I learned in the beginning of medical school that there often multiple different plans for each assessment, some more effective than others. I always thought it was logical to want the most effective plan for my patients. However, during medical school and in practice I had to consider patient preferences, insurance, socioeconomic factors in order to make sure the patient can and is willing to adhere to the plan.
An example of this was in early medical school and the patient refused to get a flu vaccine. Initially my thought was that there was no chance to get her to change her mind, especially initial firm resistance. Instead of giving up on her, I found out the reasons why the patient didn’t want the vaccine. Her reasons were because she already felt sick, didn’t think she would get the flu and that the shot will be painful. I could work on those reasons. So I found out things that the patient might care about to overcome that resistance which happened to be making sure her son didn’t get sick and that it wouldn’t add much discomfort to her overall visit. It turned out she already needed a vaccine during the visit and the second flu vaccine likely would lower the risk for her son and wouldn’t add much overall pain. All these together led her to finally accept getting the flu vaccine and promising in the future to try to get one again.
Getting a patient to take care of themselves is very important because we in the medical field only see a short snapshot of the patient’s health and wellness. If we as physicians are able to motivate patients to self-care then it becomes much easier to manage their health and to follow the most effective plan possible. Looking on the situation further it was crucial to understand the patient perspective in order to even be on the same page for care. If I tried to force things, the patient might have become defensive and not gotten the flu shot. During the rest of medical school I used some of these insights to make sure everyone working towards the same goal in maximizing the patients health outcomes.
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An important example of this later in my fourth year rotation in inpatient medicine. I noticed early in the morning without verifying the information that the new patient transferred had an allergy from the outside records. The patient was about to get the medication he was allergic to. I was initially confused on why the drug was ordered but I knew I had to stop administration of the drug no matter what. I got a lot of pushback from the senior and attending because I was told that the pharmacist and the admitting doctor would have marked it down. I used language I had learned in my surgical rotation during the time out process to halt the drug. I also volunteered to do some research immediately to figure out what happened and to get back to the team. Later, after finding and proving that the patient did have an allergy everybody was glad that we worked well as a team.
In one of the studies conducted at two teaching hospitals found that almost two percent of admissions had a preventable adverse drug event which increased hospital costs of $4,700 per admission. Bates, David W.; Spell, Nathan; Cullen, David J., et al. The Costs of Adverse Drug Events in Hospitalized Patients. JAMA . 277:307–311,1997.
In turns out that by using terminology I learned during surgery for timeout situations helped immensely with the situation and likely saved the patient’s life. The situation also reinforced for me that while that there is a hierarchy in medicine, medicine is team based and everyone’s knowledge and expertise should be valued. In the future I will not only speak up when I feel that I need to but also take other’s suggestions when I may not know all the information.