Tag Archives: health

#AtoZChallenge: A Mantra For Mistakes

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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. 🙂

 

#AtoZChallenge: LOVE

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Teeheehee, a Little Late…

One year ago yesterday I launched this blog, Happy Blogoversary to me! 😀

It started as a platform to explore ways to reconnect patients and physicians in the increasingly divisive healthcare system.  And while that idea still stands central to the theme of the blog, I soon realized a much larger and more important principle:  The best practices apply across all relationships, not just doctor-patient relations.  The more I write, read, and explore, the bolder I have grown in my writing.

The very best outcome (so far) of starting this blog has been the LOVE I have received from others around it.  From the beginning, fellow bloggers have engaged, welcomed, encouraged, challenged, and nurtured me.  My friends and family have also held me up—following me via email, commenting on Facebook and the blog itself.  A vast community of support has stood up around me as I took this risk to share my mind publicly.  If they looked down on blogging, they kept it to themselves and encouraged me anyway.  If they thought I wouldn’t stick with it, I imagine they secretly wished me persistence, and then grace if I failed.  Because of all of these people, I have confidence to continue striving to bring forth the best in me, to share with everybody, in the hopes of creating something meaningful.

What if everybody had this chance?  What if every time someone wanted to do something bold and new, we met them with this much LOVE, cheer, praise, and affirmation?  Doing so does not mean blindly endorsing frivolous endeavors and wasted energy.  We can always offer LOVE along with tactful words of truth and pragmatism.  Even when, or especially when, projects fail terrifically, everybody can learn and grow.  LOVE from others at the outset makes us more resilient to failure.  LOVE from others at the moment of failure, as opposed to ridicule, shame, and sarcasm, makes us humble, grateful, and more brave, as opposed to defensive, angry, and humiliated.

Adequate words do not exist to express my deepest and most sincere gratitude to all who have LOVED me throughout my life, including those who have LOVED me through my blogging adventure so far.  May I pay it forward, and find ways to LOVE others whenever I have the chance.  If I can do that, then I will truly contribute to making the world a better place.

 

 

 

#AtoZChallenge: Humbling and Honoring

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Though I was born in the United States, I grew up very Chinese.  Honor and respect for elders was one of the highest values in my family, as it is in the culture at large.  It would never occur to me to be on a first name basis with anyone in my parents’ or grandparents’ generation; they were all uncles, aunts, and surrogate grandparents.  Teachers, as well, always had a title.  In the presence of these zhang bei (senior generation), I would sit or stand up straight, pay attention, and never interrupt.  So it feels Humbling to find myself friends—equals!?—with so many of my elders—

Joe, my 7th grade math teacher,

Dawn, my 7th grade English teacher,

Kathy, Joe’s wife and the music director for the 8th grade play,

Barbara, my 9th grade geometry teacher and freshman volleyball coach,

Lisa and Jerry, my varsity volleyball coach and her husband, one of the football coaches,

Mary and Dan, my confirmation sponsors in college, pastoral associate and pediatrician, respectively, and

Keith, my clinic preceptor intern year.

I always wondered, what did they see in me, so young, naïve, and ignorant, that would make them want to know me as a friend?  Then about ten years ago I found myself befriending students and other ‘young people.’  I gradually realized the rewards of the exchange—new perspective, fresh ideas—connection across generations, cultures, experiences.  I felt a sense of mutual admiration and understanding, despite the age gap—an appreciation that bridged the separateness.

Somehow this reminds me of a morning I spent volunteering in a free clinic a few years ago.  As per usual, patients filled the waiting room and clinic workflow bore no resemblance to anything efficient or modern.  But the atmosphere pulsed with purpose and kindness.  First and second year medical students helped run this clinic, relishing the chance to hone their history taking and physical exam skills.  They saw the patients first, synthesized all relevant data, and presented a summary to one of a few attending physicians staffing the clinic that day.  After some discussion on pathophysiology and care plan, the attending led the team of students back to the exam room to finish the encounter.  If you have ever been a patient at a teaching hospital, it’s much like that, only much slower and often with profound technical barriers and almost no support.

That morning I walked in with my team to greet an elderly Pakistani man for follow up of his blood pressure and diabetes.  I knew he had been waiting a long time.  It was almost noon and he had not eaten all day, in preparation for fasting labs he knew he needed to have drawn.  Upon greeting him, I automatically apologized for the wait, put my hands together, and bowed slightly, while I thanked him for his patience.  I felt bad about the whole situation, and I wanted his pardon.  His face lit up and he immediately turned to the students and said something like, “See?  That is how you treat an old man!”  He was not angry or crotchety in any way.  He seemed honestly and happily surprised to be treated with Honor and respect—as if he suddenly felt seen and appreciated for who he was—a member of an older, wiser generation than all of us.

In Pakistan this gentleman had been a middle- to upper-class professional.  Here in the US his resources were drastically curtailed, such that he had no health insurance and depended on the free clinic to get treatment for his conditions.  I wonder if he was used to feeling like just another immigrant patient in a busy, understaffed clinic where there were few occasions for others to ask about and listen to his story.  Since I was a periodic volunteer, I had that chance.  I get to choose when I am willing to donate my time and energy to the free clinic—everything I do there is on my own terms.  The patients there have no such choices.  If they want care, they have to show up—early—on the day the clinic is open, regardless of what else is going on in their lives.  There are no appointments, and almost no continuity with providers.  It’s a completely different world from where I make my living, on the Gold Coast of Chicago.

I am Humbled by the opportunity to meet people from all walks of life.  Students arrive at medical school from diverse backgrounds.  Patients may hail from all corners of the world, many having come through experiences I can scarcely imagine.  It is my Honor to care for all of them, and I wish to maintain this perspective of respectful service.  I have those who support, teach, and guide me in life—older and younger.  So it is my privilege to give back—to offer my own knowledge, expertise, and maybe sometimes wisdom—and help make a positive difference in people’s lives.  I can’t remember exactly, but I think I said something to this effect to the medical students that day.

Physicians have power by default and design in the medical setting.  We can wield that power with more grace and efficacy when we remember Humility, and Honor our patients as whole, rather than broken or defective.  Be they students, friends, political opponents (yeah, stuck that in there), teachers, or patients, there is always something to learn from someone else’s perspective.  Cultivating the Humble and Honoring perspective, when I can muster it, makes all of my relationships infinitely richer.