Sometimes the wheels turn slowly. Last August I was invited to be interviewed for “WebM&M,” an online feature that I’d frankly never heard of. The invitation said
I’d like to invite you to be a featured interviewee on the topic of “The Role of Patient Advocacy in Patient Safety” for AHRQ WebM&M, the online case-based journal on medical errors and patient safety. The Web site represents the federal government’s major effort to educate practicing doctors and nurses about patient safety. Together with its sister site AHRQ PSNet, AHRQ WebM&M gets nearly a million visits annually. You can visit the site at http://webmm.ahrq.gov.
WebM&M is managed by Bob Wachter MD (blog, Twitter Bob_Wachter), with whom I’ve crossed paths a few times; I described his work and my impression in a post here a while ago, and let’s just say I’d jump at anything he recommends. So we did the interview, and it faded away into the backlog of things being processed (by somebody else :-)).
Then a few weeks ago, up popped the transcript, ready for review. A few quick edits, and voilá: In Conversation with…Dave deBronkart (“e-Patient Dave”). It includes an 8 minute excerpt of the audio.
Honestly, I’m thrilled to have been invited to do this. Thanks to Bob, to AHRQ (the Agency for Healthcare Research and Quality) … and to every single one of the clinicians and patient advocates whose thoughts and advice in these past seven years have given me these thoughts.
Glossary for people new to medicine:
“M&M” is “morbidity and mortality,” a deservedly gruesome-sounding term. Wikipedia describes M&M thus:
Morbidity and mortality (M&M) conferences are traditional [conferences] … peer reviews of mistakes occurring during the care of patients. The objectives of a well-run M&M conference are to learn from complications and errors, to modify behavior and judgment based on previous experiences, and to prevent repetition of errors leading to complications.
It sounds noble, sorta. But I’m going to take a poke at it based on what numerous docs have said: too often, M&M in one specialty ends up concluding that someone in another specialty screwed up. Human nature, I guess.
And that’s why in the interview I said this:
If I could wave a wand and cause a perception to be clearly present and disseminated, it would be that medicine is a difficult, dangerous, complicated pursuit, where the best available information is changing constantly.
Please, let’s not have clinicians bear the insanely unrealistic expectation of perfection … Let’s figure out some way to have everyone agree that this is difficult and dangerous and we’re all in it together, and it’s a blessing when either party catches the other doing something that they know could be done better.
I invite every single one of you (of us) to start shifting our conversations about medicine – all of them – to realize we’re all in it together. And it’s difficult. Let’s work on it together.
Thanks Dave for a great interview. I am glad it popped up now. I loved several examples that you used here.
First, the clinical summaries that are given to the patients that are ending up in the trash or parking lot. Many patients have talked about how the requirement was met but the goal wasn’t met. To give me basically a meds list that may not even be correct and a next appointment date on a piece of paper doesn’t really give me a way to better manage my care. It would be much more useful to have a shared to do list as well as some things to watch out for in the meantime for example.
I love the quote, “It’s perverse to keep people in the dark and then call them ignorant.” I thought your women being ridiculed while driving and then ending up having a safer driving record was a fantastic example to get the point across. It is sometimes so very difficult – and EXPENSIVE! – to get all of the information that is written about you in different electronic charts, paper charts, radiology reports, operative reports, lab reports, etc and very rarely do all of the doctors have all of the information in a way that they can easily absorb it. So patients are asked to fill out clipboards over and over by MEMORY. And then many times patients feel that the information they wrote isn’t even read. I have seen so many examples of patients finding errors and learning things they never knew simply by having access and not keeping them in the dark. I recently spoke to someone who read something about his weight in a note and it sparked him to change his diet and lose weight. It isn’t like he didn’t know he was overweight, but the way the provider worded it in the note was alarming to him. By making this information shared, the patient can really help.
I also like that you give credit to clinicians who work hard every day to treat patients and to help them deal with very serious conditions. For the most part, many of the issues are at the system level and aren’t about bashing doctors or hospitals. So many times we forget to talk about that or write it because most of us just already assume that doctors are already respected and known for the scientific part, but I think you pointed out that we need to acknowledge it more and say it to help them know as well.
I also loved the example of continuous glucose monitoring not putting endocrinologists out of business. We can’t be afraid to try new things. These new things will help providers have more time to spend with patients on the important things that can improve safety.
Thanks again for a great interview.