Lia's family also had the same problem; unlike home-visiting Shamans, the doctors at clinics simply do not have the time to fully give the time patients sometimes need. Overall, his talk examined some glaring problems in our medical culture and suggested doctors create a sharing and constructive learning environment to admit and learn from their mistakes to prevent more in the future.
Never, ever, ever make a mistake. What happens if they can't? Do we as a whole place a lot of trust in the medical system? Perhaps they made them because they tried so hard not to? Or it's just natural. A wife. A mother. A grandmother. Is it almost always possible to safe the life? Guiding Questions: This video connected to the guiding question "what is the role of a doctor? As Goldman established the role of the doctor is to be human, and try her best to heal you.
A doctor doesn't have to be perfect. A doctor cannot always be emotionally attached, as that, for most people , is extremely painful when patients die.
So, this video also tied in nicely to the guiding question "How emotionally attached should a doctor be? And I did well, I graduated with honors, cum laude. And I came out of medical school with the impression that if I memorized everything and knew everything, or as much as possible, as close to everything as possible, that it would immunize me against making mistakes.
And it worked for a while, until I met Mrs. I was a resident at a teaching hospital here in Toronto when Mrs. Drucker was brought to the emergency department of the hospital where I was working. At the time I was assigned to the cardiology service on a cardiology rotation. And it was my job, when the emergency staff called for a cardiology consult, to see that patient in emerg.
And I saw Mrs. Drucker, and she was breathless. And when I listened to her, she was making a wheezy sound. And when I listened to her chest with a stethoscope, I could hear crackly sounds on both sides that told me that she was in congestive heart failure. This is a condition in which the heart fails, and instead of being able to pump all the blood forward, some of the blood backs up into the lung, the lungs fill up with blood, and that's why you have shortness of breath.
And that wasn't a difficult diagnosis to make. I made it and I set to work treating her. I gave her aspirin. I gave her medications to relieve the strain on her heart. I gave her medications that we call diuretics, water pills, to get her to pee out the access fluid.
And over the course of the next hour and a half or two, she started to feel better. And I felt really good. And that's when I made my first mistake; I sent her home. Actually, I made two more mistakes. I sent her home without speaking to my attending. I didn't pick up the phone and do what I was supposed to do, which was call my attending and run the story by him so he would have a chance to see her for himself.
And he knew her, he would have been able to furnish additional information about her. Maybe I did it for a good reason. Maybe I didn't want to be a high-maintenance resident. Maybe I wanted to be so successful and so able to take responsibility that I would do so and I would be able to take care of my attending's patients without even having to contact him.
The second mistake that I made was worse. In sending her home, I disregarded a little voice deep down inside that was trying to tell me, "Goldman, not a good idea.
Don't do this. Drucker, "Do you think it's okay if she goes home? So I signed the discharge papers, and an ambulance came, paramedics came to take her home.
And I went back to my work on the wards. All the rest of that day, that afternoon, I had this kind of gnawing feeling inside my stomach. But I carried on with my work. And at the end of the day, I packed up to leave the hospital and walked to the parking lot to take my car and drive home when I did something that I don't usually do. I walked through the emergency department on my way home.
And it was there that another nurse, not the nurse who was looking after Mrs. Drucker before, but another nurse, said three words to me that are the three words that most emergency physicians I know dread.
Others in medicine dread them as well, but there's something particular about emergency medicine because we see patients so fleetingly.
The three words are: Do you remember? Well she was back all right. She was back and near death. About an hour after she had arrived home, after I'd sent her home, she collapsed and her family called and the paramedics brought her back to the emergency department where she had a blood pressure of 50, which is in severe shock.
And she was barely breathing and she was blue. And the emerg. They gave her medications to raise her blood pressure. They put her on a ventilator. And I was shocked and shaken to the core. And I went through this roller coaster, because after they stabilized her, she went to the intensive care unit, and I hoped against hope that she would recover. And over the next two or three days, it was clear that she was never going to wake up.
She had irreversible brain damage. And the family gathered. And over the course of the next eight or nine days, they resigned themselves to what was happening. And at about the nine day mark, they let her go — Mrs. Drucker, a wife, a mother and a grandmother. They say you never forget the names of those who die. And that was my first time to be acquainted with that. Over the next few weeks, I beat myself up and I experienced for the first time the unhealthy shame that exists in our culture of medicine — where I felt alone, isolated, not feeling the healthy kind of shame that you feel, because you can't talk about it with your colleagues.
You know that healthy kind, when you betray a secret that a best friend made you promise never to reveal and then you get busted and then your best friend confronts you and you have terrible discussions, but at the end of it all that sick feeling guides you and you say, I'll never make that mistake again.
And you make amends and you never make that mistake again. That's the kind of shame that is a teacher. The unhealthy shame I'm talking about is the one that makes you so sick inside. It's the one that says, not that what you did was bad, but that you are bad.
And it was what I was feeling. And it wasn't because of my attending; he was a doll. He talked to the family, and I'm quite sure that he smoothed things over and made sure that I didn't get sued. And I kept asking myself these questions. Support options. Are you in distress? Get help now. Video Doctors make mistakes. Can we talk about that? November 1, TED. View resource Clarifying empathy: The first step to more humane clinical care.
0コメント