A note from one of our senior faculty members in the department of surgery:
Paul,
As I am sure you are aware, we are in the process of recruiting the PGY-I class for 2009. Many of the candidates schedule their interviews so that they can visit all three Boston hospitals on their “swing through town”. During one interview with a spectacular candidate -- AOA, top of the class, and solid research experience -- was the following question: “BI has gotten a lot of bad press lately, could you tell me about it?”
At first she seemed surprised when the reply was, "I would be delighted." She was told that, I as an individual practitioner, and we as a health care organization realize that, as long as medicine is practiced by humans on humans, there will always be the likelihood for errors. She was told that although we all have a zero tolerance policy for errors, when they occur our obligation to the patient, and to the health care organization, is to learn all we can to decrease the likelihood the same error would be repeated. I then gave her several examples from my own practice over the years.
She admitted that the first step in understanding the factors leading up to an error was the admission of same. She then said that she understood the transparency focus. We left this portion of the interview with the following question: “Do you think errors are occurring in other hospitals, perhaps your own, and perhaps even other Boston hospitals? Perhaps they have chosen a different path to resolution?” The question did not require an answer.
I thought you may find the discussion interesting. Thanks.
To which I add the following open letter:
Dear prospective interns and residents,
Please consider coming to our hospital if you would like to join in our quality improvement adventure. We promise a blame-free environment in which all participants (including trainees) are treated respectfully and as part of a team devoted to eliminating preventable medical errors. For reference, please see the post immediately below, as well as this one and this one.
In short, we teach the science of medical care delivery here, as well as the science of disease. We believe that this has become an essential component of graduate medical education and will serve you well in your career. We hope you agree and will find BIDMC an attractive opportunity for the next phase of your training.
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11 comments:
Interesting post. I had a discussion with another board member yesterday who told me that he was serving on the medical education committee. I wondered out loud what was being taught in med schools about errors, accountability, and transparency. In his opinion, it didn't seem like much based on what we were seeing coming from the interns. The letter above bears that out.
But, with a little discussion, I think this topic is a tremendous strength for the hospital when it comes to recruiting. If it doesn't come up, we should be putting the subject on the table.
I totally agree. This topic is the main wave of the future health care world, and young doctors would be well advised to do their training in hospitals where it is a major component of patient care.
Wonderful and timely post as we interview resident candidates.
I find this story implausible. Who would ever ask that question on an interview?
And who would care about the answer? As a resident, you're getting reamed by your attending if you make a stupid mistake whether you're at BIDMC, MGH or UCLA. The hospital administration is virtually irrelevant in all cases.
Now as an attending you would probably care. But that's certainly well beyond the resident's level.
I don't know where you live or work, but it is a different world from here.
Dear Mr. Levy: The previous writer's cynicism is most disturbing. The essential importance of transparency about errors and it's close cousin, the clear connection between patient safety and risk-free, open, respectful communication between all members of the health care team are very much on the minds of hospital administrators across the country.
Here at the University of Michigan, we see a strong desire - a yearning really - among incoming medical professionals of all stripes for an environment that encourages this kind of culture. Only a couple of months ago following an article in the NY Times on transparency about medical errors, I received the following email: "Wanted to let you know there is a great article in today's NY Times that paints your work here at Michigan in very favorable light. Also, I thought I'd mention that Michigan's medical error policy was a big part of my choosing to come to residency here. I'm sure I'm not alone. Keep up the good work!"
The desire for, and increasingly the expectation that hospitals work to provide that environment is growing - leadership from hospital administration is vital, not "irrelevant".
The writer describes a stereotype that surely lives in some places, but his or her incredulity at the exchange described by your senior surgeon is misplaced today - that conversation is not implausible at all.
Thank you very much for the very relevant inspiration and straight talk.
Rick Boothman
Chief Risk Officer, University of Michigan Health System
As an attending at BIDMC, I can attest to Paul's assertion that it is a different world here. I have NEVER "reamed" a resident for a mistake, nor have I ever witnessed that here. Our residents are quality people who "ream" (to use your word) themselves for their own mistakes, and chastising them would be considered "piling on." No need. We treat our residents like the responsible adults they are.
> In short, we teach the science of medical care delivery here,
> as well as the science of disease.
Does "the science of medical care delivery" exist on curricula? (Serious question.) If so, what are some typical course titles? If not, let's get to work on it.
It is not generally covered very much in medical schools, Dave. I have tried to prompt interest in this at our local medical school, thus far to no result.
Brent James at Intermountain Health in Utah runs the most comprehensive curriculum on the subject.
The "science of medical care delivery" falls in significant part under the discipline of "Health Services Research." This area of academic study - largely funded by the federal Agency for Healthcare Research and Quality - receives about 1/100 of the attention and funding as basic medical research such as that funded by AHRQ, non-profit, and private sources. There are several excellent HSR programs in Boston, including BU and Harvard, with affiliated programs at hospitals such as the VA hospital in Bedford (who in turn work with other institutions like Intermountain).
That said, I agree with Paul that it is rare to find such things in a med school curriculum, which makes the study and the implementation of findings all the more difficult. (In a somewhat related anecdote, I heard from a friend that at her residency training, the session on the relationship of sleep deprivation to the likelihood of patient harm was immediately followed by the distribution of their 28 hour shift schedules).
I'm surprised that no one has called this senior surgeon on his Harvard-centric bias---"three" Boston hospitals???
Oh---he must have meant BIDMC, BMC, and Tufts. . .
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