.  Her husband was the chatter one of the duo, while she would calmly take everything in at our visits.  They both teared up when I told them they were having a girl at the 20 week ultrasound.  They told me her name was Emma. More…

Important Conversations

I was not going to share this but have been inspired by the courage of others around me. So thank you!

…In the first few days of Residency, we had a mandatory “Emotional Harm” meeting. I thought it was nice of them to do and always a good reminder. It focused on the empathy towards the patient and not losing our empathy when getting in the rhythm of dealing with similar situations and cases over and over again. I loved that they did this. This is something that is so important to remember and necessary to address.

Looking back however, I just wonder what about my emotional harm? Where are my resources? In this first 7 months of my residency experience two Senior Attendings committed suicide. I did not know the first, but I certainly knew the second. While there was heartfelt sadness and memorials to honor both, there was nothing else. No counseling offered to employees, no conversations, no checking in after some days, nothing at all. More…

Humility and Humanity

Humility and Humanity. This phrase stuck with me from Dan Ford’s talk. From medical school through residency it is drilled into us to be confident, un-phased, unemotional , these qualities are attributed to professionalism and success. Doctors are supposed to be infallible , so when we face an adverse outcome thats what we do instinctively. We become distant, listening to Helen, Sorrel and Dan thats the exact opposite of what patients need. Alienation only leads to prolongation of suffering for the patients family as well as the caregiver. Moving forward I hope to make these values a foundation of my practice.

Reading all the stories from my peers encouraged me to share as well, this was an amazing group of people and faculty. My first ICU night rotation as a PGY-2 I admitted a patient  in DKA and septic shock. More…


Voices from The Telluride Experience: Sydney

As in Doha, SolidLine Media was along to capture the stories being told at The Telluride Experience: Sydney! Thanks to Greg, Michael, John, Ali and team for pulling this short video together utilizing movie magic across the continents in time for the Minister of Health herself to view it live in Sydney, at the Clinical Excellence Commission’s reception for students and faculty before we returned home last week.

Truly a great team effort by all to bring the reflections and voices of change to life.


The Doctors Company Foundation Opens Applications for 2016 Young Physician Leader Essay Contest

Vinyard_With_ViewAs our final week of the 2015 Telluride Experience comes to a close, our Telluride blog has been nourished by a new year of talented healthcare trainee reflections. Many of these young physicians and physicians-in-training, along with their nursing colleagues, have submitted reflections that we will share more on moving forward, but they can be viewed here today.

Because our scholars and Alumni often return to the ETY blog as a reference tool, we wanted to share another opportunity for all to showcase their passion and commitment for keeping patients safe through writing. The Doctors Company Foundation, an organization that also sponsors a number of medical student attendees to participate in our Academy for Emerging Leaders in Patient Safety each year, is once again partnering with the Lucian Leape Institute at the National Patient Safety Foundation (NPSF) to offer The Doctors Company Foundation Young Physicians Patient Safety Award. The award will recognize young physicians for “their personal insight into the importance of applying the principles of patient safety to reduce the incidence of medical error.” Applicants are invited to submit essays of 500-1,000 words about a patient safety event they personally experienced during clinical rotations that resulted in a personal transformation.

More information can be found on The Doctors Company Foundation website. A short summary follows:

Applicants are invited to submit essays that will be judged by a panel identified by NPSF. Six winners of this prestigious award will be selected and receive a $5,000 award, which will be presented at the Association of American Medical College’s (AAMC) Integrating Quality meeting in Chicago, June 2016. Nominations must be submitted by 5:00pm ET, Monday Jan 25, 2016.

