Christine Zhang-Telluride Reflections #TPSER8

My eyes were glued to the ground as we hiked 2.5 miles up to bear creek falls today. There were breathtaking scenes at each step or so I imagine. All I caught were the rocks lining the trail.  It felt so satisfying to finally reach the peak and look down over the mountain we scaled.  The view from the top was unbeatable but I couldn’t help but wonder about all I had missed along the way. Ashley made a great comment later in the evening at happy hour about “missing the forest for the tree.” The phrase resonated with my experience on the trail. No, I didn’t miss the forest aka the view from the waterfall but I was so preoccupied with the ground aka the tree, I missed what could have been many great experiences on the journey. Do you ever wonder what opportunities pass you by because you’re so locked into a goal to the point of inflexibility and disengagement with your surroundings? How could that impact your personal and professional development and especially relationships? I’m curious how many physicians are oblivious to the people and things around them. And I wonder how much the almost automated motions of their daily schedule harms themselves, their staff, and especially the patients they’re trying to serve.

Telluride Reflections by Kristin Morrison, M2–Metaphors and Mindfulness

I’d have to say that one my unexpectedly favorite parts of Telluride were the absolutely stunning flowers there–from window boxes to hanging baskets to the vibrant fuchsia peonies that currently grace the home screen of my iPhone, I certainly enjoyed them. My week in Telluride gave me ample opportunity to stop and smell the roses!

But this is a blog about patient safety and quality improvement, so how is that related to flowers?

On the last morning in Telluride, Carole asked the students this question: “You’ve walked up and down that flight of stairs many times since getting here. Can anyone tell me what’s sitting on the windowsill?” A planter of pink geraniums! I thought to myself. I notice them every morning! Someone quietly mumbled “Plants?” and I interjected with “Yeah, pink ones!” because I didn’t want to look too eager to share my knowledge of the pink geraniums gracing the hallway of a middle school. Who notices that stuff anyway? Apparently I do.

But here, pink geraniums are more than a hearty plant that improves the view (like it needs improving…). As a group, we reflected about how pink geraniums are a metaphor for mindfulness–that is, the idea that one is fully in the moment and able to appreciate that moment’s unique experience. By truly immersing yourself in your environment and taking the time to appreciate your surroundings, you are able to notice previously missed elements such as a planter of pink geraniums sitting on a windowsill. Additionally, I think there are many varieties of pink geraniums; while I can tell you the geraniums are pink, I can’t tell you how many steps there are or whether the nice guy that prepared our delicious food has ever changed his shirt. It seems that working together and generously sharing information would be the best way to get the complete picture about the experience, right?

I think mindfulness is a critically important aspect to patient safety and quality care because it gives health care providers, patients, and loved ones the ability to begin to understand the whole picture of one’s health. Paying attention to the small (but important) details provides critical insight into a patient’s health and overall well-being, two elements I believe doctors wanting to provide good, patient-centered care keep in mind. I imagine having multiple perspectives–such as those offered by students, residents, nurses, pharmacists, therapists, family members, primary care docs, attendings, and the patients themselves–would help complete the picture. I think patients owe it to themselves to be mindful of their health; after all, they are the ones who ultimately must deal with the decisions made by the team. It seems intuitive that a mindful team (eg the aforementioned one) would be less prone to making medical errors, overlooking important aspects of care, and/or allowing a patient to “slip through the cracks.” It seems like all health care providers want to provide the best possible care for their patients, and it makes sense to me that part of doing so would involve being mindful of the patient.

***

I just finished my first year of medical school, which means I haven’t had the pleasure of completing any clerkships yet. I’m currently getting some experience working with an internal medicine practice in St Louis, and believe it or not, today was my first day (I think it went really well!).

I’d like to tell you about a pink geranium I noticed today. The patient came into clinic this morning for follow up regarding his COPD and diabetes, among other things. My job was to speak with him about how he’s been since his last appointment so that I could present him to the doc I’m working with. We talked about both of these conditions sufficiently, and while we were sitting there I noticed that he kept fidgeting with his hands. Unsure how to bring it up with him, I decided to kindly ask him if there was anything else he’d like to talk about this morning. He thought for a moment and said, “Well, now that you mention it, my hand has been bothering me lately,” and he proceeded to tell me about the discomfort he’d been experiencing in his hand for about the past year (which has gotten worse recently). When he was finished, I thanked him for his time and excused myself to go talk to the doc.

