We received an interesting comment to another post on the MITSS Patient and Family Blog yesterday. This person asked such pertinent questions and brought up such rarely discussed issues that we thought we would repost it here.
Anonymous writes...
I really appreciate this blog.
My medical injury occurred almost 15 years ago, at a time when these issues simply were not acknowledged. Ever. I think it's only to our benefit that it's now being talked about.
If I could ask a question: What, if anything, should a patient tell subsequent physicians?
Medical injury has a way of casting a long shadow over future medical encounters, especially if it's handled badly. I became very avoidant after my injury. On my rare visits to the doctor, I'm usually tense and unhappy and on the verge of an anxiety meltdown. My current doctor doesn't know what happened to me and I think he's both puzzled and annoyed that the relationship isn't more productive. Weirdly enough, I actually really like him, but I don't know how much I should tell him. What if he doesn't get it? What if he trivializes it? What if he blames me for everything? What if he decides he doesn't want me as his patient anymore?
I know, I know; the distrust is talking here. But it's not that easy to switch it off. Also, telling the truth would entail saying some negative things about some of his colleagues, and I'm really uncomfortable going there. Does he have a right to know? Would it help provide safer care? Or would it be better not to burden him with all the baggage I've been carrying around?
I've never seen this addressed in any of my (admittedly obsessive) readings on the subject. So if you're ever looking for a future blog topic, maybe you could address it. Thank you for listening.
What do you think? The writer raises some very legitimate concerns. Does anyone have any suggestions or comments?
Wednesday, May 28, 2008
Tuesday, May 27, 2008
WHAT WE KNOW NOW
Last Thursday, along with MITSS Board Chair, Karen Moore, I had the opportunity of meeting with the Caritas Quality Committee at Caritas Holy Name Hospital in Methuen, MA. The Quality Committee is made up of key leaders from all of the Caritas Hospitals. It was a great discussion on the changes in culture over the last several years, especially in the area of disclosure and apology. The conversation was truly focused on the support following adverse medical events (which we all know is MITSS’s passion!). A courageous CEO from one of the hospitals admitted that although we are doing a better job with disclosure and apology, we really aren’t doing well with supporting the staff. It became so clear to me in that moment – of course, we aren’t doing a good job with support. We didn’t know what we didn’t know, and, until recently, there really wasn’t much out there about the emotional impact on clinicians. But, now that we know, shouldn’t we have systems in place that can provide support that is timely and accessible for both clinicians and patients and their families?
Friday, May 16, 2008
GREETINGS FROM NASHVILLE...
Beth Conlin, MITSS Volunteer; Linda Kenney, Executive Director; and, Erin O’Donnell, Support Team Member, pose for a photo at the MITSS Booth at the National Patient Safety Foundation’s Annual Congress in Nashville, Tennessee (May 13th through the 16th, 2008).They promise to be blogging about their experiences in Nashville once they get home to Boston and settled. Look for their reports next week!!!
Friday, May 9, 2008
Is This the Tipping Point?
There is so much I want to share about my interactions with so many people in and out of healthcare on this blog…I will try to keep it to one observation at a time!
During the past five years or so, I have been extremely privileged to speak at conferences all over the country. After most presentations, there is a question and answer period (which is always painful to me personally). I wait and pray there will be someone brave enough to ask a question. The moments usually drag on…and, at last, there will be a question. Usually that question is simple – no controversy. But, what never ceases to amaze me is that after these presentations, there is a line a people waiting to ask questions or tell me their personal stories that they weren’t comfortable enough to share publicly. The personal stories were usually from clinicians who had been at the sharp end of an adverse event and got no support whatsoever. They still felt horrible about what had happened.
In the last six months to a year, though, there has been a bit of a shift. The painful stories clinicians have are now being shared publicly, and they are no longer waiting to line up after my talk. It’s clear there has been a shift -- no longer are clinicians willing to suffer in silence about how these adverse medical events affect them. Is the phrase “this is the price of practicing medicine (or doing business)” still applicable, or are we reaching the “Tipping Point”?