Eligibility:

  • As of July 1st, 2015, applicants must be either a 3rd or 4th year medical student at an American medical school
  • Award is for the best essay explaining your most instructional patient safety event experienced during a clinical rotation and that resulted in a personal transformation
  • Award will be presented by The Doctors Company Foundation at AAMC’s Annual Integrating Quality meeting in Chicago
  • Registration, hotel and travel will be covered to the AAMC meeting for Award recipients

Examples of winning essays from 2014 can be viewed via a past ETY posts (click here), and a review of the 2015 Essay Winners will soon follow. For additional questions, visit The Doctors Company Foundation website, here. We know there are many Telluride Alumni deserving of an award like this so please enter, and share the patient-centered care you are working so hard to make standard of care. Good luck!

 


Who is Healthcare Delivery Really About?

Helen_Discussion_072715_cropOur final session of the 2015 Telluride Experience kicks off in Napa, CA this week. Once again, the learning began by sharing the Lewis Blackman story, and we were fortunate to have Helen Haskell as part of the faculty to lead discussion after the film, along with Dave Mayer. Having been part of the team who created the film, and having viewed it more times than I can count, I am always in awe of the new ideas each viewing inspires. A large part of that inspiration arises from the conversations and stories that are shared by attendees after they hear the story.

Today, there were many excellent comments but it was something Natalie B, a nurse practitioner and educator, mentioned about the fear junior healthcare professionals hold of getting chewed out by healthcare leaders that often prevents them from speaking up when they are unsure. (See her post Transparency and Vulnerability=Scary! on the Telluride Blog). The second inspirational comment came from our newest faculty member, Kathleen Bartholomew, also a nurse, who pointed out the need for a greater sense of urgency around adopting a culture of safety above all else. She continued by pointing out that 900 similar case like Lewis’ occurred in the single day and a half since our group arrived at this meeting.

Dave_Lewis_StoryThis begs the question that, shouldn’t delivery of care always be about putting the patient first versus the care provider’s ego or fear of jeopardizing a career? This phenomenon is far from limited to trainees too, which is of even greater interest. Perhaps an interesting model to consider would be to have medical and nursing schools recruit, train and accept only the most courageous students versus those with the best MCATs or test scores. It would be nice to weed out those who would/could put their own professional well-being before that of their patient at any level.

The reminder of the need for a greater sense of urgency was both valuable and validating. There have been times when it has been hard to watch Lewis’ story yet again, knowing errors related to healthcare hierarchy and culture continue to occur again and again. Helen shared that on November 6th, it will be 15 years since Lewis died–was killed–if we’re being honest. She pointed out that all too soon he will have been gone from her life longer than he was alive. This is a hard fact for all of us to hold.

One of the greatest values to the Telluride Experience is infusion of the mindfulness and ire into the minds of young healthcare trainees that comes from hearing these stories. It is both that will be needed for real change. We need providers at all levels of training who are more afraid of harming a patient than of being chewed out by a dysfunctional healthcare mentor. I would challenge those going into healthcare, as well as those already in healthcare, to be prepared to put the patient first, always. Those who are unsure this is something they can do might want to consider a different career path.


The 80-20 Rule and Disruptive Healthcare Professionals

80_20_Rule_ImageA colleague forwarded on a momentarily disheartening clip from the Washington Post last week. The article, entitled Anesthesiologist trashes sedated patient–and it ends up costing her, included an audio clip from the patient’s cell phone that he had inadvertently left running during a colonoscopy in which healthcare professionals charged to care for him instead chose to act like grade school bullies. The anesthesiologist, who was one of two physicians named in a lawsuit for medical malpractice and defamation, is clearly heard on the audio clip belittling and taunting the patient while sedated. Additional staff is heard laughing as the proceduralist and anesthesiologist continue their disturbing banter. No one in the room, or at least no one on the audio clip included in the Post article, told them to stop. I will bet, however, there was at least one person in the room who wanted to say something.

I say momentarily disheartening because as I sat listening and briefly wondering how any of the work we do educating the young–teaching them to stand up to bullies and disruptive healthcare “professionals” like this in the workplace–was going to overcome the still so well-ensconced medical culture, I quickly found solace in the fact that we like to elevate the train wrecks in all walks of life. And the Post was most definitely covering the story of a train wreck.

