Comment on Bob Wachter's "Letter From London"

Wachter's World is a somewhat irregularly posted, always thoughful, sometimes provocative blog that Bob Wachter, Chief of Hospital Medicine at UCSF maintains.Reading it is a great pleasure for me as Bob's posts elicit both reflection and responsive comment. I commonly wait until I can use my computer to read his posts, rather than read on my blackberry or iPad as I do with so many others. For me, the pleasure of consideration and reflection is enhanced by Bob's fine job of eliciting dialogue--which he clearly seeks to accomplish and engage. Writing a responsive comment on a Bob Wachter post brings me pleasure.

Unfortunately, for the last several months his site hasn't accepted my comments. Let me be clear, Bob does moderate comments to his site, but his site hasn't allowed me to enter a comment to the site for moderation. He and his technical team are aware of a problem and have been working on it. Given that I've tried three different browsers on two different Windows7 computers, I don't think it's on my end, yet it persists. Today, I wrote a comment evoked by Bob's recent post, Letter from London" and since I can't post on his site, I thought I'd post it here with this explanation. Though many fewer will see it here than if it had been part of his site's comments--the text below, somewhat satiatiates the urge to usefully comment on Bob's post.

Slightly more than two years ago @KentBottles and I had a conversation in multiple parts about trust and the physician relationship with patients and the public more generally. Somewhat later the June 2009 issue of HBR in Rethinking Trust provoked consideration of the question more broadly. Given the greater political malaise and active diminishing of trust through various political antics, including perhaps some of those mentioned by the commentator @Cory on Wachter's original post, it seems most useful to focus on the profession and local efforts at raising trust.

So I ask, "Is improving patient safety a good way to do that, Bob--raise trust between physicians/clinicians and patients?" For Bob's post tells us he is off to London for a sabbatical, June-December 2011.

Don't get me wrong, I'm in awe (and envious!) of Bob's planned sabbatical with Charles Vincent who I've followed since meeting at the AEMJ Sponsored Consensus Conference in 2000 and Vincent's subsequent published contribution.

Bob's blog posting as always looks to the substantive as does his planned sabbatical. Yet I wonder if that's enough. Today's NY Times Magazine in "The President and the Passions" makes the case:

 "The lesson to be drawn is that the art of politics must be the art of engaging the passions, first by exciting them, then by moderating and directing them to a worthy end, one that reason may reveal but cannot achieve."

 

So too do Solomon & Flores in Building Trust which @KentBottles introduced me to. They make the case that it's less what goes on in the exchange and more about how engaged, interested and compassionate the exchange with another is conducted.

Thus, if I were to submit my contribution to that decade past consensus conference AEMJ issue today, I think I'd likely add a fourth area of comment: communication, particularly the use of social media in expanding connections between providers and patients and thereby hopefully rebuilding trust among them.

It's not just the science we bring to bear and how we explain it; it's also how we show the patient that they are safe and their concerns and interests are valued.

A feature the decade younger me hadn't yet grasped.

Thank you, Bob, for sharing your thoughts and experiences through your blog postings and your encouragement of the subsequent commentary and dialogue. Oh, and I look forward to the correction of the technical difficulty that prevents me from commenting on your site.

"The problem with communication is the illusion it has occurred." --G.B. Shaw

Report to the Maimonides Board on Stepping Down as Chair of EM

Thank you for the opportunity to address you once again. Last September 2009 when I presented a status report on the Department of Emergency Medicine, little did I expect to find myself here again so soon.

15 years ago at a board meeting very much like this one you created a new Department of Emergency Medicine for Maimonides. I was fortunate to be selected as the Founding Chairman of that new department. I’d like to spend a few moments recounting a chronology of the department’s physical and program development and then share another aspect of the department’s development--one perhaps less apparent to you, yet a facet of the department’s development I hope you’ll come to view as significant as facilities and program.

The first step towards the construction of the Weinberg Emergency Department took place in May 1996 with the move of the Ambulance Department from a trailer on the corner of 49^th and Ft. Hamilton parking area to a garage on 39^th Street. Maimonides operated 6 tours daily in the NYC EMS System. At about the same time, the Department moved into its administrative home at 965 48^th St.

June 1997 brought the opening of the adult ED in the newly constructed Weinberg Emergency Department and the following month, residents from the Kings County/Downstate Emergency Medicine Residency began rotating with faculty in our ED.

March 1998 brought the opening of the Sephardic Friends Pediatric ED and the Bruce Birnbaum Administrative Suite where our department leadership was housed through 2001 until the Cardiac Cath lab expanded in 2002. In 2000 we had our own CT scanner installed in the suite on the main hallway.

In late 2000 we began developing an application for our own Emergency Medicine Residency, an application that was approved in 2002, leading to the graduation of our first class of EM residents in 2005. In February 2004, the MMC Ambulance department moved to its present location on 38th Street operating 12 (8ALS/4BLS) tours daily in the FDNY EMS System.

The Department initiated both a 3-year Pediatric Emergency Medicine Fellowship and a 1-year Emergency Ultrasound fellowship training program in 2008. Our sixth class of EM Residents graduates tomorrow evening.

As a capstone, the hospital opened the new ED in January 2009 and installed a 64-detector/dual-source CT scanner in August of 2009.

I’d like to turn to the other development that I mentioned earlier. Over the past 15 years the staff of the Department of Emergency Medicine have truly incorporated the many communities we serve as partners in improvement and incorporated improvement into the daily work of patient care.

The staff of the department, whose roles as clinician, technician, administrative and operational support are centered on individual patient care, have also incorporated into their core work improving how patient care is delivered at the bedside. Particularly in this latter role, the hospital’s community partners have been invaluable for their ready advice. Partnering with community representatives hasn’t always been easy and neither we nor our community partners have always gotten it right in our initial efforts, yet much of the improvements accomplished can be attributed to the interdisciplinary team in the department of EM and to effective collaboration with the community and its representatives.

I’ve experienced a thrilling and challenging 15 years.  As your steward for the department of emergency medicine I’ve done my utmost to fulfill your vision for program development supported by the facilities and resources you’ve invested. I trust you can equally value the extant culture of the department of EM which fully engages the necessity of continuous improvement in caring for patients as a fundamental element of daily work. The creation and existence of this culture is a source of considerable satisfaction to me.