Lewis Blackman Film Discussion Day 1 – Telluride

Student scholars and medical education leaders joined in a group discussion after watching the film that shed light on areas of opportunity in healthcare across the country. Comments touched on the over-arching failure of leadership that led to the communication breakdown in Lewis’ case and the national need to empower students, interns and nurses to ask the necessary questions to keep patients safe today.  When no one is willing to say “I don’t know” the patient is at risk. Lewis and his mom, Helen Haskell, whose life’s work has become keeping all of us safe in the hospital, paid the ultimate price for the inability to exchange three simple words.

What can be done to create a culture starting in medical school that welcomes these questions, allows providers to maintain belief in their abilities while still doubting an initial diagnosis and communicate with one another openly, transparently and with respectful professionalism?

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4 Responses to Lewis Blackman Film Discussion Day 1 – Telluride

  1. Thanks so much for a great day one! I love the atmosphere of Telluride, and I felt that the Lewis Blackman film was a perfect way to start off the conversation. A big take away from the film for me was reconciling team-based care with individual providers feeling a sense of accountability to their patients. Without any individual feeling the duty and ownership of taking care of Lewis, each member of the team allowed things to slip. We need to focus on ways to help providers and staff still feel a strong duty to ensure their patients receive the best care possible. I fear that with larger and larger “teams”, this feeling of duty and accountability is easily lost. Does this ring true for others?

    Looking forward to continuing the conversation tomorrow!

    Julia Pederson
    Stanford MS II
    2011 Patient Safety Scholar

  2. Sonia says:

    I have been amazed throughout today to learn the varied backgrounds and experiences that everyone in the classroom has that have led them to this meeting. It has been incredibly inspiring to hear all of these stories and have an opportunity to reflect on how we need all of our combined intellect and skills to conquer one of the last least understood frontiers of patient safety – how our own perceptions, behaviors, and communication styles impact the care we provide. It has certainly been refreshing to be in a room of medical professionals that accept that automatically – that did not distract us all with a fight about whether this is even true. It allows us to jump straight into an analysis of what barriers exist to our desired health care system and to creating solutions that will promote a culture of honest, open, and professional communication amongst us all.

    Some of the suggestions I appreciated most from today’s conversations were:
    – Incentivizing the positive behaviors we desire (which would of course start with us identifying those positive behaviors – really great to be asked about good provider-to-provider communication examples)
    – remembering that we have to include forgiveness and remediation in the process of addressing bad behaviors; which is to say we are not powerless to change such behaviors but we must provide resources to help people improve
    – setting clear expectations for everyone – students, docs, nurses, PAs, the entire care team – that we can then use to evaluate people’s behavior (yay for UIC’s code of conduct!)
    – including patients and any of their support system they would like in the care team; these people know the patient better than anyone and should share in medical decision making

    I’m really excited to see what comes out of the next couple days – when the focus is actually more about solutions – to think these are some of the ideas we came up with only when trying to identify the problems!

    Also excited to pursue our student project – how do we use games as an engaging way to teach our colleagues about patient safety. More to come on that!

  3. Alejandra Navarro says:

    Something that was emphasized in Lewis’ case was how “confirmation biases” leads to “premature closure” and how focusing on one diagnosis can lead physicians to not think outside the box. As Dr. McDonald stated in the video, physicians need to think of “what’s the worse it can be?” and how important it is to communicate to be able to provide an open and honest interaction between patients and everyone else involved in the patients care. To create a culture of open and honest communication early in medical school it is important to be able to be exposed to and interact with patients, nurses, doctors, pharmacists and everyone involved in the care of patients. We each need to ask ourselves what can we each do to improve communication in the medical field to improve medical care to everyone in every culture.

  4. I would like to begin by thanking Helen Haskell for sharing her story with us today. I would also like to thank the Doctors Company Foundation and everyone involved in making this roundtable accessible to medical students. I think it’s great that we (medical students) have this opportunity to interact with leaders in patient safety from various health professions, patient safety advocates, and fellow students. The various large and small group discussions held today in an effort to answer the questions about “where we are and how we got here” highlighted the gaps in patient safety awareness/education from a wide range of perspectives. Some issues identified include misaligned incentives, hierarchy/power gradients, fear of reprisal, and inadequate faculty development in terms of educating the educators. Over the course of the next few days we will tackle questions about what other barriers need to be overcome and possible solutions to these problems. I think giving medical students the opportunity to be a part of patient safety discussions such as this begins to instill the culture of excellence in patient safety in them at an early stage in the carriers, which they can develop and use as foundations for future patient safety and quality improvement innovations in their practice settings and beyond. When we learn at an early stage to put the patient’s wellbeing and safety first and the implications of deviating from this mindset, we are more likely to avoid pitfalls like premature closing, more mindful of the warning signs associated with lapses in communication, more welcoming of the team collaboration to improve patient outcomes, and more likely to speak up when we need help. A patient safety education roundtable, such as this one, could be a great starting point for medical students. There are also other opportunities for students to learn about the excellence in patient safety culture, such as through online courses offered by the Institute for Healthcare Improvement Open School (www.ihi.org/openschool), and through patient safety courses incorporated in medical school curricula, for medical schools that have such.

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