During the past five years or so, I have been extremely privileged to speak at conferences all over the country. After most presentations, there is a question and answer period (which is always painful to me personally). I wait and pray there will be someone brave enough to ask a question. The moments usually drag on…and, at last, there will be a question. Usually that question is simple – no controversy. But, what never ceases to amaze me is that after these presentations, there is a line a people waiting to ask questions or tell me their personal stories that they weren’t comfortable enough to share publicly. The personal stories were usually from clinicians who had been at the sharp end of an adverse event and got no support whatsoever. They still felt horrible about what had happened.
In the last six months to a year, though, there has been a bit of a shift. The painful stories clinicians have are now being shared publicly, and they are no longer waiting to line up after my talk. It’s clear there has been a shift -- no longer are clinicians willing to suffer in silence about how these adverse medical events affect them. Is the phrase “this is the price of practicing medicine (or doing business)” still applicable, or are we reaching the “Tipping Point”?
Tuesday, May 6, 2008
TODAY IS NATIONAL NURSES' DAY -- MAY 6th, 2008
National Nurses Week is May 6th through the 12th, and today is National Nurses Day. MITSS would like to salute the dedicated nursing professionals across the country who come to work every day committed to providing the very best of patient care.
During those times when things don’t go quite as expected, MITSS continues to be a safe place where nurses can come for support. If you’re a nurse dealing with the emotional fallout from a bad medical outcome, give us a call (1-888-36MITSS). Also, we would encourage any nurse to join in the discussion on this blog for clinicians as nurses are most oftentimes the frontline caregivers, and, from that perspective, your input is invaluable.
Happy National Nurses’ Day!
During those times when things don’t go quite as expected, MITSS continues to be a safe place where nurses can come for support. If you’re a nurse dealing with the emotional fallout from a bad medical outcome, give us a call (1-888-36MITSS). Also, we would encourage any nurse to join in the discussion on this blog for clinicians as nurses are most oftentimes the frontline caregivers, and, from that perspective, your input is invaluable.
Happy National Nurses’ Day!
Friday, May 2, 2008
WE NEED TO MOVE TOWARD A CULTURE OF SAFETY
From time to time, we will be featuring guest bloggers – doctors, nurses, pharmacists, and other healthcare providers who have graciously agreed to share their stories and insights in the hopes of supporting one another.
Dr. John Fromson, Chairman of the Department of Psychiatry at MetroWest Medical Center and also a MITSS Board member, writes…
Not long ago, while attending a medical society continuing medical education conference, a resident physician in internal medicine, who I had known as a student, asked if she could have a confidential talk with me. Initially, I assumed this was for a "curbside" consultation about a patient she had taken care of who was having some sort of psychiatric problem. It soon became apparent that the problem was not that of a patient, but of an entire culture of medicine that was in desperate need of repair. Here's what happened. The resident had mistakenly ordered and was administered the incorrect dose of insulin for a diabetic patient. The dose was double what it should have been for this particular type of relatively short acting drug that helps to control blood sugar levels in patients with diabetes. Minutes later, after having had a chance to review her orders, the resident realized what had happened. Instead of letting a medical colleague, nurse, or hospital pharmacist know about this medication error, she kept it a secret. Concerned about the patient, but not telling him what had happened, she supervised and encouraged him to drink and eat foods that contained high levels of sugar so his blood sugar levels would not drop dangerously low. She also checked in with him every few minutes and monitored his vital signs until the insulin's effects wore off and she was sure he was no longer in physical danger.
