Category Archives: Interactions

Physician Accountability After Critical Events

Molly Jackson, Elizabeth Kaplan

1) Read Article

Read the Medical error: the second victim. The doctor who makes the mistake needs help too (Wu, AW., 2000)

GOAL: Appreciate the idea of aftermath of medical error and idea of provider as second victim..

Context and Instructions: Read article to begin to appreciate medical errors can have on providers and get introduced to a way of thinking of how to support ourselves and colleagues who experience the aftermath of a medical error.

2) Read Article

Read Patient Safety Primer – Debriefing for clinical learning (as a pdf).

GOAL: Gain more familiarity with tool of debriefing especially as it might pertain to the aftermath of an adverse clinical event.

Context and Instructions: Read article to learn about the definition of debriefing, the components of debriefing, and special considerations.

IPE: Error Disclosure

Assigned preclass video (15 min): Online video on Interprofessional Error Disclosure

Disseminating Change

Optional:

IHI Online Open School Modules – http://app.ihi.org/lms/home.aspx

QI 105 Lessons 1-3
QI 101 Lessons 1-3

Systems Improvement Methodology (PDSA)

Required:

Complete assignment: “Creating and Aim Statement”

IHI Online Open School Modules – http://app.ihi.org/lms/home.aspx

QI 102 Lessons 3, 4, and 5
QI 103 Lesson 2

Optional:

IHI Online Open School Modules – http://app.ihi.org/lms/home.aspx

QI 101 Lesson 1-3
QI 102 Lessons 1, 2
QI 103 Lessons 1, 3
QI 104 Lessons 1-3

Conflict of Interest in Patient/Physician Interactions

Required:

AMA Code of Medical Ethics’ Opinion on Physicians Treating Family Members – Develop awareness of AMA Code of Medical Ethics’ opinion statement on treating family members
Requests for Care from Family Members – Review a commentary about caring for family members that brings up key issues and provides some structure for guidelines around these issues.
The Overlapping Roles of the Rural Doctor – Review a commentary about unique issues that come up when being a provider in a rural or smaller community.
Caring for ‘Very Important Patients’ – Ethical Dilemmas and Suggestions for Practical Management – Students should be aware that they will care for patients with different influence, power, etc. and should be prepared to reflect on the challenges inherent in these relationships, as well as their professional responsibilities to these and all patients.

Optional:

Social Determinants of Health in US Populations

Required:

Link and Phelan. 1995. “Social Conditions as Fundamental Causes of Disease” Journal of Health and Social Behavior pp.80-94
- In this foundational article, social epidemiologists Bruce Link and Jo Phelan argue three main points:
  1. social conditions (e.g., SES, inequality, racism, segregation) have a causal effect on health and well-being,
  2. to understand patterns of disease prevalence and incidence, we need to contextualize risk factors and understand what conditions put people “at risks of risks” (i.e., people in poor neighborhoods have an elevated risk of exposure to crime which increases the risk of stress accumulation), and
  3. researchers need to acknowledge that social conditions are not just distal causes of disease, they are FUNDAMENTAL causes, meaning that the relationship between the social conditions (e.g., SES) and health is robust and will remain present even as the risk factors for disease and the leading causes of disease/death change.
- This is because high SES individuals are afforded flexible resources that they can use to avoid risks and minimize the consequences of disease.
Frieda, Misha. 2016. “For Native Americans, Health Care Is a Long, Hard Road Away”.
- NPR : https://www.npr.org/2016/04/13/473264076/for-native-americans-health-care-is-a-long-hard-road-away
Social Determinants of Health PPT

Barriers to Confronting Bias: Fragility

Required:

Read DiAngelo, White Fragility
Listen to entire podcast State of Opportunity Dr. Di Angelo Interview on White Fragility: http://stateofopportunity.michiganradio.org/post/you-asked-it-extended-interview-theory-white-fragility
Review In-class handout: The Art of Mindful Inquiry and Health Ways to Communicate

Optional Readings:

Bridging Difference: An approach to conflict with colleagues

Conflict is frequent and inevitable in healthcare. Why?

We have different personal and professional values. Moral issues and values often play a role in medical care and decision-making, and the values of individual team members may at times conflict.
We may have a different understanding of the same patient or situation. For example, one physician may see a patient as having a potentially treatable illness, while another sees him as someone who is suffering and should be allowed to die peacefully.
There is often not a single “right” or evidence-based answer. The different experiences of team members may lead to different approaches to the same patient or issue.
We come from diverse cultural backgrounds. Team members – including patients – all bring their personalities and cultures to the table, and icebergs can bump.
Working in healthcare is stressful and can cause individual ‘resource depletion’. Fatigue, stress, and burnout all make conflict more likely.
We may have inadequate institutional resources, leading to tussles to get our patients what they need – the next operating room, an expensive medication, etc.

Health professionals AND medical students need to have a constructive approach to conflict

To provide the safest and highest quality care for patients
To create a safe learning and working environment for ourselves and our colleagues
To build and maintain relationships with each other. Health care team members often work together for years. Medical school classmates will be a source of support for each other, and may find themselves in the same residency programs and ultimately practicing together.

Conflict Handling Modes

TKI Conflict Handling Modes

Competing

A competing style is higher in assertion and lower in cooperation. Someone using a competing style might approach the conflict by making as strong a case as they can for their own position. They may be very amiable and polite about it – competing does NOT mean harsh – but they have a viewpoint that they strongly assert.

Perhaps someone using a competing style is very confident that hers is the correct position. She may be in a position of power and intend to pursue this course even if it is unpopular with others – a competitive style may avoid wasting time in meaningless discussion if the course is already set.

Collaborating

A collaborating style is both assertive and cooperative. Someone using a collaborative style might approach a conflict as an opportunity to work together to build the best possible understanding or solution. He would express his own perspective, but would also elicit and listen to the perspectives of others.

Perhaps someone using a collaborative style knows that each member of the group is likely to have different ideas and input, and that all might be contribute to the group’s understanding of a critical issue, or to solving a challenging problem. He may want to build strong relationships within the group, even though it might take a lot more time than a less cooperative style.

Compromising

A compromising style is medium in both assertiveness and cooperativeness. Someone using a compromising style might approach the conflict as an opportunity to meet in the middle, to give and take to find something all group members can live with.

Avoiding

An avoiding style is low in both assertiveness and cooperativeness. Someone using an avoiding style does not share their own perspective or listen to others – they don’t want to engage with this conflict right now!

Perhaps someone using an avoiding style needs time to process their own thoughts or cool down, and they plan to return to the topic later on. Or perhaps the issue is unimportant to them, or they don’t think they have the power to make change.

Accommodating

An accommodating style is low on assertiveness, but high in cooperativeness. Someone who is using an accommodating style is putting the concerns or needs of others ahead of their own.

Perhaps someone using an accommodating style knows that the issue is far more important to the other(s) than it is to them, or that the relationship is more important than the issue.

An Approach to Handling Conflict

Can we insert vital talk web page here? http://vitaltalk.org/guides/conflicts/ ALT TEAM

Social Ecological Model

McLeroy, Bibeau, Steckler and Glanz are generally credited with creating the social ecological model of care. A quick Google search for the social ecological model will reinforce how widely it has been adopted. There are numerous community, state, national and international organizations that utilize this model in their programs.

Think back to your session in immersion on the social history. How often do you think beyond the individual and interpersonal factors that influence you and your patients health?

Image result for social ecological model uw

From CDC Colorectal Cancer Control Program (CRCCP)

TKI Conflict Handling Modes