We discussed the conversation I’d just had with the patient, and at the end I brought up the hand discomfort that he’d been dealing with awhile. I related that it wasn’t bad enough to cause him not to use that hand, but it was bothersome enough that it was often quite distracting. The doc looked at me, a little perplexed, before he smiled and said “You know, I’ve never noticed that, and he’s been my patient for quite some time. In fact, he was my dad’s patient before he was mine! Good job.”

We went back into the patient’s room and discussed his COPD and diabetes before examining his hands. After all was said and done, there wasn’t much we could do for his hands beyond suggesting some exercises and over-the-counter medications.

But still, I was pleased I noticed this patient’s little quirk and found a way to ask him about it. I’m glad he took a minute or two to speak with me about it and am happy the doc thought it was a valuable piece of information. I doubt it made a big difference in his life or in his overall care, but nonetheless I think it’s a fitting example to show how noticing those pink geraniums can make working with patients a little more enjoyable, and I’d like to think that taking the time to discuss it with him helped him realize that his doc (and med student!) really care about the little things in his life.
***
Do you have time for one more pink geranium? First, a little background. For many years, my grandparents owned an art gallery in their hometown. They inspired another couple to open a gallery in their town (which happens to be my college town), and the two couples became best friends. Unfortunately, my grandmother died before I was born. I became friends with her best friend (the woman who runs the gallery in my college town) about a year and a half ago–my new grandmother! It is a relationship I have grown to absolutely cherish, and every time I visit her at the gallery I leave with a smile on my face.

Back to the pink geranium. One afternoon we were walking through her gallery, and I finally asked her about this painting I had my eye on (she tends to gift me any painting I mention, so I’m careful not to mention too many!). She proceeded to tell me this wonderful story about how that painting was the first one my grandparents sold to her and her husband, that she’s had it for 40 years, and that she hopes it winds up in a home that really appreciates it. A few weeks later, I asked her if it was for sale–mom’s birthday was coming up, and I thought it would be sweet for her to have the piece that her mom sold my new grandma–I knew it would be a treasured addition to our home. True to form, she gave me the painting, and just as I imagined, it’s currently brightening the big wall in our kitchen.

***

So, there you have it: a few geraniums from my recent life. The true pink geraniums from Telluride; the one I found today, in noticing the patient’s hand; and the ones I found at the gallery–the painting, the story, the desire to find a good place for it, and my mom looking for a way to connect with hers.

I hope you’ll find a way to pay attention to the sweet details of life, and in doing so, I think you’ll find yourself much more mindful of your surroundings and your practice.

Have you noticed any lately?

-Kristin Morrison, M2 at the University of Missouri School of Medicine

(The pink geraniums on TSRC/Telluride Intermediate School’s windowsill)

Mindfulness As A Foundation For Principled, Compassionate Actions

Telluride Patient Safety Roundtable Class of 2010

Topics tackled by the group on the fourth day of our Telluride Roundtable on “Open and Honest Communication Skills in Healthcare” included mindfulness and culture. The morning’s session on mindfulness, led by Bob Galbraith and Anne Gunderson, generated considerable discussion on the impact mindfulness plays in both open and honest communication skills and in high-reliability organizations (HRO’s). HRO’s are not satisfied with their successes. They have a preoccupation with failure and their culture is one where people feel safe to report incidents.

Mindfulness, as defined by Weick and Sutcliffe, is to become more aware of one’s own mental processes, listen more attentively, become flexible, and recognize bias and judgments, and thereby act with principles and compassion; it is one’s ability to uncover our own blind spots. Discussion also focused on the characteristics of curiosity, self-awareness and situational awareness in open and honest conversations. Being mindful requires more than just active listening, it requires empathetic listening. Participants debated whether mindfulness can be learned or whether it is something that is role-modeled by mentors and then cultivated in learners. The morning concluded with Cliff Hughes sharing a remarkable story on mindfulness and a near-miss of a major commuter train derailment.

The Telluride Team 2010

On Friday, we will reflect on our week’s work and begin the process of pulling everything together so we can create a consensus curriculum on open and honest communication skills in healthcare.

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