Knowing that our culture is comprised of the stories we share, I just as quickly recalled multiple stories of the great work being done in my small corner of healthcare alone. Take, for example, the weekly Good Catch stories shared throughout the MedStar Health system showing exactly how the 80-20 rule can be applied to the prevalence of healthcare bullies. I was comforted by the fact that for the 2 physicians mentioned in the Post story, I knew of at least 8 good people protecting patients in just one health system. Stories of visiting nurses who ensure the safety of those in the home, or of the local security guard who sits with a soon-to-be patient until help arrives. Stories of nurses who speak up when care does not seem to be going in the needed direction, and stories of physician leaders who actually lead, setting the stage for those often silenced to share their voice. Yes, the 80% is alive and well!

Those who aren’t convinced it is just good form or good karma to treat patients and/or colleagues with dignity and respect can turn to a growing body of formal research that contends bullying and incivility in the workplace has many costs, including patient safety and workforce overall well-being. An opinion piece in the New York Times on June 19th entitled, No Time to Be Nice At Work, by Christine Porath refers to a survey of more than 4,500 doctors, nurses and other hospital personnel of which “…71 percent tied disruptive behavior, such as abusive, condescending or insulting personal conduct, to medical errors, and 27 percent tied such behavior to patient deaths.”  Porath also references work recently published in the American Journal of Management, Does Rudeness Really Matter? The Effects of Rudeness on Task Performance and Helpfulnesswhich showed people working in an environment that lacked civility missed information directly in front of them and offered fewer creative solutions to tasks before them. The same was true if individuals simply witnessed an exchange of rudeness.

It matters not whether it ends up being the data or the stories that drives us to treat one another, especially patients, with dignity and respect in the healthcare environment. And maybe stories like the one in the Post last week are needed in some strange way, if only so that they might discourage the next bad actor who has failed to mature themselves from lashing out at the vulnerable. I do know, however, that we need to add at least five stories of the good work healthcare professionals are doing each day to counteract the negative force a story like this carries into the mainstream. In the meantime, we need to continue to empower those healthcare professionals who want to do better, especially young healthcare trainees. There are many within healthcare who look at the Post story and are embarrassed to be part of a profession that would allow this to continue but have yet to find their voice or platform. Here’s to the good guys and gals–the 80%–we know you’re out there. It is up to healthcare leaders to give them a pen…or a mic!


The Content We Share: MedStar Health Inspiring Healthcare Scholars in Telluride

One of the conscious strategies behind the content created at MedStar Health is to inspire high reliability practice and patient centered care locally. Dave Mayer has always insisted we share as much of that content as possible with our colleagues across healthcare, as well as with young healthcare learners and resident physicians during the Telluride Experience. The piece referenced, Please See Me, was released in April of 2015, and was shared this week in Telluride. Following is a wonderful reflection from the Telluride Blog entitled, Forgetting Our Purpose, by one of our medical student scholars on the value she found in this piece. To see additional student reflections from the first session of the Telluride Experience for 2015, go to: www.telluridesummercamp.com/blog

Colleen Parrish is a Telluride Scholar, and rising M2 at the
University of Oklahoma

Throughout today’s sessions, one thing that really hit home for me as a student was the last video we watched created by the MedStar team. Within the video, it brought up a point that I think we as students tend to forget – especially those within the first 2 years of medical school or those within the most book heavy, patient free part of their healthcare curriculum. In the video, the doctor mentioned that she had memorized all the muscles and bones within the body, and gone to school for x number of years in order to take care of this particular patient; she had spent all this time and energy, sleepless nights, and damaged personal relationships in order to be a great caregiver for him.

