Module II

This week I reviewed the section on medical errors. This case really reminded me of the Dana-Farber Cancer Institute. It was also a highly regarded research hospital that came under much public scrutiny after a lack of communication led to medical errors and consequently a patient death. Within a Capstone assignment we were instructed to come up with a plan on how we would deal with it as an administrator. As any health care lawyer will tell you a physician's relationship with the patient often determines whether litigation will follow. Also by example of John Hopkins, it is always best to have open communication with the family when medical errors occur.

In one instance a family whose daughter died at Johns Hopkins from a medical error teamed up with the hospital to develop medical prevention techniques. Although this may sound unusual the family, instead of blaming the hospital for the error and harboring ill will, worked together with Johns Hopkins and quietly settled out of court due to the hospital's open demeanor in explaining the cause of their daughter's death. So with open communication the hospital turned a liability into a strength.

Below is an article that shows how having open communication about medical errors can actually be a risk management technique. http://web.ebscohost.com.ucfproxy.fcla.edu/ehost/detail?vid=12&hid=106&sid=399d8d56-acf8-4345-a595-7f1a5042c695%40sessionmgr108
Here David Studdert Melio, M., Gawande, A., Brennan, T.A., and Wang, C.Y. also state that such communication is the only way effective preventive strategies can take place or be constructed in the first place.

Getting back to the case in the Perry book, this question definitely has legal implications. I would consider withholding information about medical treatment they are receiving a definite violation of informed consent. This is due to the fact that chemo is not one isolated incident but an on-going treatment lasting over years so shouldn't the patient have a right to informed consent for each and every treatment? Physicians should always note that patients may not always be giving the full details about how they are coping with the chemo from treatment to treatment. Thus they cannot rely on themselves to catch something adverse reactions to overdoses. One main lesson from the Dana Farber case is that even the most gifted and close group of physicians and nurses cannot be trusted to catch everything.

In my opinion in cases like these..."the truth will set you free". This is a great burden for staff and physicians to carry by keeping secrets and definitely does not set the correct tone and culture for the organization. If incidents like these are let slip by the organization as a whole will simply keep spiraling down until something devastating happens. If some of the best hospitals in the country are able to step up and admit mistakes and actually benefit from it, open communication should not be a scary proposition for health care administrators. Trust is something one can rarely win back especially when it regards one's health.

I will end with an example from my life. This Thursday, we had a home health nurse inform us that her client was not in her room and other staff had commented that the last time she was seen was outside in the garden close to the exit. This resident is also under watch for having dementia problems and administrators feared that she had wandered out into the city's downtown streets. If the company had done what those in the case had done they would have had followed procedures and searched for 15 minutes and then called the police. However by calling the family first they were able to find out that the granddaughter had taken the resident to another floor to visit friends. Open communication about possible errors can often be the key to the error's solution.

Module I

This week I reviewed many of the ethics websites recomended including those concerning ethical decision frameworks. I think this is a great idea. In the book Blink by Malcolm Gladwell (A book from Capstone), the author reccomends having simple rules to make quick and complex decisions. When used in a hospital, simple rules helped reduce unecessary costs, helped better utilize valuable resources and potentially save lives within one complex triage situation. I believe the same pattern of thought can apply to healthcare ethics in certain re-occuring situations. I think as one gains more experience in healthcare one may better aptly personalize the suggested rules found in these websites. Currently, in my internship I often speak with experienced administrators. No matter what the decision made in terms of human resource issues such as discipline, performance standards etc. I was advised to always be consistent in order to gain respect and employee loyalty. So in essence go through a framework to make ethical decisions in human resources.

I also found a comment on MDPME website to be very helpful. It said that if you told your decision to someone you admire what would their reaction be? Whether it be an old teacher, my grandfather, my father, Jesus or an old friend, I think this will be something I will definitely use in the future. I think this is the sort of tool where you can accurately gauge whether your "gut reaction" is headed in the right direction. However it is also important to remember not only certain people to make correct decisions but also remembering poor decision makers in order to not make these same mistakes again. After watching the Capstone required film, ENRON: The Smartest Guys in the Room, it always reminds me never to do anything I have a problem without question just because I was told to.

I found the overview of ethical theories fairly interesting. I've always thought that morals and ethics are two different things. Morals are more of the self-evident good vs. bad, whereas ethics are the accepted standards of behavior within a group or culture. I found moral relativism to be very confusing. With ethics so much is situational. Are there universal standards of moral judgements? If there are they would have to be very basic such as do not kill, steal, cheat....but even still there are always exceptions. For example, shooting someone in self defense etc. I definitely do not think just because a person thinks something is morally right does not make it so and just because a large group of people agree that something is morally right does not make it so. I don't know but I've always found philosophical theories just aggravating since there will never be a fully correct theory.