Category Archives: Individuals

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.

Thinking Fast and Thinking Slow

This session begins an exploration of thinking about thinking.  Nobel laureate Daniel Kanhneman deserves credit for the title- he published Thinking, Fast and Slow in 2011.  In our quest to become master clinicians, it is paramount we explore all aspects of clinical reasoning.  This session introduces the thought process behind conscious and unconscious bias and how it may influence the way you think about clinical problems and patients.

A brief note on bias.  The Oxford English Dictionary (OED) defines bias as “Cause to feel or show inclination or prejudice for or against someone or something.”  As you read the below articles and participate in the in class discussion consider how these theories of thought contribute to how fast or slow you arrive at conclusions.

Over the course of EHM we will continuously refer to Type I and Type II thinking.  An understanding of these fundamental thought processes can improve not only your clinical reasoning but your interactions with patients and peers.

Actively watch this introductory video on Dual Process Theory. Compare and contrast system 1 and system 2. 

“Think Fast! Critical Thinking and Dual Process Theories.”

Read entire article, paying particular attention to the highlighted portions. Begin to think about how the 2 systems interplay in clinical decision making and how physicians must rely on both.

Croskerry P. A universal model of diagnostic reasoning. Acad Med. 2009;84:1022-8. Be sure to read the highlighted sections

Individual Responsibility to the Profession

Consider: the role of empathy in medical student education while reading Walking a mile in their patients’ shoes:empathy and othering in medical students’ education. The article discusses the barriers for medical education to promote empathy and offers up a paradigm that may help trainees deal with these barriers and possible ideas of how they could be surmounted.

Physicians and patients alike will agree that empathy is integral to patient care. But it is not as easy as we might think. Empathy is not unlike other clinical skills and practices. Take learning to listen to a heart. We begin with simple instructions about how to use a stethoscope and then slowly build more precise attunement to any irregularities in heartbeat. In empathy, we begin with simple questions like “how do you feel today?”, but experience, practice, and knowledge will create greater attunement to the feelings of others. This article by Dr. Shapiro is just one step in the direction of building the knowledge necessary to becoming an excellently empathically attuned physician. 

WATCH: Examined Life – Judith Butler & Sunaura Taylor

The conversation in this video is an excellent example of what it means to be curious, humble and empathic in conversation with others and across sameness/difference. Sunaura Taylor is an artist and writer, she articulates the social model of disability and demonstrates its effect on her life excellently. Taylor and Butler call on us to think about how what our bodies can do in the world depends on what the world allows physically and through social norms. Most importantly, Taylor and Butler show us how important it is to know about the experiences of others by talking with them and privileging their perspective by always remaining curious and open.  

Review these Key Ethics Terms:

If you’re feeling eager for more… explore this article on How to Teach Doctors Empathy which talks about the growing emphasis on empathy training for health care professionals and describes a few such trainings across the country.

Honoring the Individual: Narrative and Cultural Humility

This New York Times article, written by Harvard Professor of Economics Sendhil Mullainathan discusses how our identity shapes how we think about inequality and our advantages and disadvantages.

To Help Tackle Inequality, Remember the Advantages You’ve Had, by Sendhil Mullainathan

This PBS Newshour video and brief accompanying article by Kamaraia Roberts about young Black Republicans suggests that individual identities can be challenged by society and peers.

The stigma of being young, black and Republican, by Kamaria Roberts

Watch this compelling YouTube video by Director Vivian Chavez.  Melanie Tervalon, a physician and consultant, and Jann Murray-Garcia, a nursing professor at UC Davis, thoughtfully discuss the philosophy and function of cultural humility and the need for cultural humility to improve provider to patient interaction and care.

Cultural Humility, by Vivian Chavez

Social Ecological Model

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)

Carrier Testing and Genetic Counseling

Review the following key ethics terms:

Read Genetic Screening by Burke, et al.  Focus on the content found on pages 154- 156.

Then watch Nathan’s Story:  Tay-Sachs Disease in the Irish Population followed by Dr. Fullerton’s introductory video.

Dr. Fullerton introduces the following case:

“A young couple who are interested in starting a family come to you to discuss undergoing genetic carrier testing prior to trying to conceive.  Both members of the couple are healthy and there is no known history of genetic disease in either patient’s background.  However, the husband does have a younger brother affected by Down Syndrome who lives semi- independently in a group home.  They each self-identify as being of Caucasian (not Irish or French Canadian) ethnicity and report no known Ashkenazi or Jewish Ancestry.”

“They are now aware of a wide range of recessive genetic conditions for which they could be tested.  They simply want to avoid having a child with a truly devastating prognosis such as Tay-Sachs disease.  Therefore, they request a test of the HEXA gene only.”

Should you honor this request or recommend that the couple consider carrier testing for additional genetic conditions instead?

COMPLETE the 4-boxes – use this 4-Box worksheet for guidance.

HOW SHOULD YOU RESPOND? use some of these ethics concepts to guide your answer:

  • CONSEQUENCES: What are the harms and benefits?
  • RULES: What are the norms, laws, standards of practice, legal and ethical rights, obligations and responsibilities?
  • VIRTUES: What might it mean to manifest sympathy, empathy, courageousness, trustworthiness, openness, respectfulness, or other virtues in this case?
  • SOCIAL RELATIONS:  Consider the interpersonal relations, social norms, and power structures.

 

If you’re interested in further investigation… (not required)

These two links are optional and are intended for the student who has prior experience with the topic and/ or a strong desire for additional information.

For more information about genetic testing we would refer you to this video by Dr. Robin Bennett, UW Professor of of Medicine and Medical Genetics: https://mediasite.hs.washington.edu/Mediasite/Play/42b4867d9fe14589838c9415498a19a11d.

Also see “Carrier testing for Ashkenazi Jewish disorders in the prenatal setting” by Ferriera et al. This article was published in the American Journal of Obstetrics and Gynecology.  It is above the level of the average foundations phase student.

For more information about ethical issues around genetic testing in Ashkenazi Jewish populations read “A young couple tests compatibility” and then explore the Dor Yeshorim website.