This really resonated with me, especially with the recent completion of my first 2 years of schooling. I realized that within this period of books on books and lectures on lectures, we as students tend to forget our purpose – our “true north” if you will – of personally caring for and improving the overall well-being of our patients, our fellow humans. Without that constant reminder of why it is we are investing such time and energy into learning about bugs and drugs and such absurd sounding things as poop charts, we tend to veer from our true north into a path of “jadedness” and even resentment.  If we can take the time everyday to remind ourselves of why we are doing all this, perhaps by watching videos such as this one or “Empathy” from Cleveland Clinic or by simply writing ourselves a letter that we read in moments of stress and frustration as we watch our peers in other professions begin to have careers and families, if we can bring ourselves back to our purpose even within the classroom I believe we can all be not only more effective healthcare providers but happier ones.

I’m reminded of an article, [from The Atlantic, For the Young Doctor About to Burn Out] that I tend to turn to that helps remind me a lot of the deeper issues of the stress and burnout of physicians. It’s more of book review perhaps, but it really resonated with me as to a different perspective on how we can get distraught within our beloved training and professions.


Enter to Become A Young Physician Patient Safety Award Winner

Screen Shot 2015-01-12 at 5.59.46 PMWe have recently been reminded just how powerful the pen remains in stirring the hearts and minds of men and women around the world. And, we have often discussed on ETY how stories can change ideals, culture and even societal norms. With this knowledge in mind, we wanted to share the following opportunity offered by one of our Telluride Experience sponsors, The Doctors Company Foundation, in Partnership With The Lucian Leape Institute at The National Safety Patient Safety Foundation. This patient safety centered organization and partner is once again hosting a Young Physicians Patient Safety Award and essay contest for young physicians in training interested in sharing their story related to a personal experience with patient safety through the 4th year of medical school. The deadline to enter an essay is 5pm ET, February 2nd, and additional information on entering can be found below, as well as at the Doctors Company Foundation website.

Our Telluride Alum have been blogging and reflecting with great depth on wisdom gained in only the early years of their healthcare careers regarding just how complex an issue all things patient safety related can be. The hope is that at least a few will share their stories, along with their writing talents and passion for patient safety via this venue! Excerpts of essays from 2014 winners can be found in the ETY post, Sharing the Doctors Company Foundation 2014 Award Winning Essays. These winning essays have already served as safety moments in a large health system, as well as inspired peers to think and act differently when it comes to keeping patients safe.

In brief, The Doctors Company Foundation Young Physicians Patient Safety Award recognizes young physicians for:

…their personal insight into the importance of applying the principles of patient safety to reduce the incidence of medical error. Individuals are invited to submit essays about patient safety events they personally experienced during clinical rotations. The essays will be judged by a panel selected by the Lucian Leape Institute of the National Patient Safety Foundation (NPSF). Six winners will be selected and each will receive a $5,000 award, which will be presented at the Association of American Medical College’s (AAMC) Integrating Quality meeting in Chicago, June 2015.

Eligibility/Submission Requirements:

    • As of July 1, 2014 applicants must be either a 3rd or 4th year student in an American medical school
    • Award is for the best essay explaining your most instructional patient safety event during a clinical rotation-one that resulted in a personal transformation
    • Award will be presented by The Doctors Company Foundation at AAMC’s Integrating Quality meeting in Chicago
    • Essays will be judged and winners selected by panel identified by NPSF, all review committee decisions are final
    • In 500-1,000 words describe the most instructional patient safety event you experienced, one that resulted in a personal transformation. The essay should have an emotional impact on the reader and provide a lesson that is transferable to other medical students and medical professionals.
    • Explain how the event impacted your learning and growth and how the experience will help you to provide the safest care to your current and future patients. You must include examples of how to improve any system errors or processes that contributed to the adverse patient event and explain how you will ensure that the changes are implemented.

Description of relevant events for the essay includes any patient safety event, including “near misses”. A patient safety event is a process or an act of omission or commission that results in hazardous health care conditions and/or unintended harm to the patient. The event is often a consequence of a systems failure or error. Examples include medication related errors, communications errors, health care – associated infections, medical record errors, identification errors and delays in responding to critical diagnostics.

Essays must maintain the confidentiality and integrity of the patient and location of the event. Please use fictitious names and locations in the essay.