This month’s topic of discussion with my awesome third year medical students was dealing with medical Mistakes and adverse outcomes.  The students are required to write blog posts each month, answering a particular question related to the topic.  It is then my job to facilitate a small group discussion around their responses.  I struggle with it every month, because their writing brings up so many thoughts and responses in me, and yet I know I need to hold that back and focus on fostering their dialogue, instead.  Every meeting feeds my soul, and I always walk away rewarded.

The conversation this time started out more animated than usual, which made me very excited.  It seems they felt like the topic had been well-flogged by now, starting from videos during first year orientation warning that we all commit errors and to just expect it.  And though the topic might have seemed tiresome, their energy in discussing was the opposite.

We recounted some of the stories they told in their blog posts, in which they consistently expressed empathy for patients, families, and care teams when mistakes were made or patient care was compromised in some way.  I wanted to steer the discussion toward reconciliation.  We all know that mistakes will happen; doctors are human, after all.  But then again, our errors often result in grave consequences.  Further, grave consequences happen even when no errors are committed.  So how can we best prepare for, prevent, and manage these situations?

One of the Stud(ent)s eventually offered that patients just want to be seen and heard.  Ding-ding-ding-ding, flashing lights, confetti poppers, and The Price Is Right you-just-won-a-brand-new-car! music immediately vibrated in my head.  I wonder if they noticed, but I think I was completely emotionally hijacked—in a good way for me, not so sure for them.  It’s because this is what I have been thinking and saying for years now.  Whenever I’m in a room with a patient, or when I’m practicing and teaching motivational interviewing, my chief concern is whether or not the patient feels acknowledged.  Because nothing I say or do will be accepted if they don’t feel I’m fully present.  I immediately jumped on the idea and professed my own list of what patients (and really, all of us) want: To be seen, heard, understood, accepted, and loved.  Then, assuming we all agreed on these as relationship goals between patients and us, I asked the group to list what actions they could take to achieve them.  When standing at the doorway before a patient encounter, what can we remind ourselves to do to make patients feel these five things?  At this point I was definitely seized—I could not hold back, I would not let go—I had to drill the list over and over—our ‘discussion’ turned didactic for a while.  *sigh* I got a little carried away.

The students take turns documenting the central ideas from our sessions.  Here is what the appointed Stud Scribe wrote:

THE MANTRA:

• SEEN
• HEARD
• UNDERSTOOD
• ACCEPTED
• LOVED

Strategies:

• greet the patient
• sit down
• make eye contact
• tell them what you are doing
• no interrupting, gentle redirection
• reflective listening
• prioritize problem list (together)

I love that word, Mantra.  It’s a reminder—an anchor, or a beacon—that keeps us focused on our central values and goals.  It gives us stability and bearing when we find ourselves adrift.  I did not suggest that word to our transcriber, but I am grateful he chose it, as it was perfect for the ‘M’ post in this A to Z Challenge.  That list really is a Mantra, isn’t it?

We mentioned the idea that malpractice lawsuits occur less, when patients feel their doctors have communicated well and truly care, regardless of whether errors are committed.  And though our principal objective in medicine should not be simply to avoid lawsuits, I think the incidence of malpractice claims can serve as a kind of barometer for patient-physician communication and relationship.

I think the Mantra and behaviors the students outlined are simple and effective, and can be applied in all relationships.  Kudos to the group for tolerating my little outburst and staying engaged.  I sincerely hope they found it helpful in some way, and I will try to control myself better next time.  Maybe they can forgive my Mistake this time, if I successfully practiced the strategies in service of our Mantra. 🙂