#AtoZChallenge: A Mantra For Mistakes

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

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: Journey More, Judge Less

photo (2)

In college I had the privilege to learn from Professor Charles Yarnoff.  Mrs. Summers taught me to write in my sophomore year of high school, but Professor Yarnoff took it to a whole new level.  I think he would say I’m still too wordy, but hey, it’s my style.  I didn’t know at the time, but the essay I wrote on growing up Chinese in America would become a recurrent touchstone for me over the years—including now.

My cross-cultural education commenced early—I remember going to a friend’s house for a playdate in first grade.  I started to take off my shoes and she looked at me strangely.  Apparently her family wore shoes at home.  I looked at her strangely.  Over the years, I learned to pay attention to how my American friends did things.  I tried to follow suit and not appear ignorant.  When they came over, I found myself explaining to them how we did things in my house.  I considered myself very Chinese.

Then our family went to Taiwan in 1985, and I found out how American I was.  We visited my grandparents in Tainan, who still lived in the homes where my parents grew up.  That is where I learned that some people simply live with occasional ants and salamanders climbing the walls.  At first it was gross, then intriguing, and then, okay, that’s just how it is.  In my aunt’s modern apartment building, there was one drain for the whole bathroom floor, rather than just for the shower area.  You just stood on a wet floor until you were all done in there and it would dry off eventually.  That was a lot harder to abide than bi hu, or ‘wall tiger’ amphibians, for some reason.

bi hu 2011

 

At that time, my twelve year-old world view was pretty narrow.  I thought it was an interesting trip.  I liked some parts and definitely not others, and I was very happy to be back in the States where everything was normal.  I Judged America as clearly better than Taiwan—more advanced, cleaner, and with superior plumbing.

Since then I have Journeyed a little more.  In 1999 I went back to Taiwan on vacation, the first time since 1985. I got to visit Taiwan National University Hospital in Taipei.  I felt surprised at how modern it was—like I could easily have put on a white coat and cared for patients there myself.  Then my grandmother became ill and I flew back again in 2000.  She was admitted to the teaching hospital in Taichung.  She was already intubated when I arrived, but still awake and in the room she shared with another patient.  I was shocked—intubated patients in the US are almost always sedated, and transferred to private rooms in the intensive care unit.  She was soon transferred to the ICU, where we were given a shopping list.  While the staff settled her into her room, which resembled more of a sterile alcove with a bed to me, we the family walked across the street to the medical supply store to buy the towels, feeding tubes, syringes, and other items they would need for her care.  I remember thinking, You have got to be kidding me—seriously?  But I was with my mom and aunts, who reminded me that this was not America, and things worked very differently there.  They were patient with my young adult, young physician, American disdain.

Each day for lunch, we ate at a little hole in the wall, Tsai Duo Duo (Food Much Much).  It’s still one of my favorite places to eat, ever.  It was always crowded with people, in typical Asian fashion.  The two-level food console astounded me—laden with a hot food assortment so vast, it would take me a month or two to sample it all.  It was like the entire Whole Foods eatery packed into eight square feet.  We each picked up a small paper box, filled it, weighed, paid, and scrounged for seating.  When we finished, we dumped leftovers in one big waste basket, boxes in another.  My aunts told me that at the end of each day, the food waste was taken to local farms to feed the pigs.  How brilliant! I thought.  It made me reconsider my assumption that everything worked better in the US.

In the summer of 2006 I went back to Taiwan yet again.  This time my parents had their own place there, and everybody was healthy.  I gave a presentation on womens’ health (in Chinese—I was so proud of myself), and we got to see some historical sites in Tainan.  One night from my parents’ high rise, I heard music coming from the street.  It sounded like an ice cream truck—at 9pm.  It was the garbage truck.  My mom scurried to the kitchen, where she opened the freezer and pulled out a small, securely tied plastic bag.  It was their organic food waste for the week.  She explained that in that hot, humid climate, keeping organic waste out would wreak after a day or two, so people kept it cold.  Everybody brought their trash to the collector when they heard the familiar music.  The singing truck reminded me of that Monty Python scene—“Bring out your dead!”  Once again I was struck by how humans adapt to different circumstances, and how differently people live in other places.

The point of all this is that I think access to multiple, different points of view helps us understand one another more easily—if we let it.  I suppose it could just as easily make us more narrow and judgmental—“I don’t like this (you), it’s (you’re) not like what I know (me).  I don’t know how it (you) will change my way of life, it (you) scares me, and I don’t like it (you) even more.”

I find most of my well-traveled friends to be more open-minded and non-Judgmental.  The world can only get more connected, integrated, and small from now on.  The more readily we can see the similarities between us, the more willing we are to embrace one another, the better off we will all be.  I need to travel more!