Teaching on Disclosure of Medical Errors

I’ve been a teaching physician for a bit over 10 years now.  One of the great things about teaching learners about medicine is that in doing so, I myself learn something every day.  There are so many things to learn in medicine.  Sure, a lot is “medical content”, but there are so many other things.  How to “connect” with a patient, how to interact with other health care professionals, how to improve adherence: all of these are some of the “softer” sides of medicine—but just as important as the newest drug for managing a particular disease.

Since 2003, I have been privileged to teach quality improvement principles to residents.  While what we were doing was “innovative” in 2003, now it is no longer innovative: it is REQUIRED.  Teaching what I call "the science of improvement" is very exciting to me, and demonstrates how advances in medicine move forward. 

One area within quality improvement that is particularly exciting to teach about is Disclosure of Medical Errors.  What this means is that we realize that errors occur, and rather than hiding them, we (the medical community) should tell patients about these errors.  Literature is now actually supporting the fact that when errors are disclosed, patients/families are LESS likely to be sue physicians, not more likely.

While this is fascinating information to me, the real impetus should not be about getting sued versus avoiding a lawsuit: it should be about doing the right thing for patients.  It has been fascinating to read the literature on this topic, and how it has “pushed the envelope” towards doing the right thing for patients which ultimately improve patient care.  Authors such as Tom Gallagher and Wendy Levinson (from the University of Washington, and the University of Toronto, respectively) have written on this topic for years, and have really advanced the field.

While reading some posts on Twitter today, Mike Moore, a medical student in the Seattle area posted a link to this outstanding TED talk on Disclosing Errors by Dr. Brian Goldman.  Wow.  This is absolutely worth watching, and should be required for medical students and residents (as well as teaching and practicing physicians).

So how should medical schools teach about Disclosure of Medical Errors?  If it isn't happening, it is time to do so.  If it has been integrated, kudos are in order: it is an important tenet of quality improvement to make the care that we provide for patients better—and isn’t that why we are all here anyway?

Social Media and Stages of Change

I am a physician educator, and have been for over 10 years.  I have been involved in teaching residents (GME, or Graduate Medical Education) for 10 years now, and have recently added to that the opportunity to work and learn in the CME (Continuing Medical Education) world.  Both of these areas carefully study ways to best teach medicine and medical concepts to learners.

One concept important for any physician to learn is something called “Stages of Change”.  One key tenet of this model is that people progress through different stages in the journey to change.  Sometimes, it takes a long time to complete this progression. 

The first stage is Precontemplation, in which one has not yet fully acknowledged that a change for a problem behavior is necessary.  In Contemplation, the second stage, acknowledgement has occurred, but the person is not yet ready for the behavior change.  In the next stage, Preparation, the person is ready for the change.  The next stage, Action, involves changing the behavior.  The Maintenance stage is one in which the behavior remains changed.  Sometimes another stage is Relapse, in which the person reverts back to the undesired behavior.

Two classic examples used to teach this in medical school are quitting smoking, or starting an exercise regimen.  However, one can apply the principles of the Stages of Change Model to other areas. 

Obviously, one very hot topic nowadays is physician involvement in social media.  Many physicians are jumping on the bandwagon.  Others, however, are “holding out” for various reasons (many of which include some reference to lack of time).  Personally, I was actually in this second category until May, 2011. 

In May of 2011, my wife mentioned that I should join Twitter.  That turned out to be the beginning of a new era in how I do what I do.  I joined one weekend, and have never looked back.  Now, I have actually been a heavy user of Twitter during medical conference meetings (apparently, I was the highest volume tweeter at the AAMC meeting in November, 2011, and also came back from the ACEHP meeting this past weekend as a high volume tweeter as well.  I’ve joined a few others (LinkedIn, Google+, Doximity, and others), and have learned so much in the process.

One of my plans is to become involved in the scholarly work around the use of social media by physicians, to ultimately help patients.  I had a great opportunity to meet with others at the ACEHP meeting in Orlando about this topic, and think that it will definitely be lots of fun to study this area.

So what does that mean for me?  I went from the Precontemplative stage to the Action stage relatively quickly, regarding my own personal use of social media.  I use it to learn, to teach, and to advocate (Reference 1).  I personally feel it has made me more efficient, not less.  Plus, it has been a lot of fun, and I have met (virtually, and a few in real life) many new people I would otherwise not have had the opportunity to meet.