Having had some exposure to patient safety education, the resident physician intellectually knew that a very faulty system contributed to this medication error. She was able to rationalize that if a root cause analysis had been performed by the patient safety officer at the hospital, multiple causes or failures in the drug delivery system would have been identified and corrected, preventing this type of error from happening again. Specifically, the nurse who took the order for the insulin should have questioned the unusual dose, so too should have the pharmacist who sent the drug from the pharmacy to the patient's unit, as well as the nurse who administered the drug to the patient. But emotionally, the resident could not forgive herself for not letting the patient and other health care professionals know what had happened. When asked why she could not share this information, even if it meant preventing future reoccurrences, she replied, "Fear, fear that I would be punished, perhaps lose my job, and perhaps lose everything I had spent years working toward, my professional career." She had witnessed public retaliatory, blaming, and shaming behavior on the part of the senior medical leadership toward another resident who had made a drug dose miscalculation that was reported by nursing staff. She feared experiencing similar humiliation and the subsequent bout of depression that her colleague experienced. While the resident was relieved that her patient fortunately was not injured during this event, it became apparent that she was still experiencing severe emotional distress, in fact she was profoundly depressed. The fear of being blamed turned out to be just as debilitating as actually being publicly blamed. Caregivers can bear the emotional scars of an adverse medical event even when their patients may escape injury. The culture of medicine must change from one of shame and blame to a culture of safety.
John A. Fromson, M.D.
Dr. John Fromson, Chairman of the Department of Psychiatry at MetroWest Medical Center and also a MITSS Board member, writes…
Not long ago, while attending a medical society continuing medical education conference, a resident physician in internal medicine, who I had known as a student, asked if she could have a confidential talk with me. Initially, I assumed this was for a "curbside" consultation about a patient she had taken care of who was having some sort of psychiatric problem. It soon became apparent that the problem was not that of a patient, but of an entire culture of medicine that was in desperate need of repair. Here's what happened. The resident had mistakenly ordered and was administered the incorrect dose of insulin for a diabetic patient. The dose was double what it should have been for this particular type of relatively short acting drug that helps to control blood sugar levels in patients with diabetes. Minutes later, after having had a chance to review her orders, the resident realized what had happened. Instead of letting a medical colleague, nurse, or hospital pharmacist know about this medication error, she kept it a secret. Concerned about the patient, but not telling him what had happened, she supervised and encouraged him to drink and eat foods that contained high levels of sugar so his blood sugar levels would not drop dangerously low. She also checked in with him every few minutes and monitored his vital signs until the insulin's effects wore off and she was sure he was no longer in physical danger.
Having had some exposure to patient safety education, the resident physician intellectually knew that a very faulty system contributed to this medication error. She was able to rationalize that if a root cause analysis had been performed by the patient safety officer at the hospital, multiple causes or failures in the drug delivery system would have been identified and corrected, preventing this type of error from happening again. Specifically, the nurse who took the order for the insulin should have questioned the unusual dose, so too should have the pharmacist who sent the drug from the pharmacy to the patient's unit, as well as the nurse who administered the drug to the patient. But emotionally, the resident could not forgive herself for not letting the patient and other health care professionals know what had happened. When asked why she could not share this information, even if it meant preventing future reoccurrences, she replied, "Fear, fear that I would be punished, perhaps lose my job, and perhaps lose everything I had spent years working toward, my professional career." She had witnessed public retaliatory, blaming, and shaming behavior on the part of the senior medical leadership toward another resident who had made a drug dose miscalculation that was reported by nursing staff. She feared experiencing similar humiliation and the subsequent bout of depression that her colleague experienced. While the resident was relieved that her patient fortunately was not injured during this event, it became apparent that she was still experiencing severe emotional distress, in fact she was profoundly depressed. The fear of being blamed turned out to be just as debilitating as actually being publicly blamed. Caregivers can bear the emotional scars of an adverse medical event even when their patients may escape injury. The culture of medicine must change from one of shame and blame to a culture of safety.
John A. Fromson, M.D.
ANOTHER GREAT BLOG...
One of our favorite blogs at MITSS is Paul Levy’s Running a Hospital. In the interests of sharing another great resource (as well as giving ourselves a shameless plug), check out today’s post at www.runningahospital.blogspot.com.
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