So where do you fit in to the Stages of Change Model with regards to using Social Media?  Are you still dead set on not joining Social Media (Precontemplative)?  Have you considered joining social media (Contemplative)?  Are you planning on taking the plunge (Preparation)?  Have you joined (Action), but then gave it up (Relapse)? 

Reference 1.  McGowan B. Technology and Medical Education.  Presented at ACEHP PreConference Workshop on January 21, 2012.  Found at: http://www.slideshare.net/cmeadvocate/acehp12-preconference-emerging-technology-and-medical-education 

Reference 2. Sherman L. Sitting next to me during Reference 1, saying “Do you realize that you bypassed some stages of change?” on January 21, 2012.

Social media policies within medical schools

I have been in multiple discussions in various venues about social media in medical schools recently.  It appears to me as if every conversation ends up focusing on professionalism (or more specifically, unprofessionalism and what students should NOT do).  The conversation then turns to “a policy is necessary so that trainees/students understand what  isn’t ok”.  About a month ago, I wrote this blog here, which touched on this topic. 

While I agree that a policy or a guideline (the IU School of Medicine calls it a guideline) is important, and professionalism should of course be mentioned, I always tend to notice almost no discussion of what good can come from social media in medical education.

Is it that people are scared?  Is it that people are worried about doing something that will come back and haunt them?  Can medical schools be sued over comments made by students or faculty in social media circles?

I am particularly proud of the IU School of Medicine’s social media guideline here (shout-out to my colleague Gabe Bosslet for his direction and leadership in crafting this document). 

My personal opinion is that of course people need to be smart and not post patient information, or anything that might link with a direct patient, in a social media context.  But we sure are missing what great potential is out there.  What about disseminating helpful health information to patients?  What about the opportunity to dispel rumors, false information, and “snake oil cures”?  What about the potential for maintaining quality public health information (on vaccines, for example) for all to see or read?

Below are some interesting posts on the topic of Social Media policies, specifically with regard to health care.  Please let me know your thoughts on this subject, and how we can leverage the good from social media with the concern over unprofessional online behavior.

Social media policy gone wrong

Medical school social media policies

A publication on Social Media policies in US medical schools

Social Media guides

Western Australia Social Media policy

Twitter and Conferences, Part 2

For those that know me, I have enjoyed being on Twitter over the past 8 months.  Based on one of the recent Twitter chats I had the privilege of participating in recently (#hcsm, to be exact), I am looking at trying to disseminate information out into the Twitter world that may be helpful to those who follow me.

I wasted no time in getting to work on this.  On January 4, and again on January 11, 2012, I “live-tweeted” bits of information from the Department of Pediatrics Grand Rounds where I work, at the Indiana University School of Medicine.  The topics were phenomenal.  The first was on the state of oncology care at Moi University Referral Hospital in Eldoret, Kenya, with which our institution has an affiliation.  The second, this morning, was a talk on the use of technology for teenagers beginning the transition from pediatric providers to adult providers.  Both were excellent, and I personally learned a lot of great information from each conference.  But how do my followers feel?  I received many “retweets” and comments from each, and am pleased to see that at least a few followers had positive comments about this. (If you are interested in the information from either of these tweets, the Twitter hashtag is #IUPedsGrRounds).

However, live-tweeting a local conference such as one’s own grand rounds is still small, compared to live-tweeting national conferences.  Here is a paper on the topic from 2010, that describes the process.   You can also see a previous blog I wrote about this here, as well as this nice scientific discussion of how Twitter can be used to spread the message about science or medicine.

Progress appears to be somewhat slow with respect to how we can incorporate the use of Twitter at such conferences.  How about putting the Twitter handle on nametags at national meetings, just under their names, and promoting this when people register?  (As an example, I recently joined the Society of Academic CME, and on the application, I was asked for my Twitter handle; way to go, SACME!)  This would be one step towards utilizing and embracing social media for the promotion of great content for either health care professionals or for patients.

So do you tweet conferences, and if you do, why do you do it?  If not, would you be willing to try it at least once for a future conference you attend?  I will guarantee you that this way of “taking notes” has the potential for learning not just for the one tweeting but also others, and can been a lot of fun as well!