Doctor and Patient: Two Views on Patient Safety

Blog - Doctor and Patient: Two Views on Patient Safety

What happens when a nurse and healthcare safety advocate crosses paths with a patient-centered doctor while on the opposite side of care? Mary Fey, PhD, RN, CHSE-A, ANEF, Associate Director of the Simulation Educator Training Program at the Center for Medical Simulation, put her “speaking up” skills to the test as a patient rather than caregiver when she met with fellow patient safety advocate, Dr. Walter Hembree.  

Mary Fey: “Routine” surgery…having worked in the area of patient safety for years, I knew there was no such thing…  I decided to have an elective surgery to fix a longstanding problem that had become untenable.  I saw 2 surgeons.  How do you know which to choose?  It’s the one who listens – with curiosity and respect.  Walter Hembree, from Medstar Union Memorial Hospital in Baltimore, MD.   

Dr. Walter Hembree: Mary visited the MedStar Orthopaedic Institute with a painful condition that was limiting her athletic pursuits.  She had attempted nonoperative management for many months, with limited relief, and was interested in discussing surgery.  I was her second opinion.  After listening to her complaints and examining her foot, we discussed a couple of options available to correct the deformity…from the simple to the more complex…and the pros and cons of each.  She wanted to take some time to reflect on our discussion and said she would contact my office when she was ready to proceed.   

A week or two later Mary called and said she was ready to schedule, but that she had some other questions.  I spoke with her by phone and again reviewed the planned surgery including a standard discussion of risks, benefits, and alternatives. I knew Mary was a nurse and worked in patient safety.  

Mary: We had the usual pre-operative discussion of procedures, concerns, Q & A.  Then the talk turned to patient safety.  He listened as I described research on leader inclusiveness in creating a psychologically safe space in the OR.  He saw the connection between that and keeping patients safer.  He hoped, believed, that this was the type of OR environment he created.  I bet he does a better job than most… 

Dr. Hembree: I reassured her that at MedStar we follow standard safety protocols.  These include, among other things, obtaining informed consent, marking the correct extremity, and performing multiple time outs.  However, as our conversation progressed, I could sense that she wanted more detail.  She asked about the “culture” in my operating room.   Does everyone introduce themselves at the beginning of the procedure?  How do I communicate with the staff?  How do I communicate with the anesthesia team?  Do people feel comfortable speaking up in my OR?  In the event of an emergency, who will be in charge? 

Mary: I gave some examples of wording:  “I’m going to be the team leader, but I need you all to help me – if you see anything you’re concerned about, please let me know right away”.  He didn’t think he was quite this explicit about it.  As we talked, he suggested that we partner, and do it together.  I knew then I had chosen the right surgeon.   

Dr. Hembree: Wow!  While it is not unusual for patients to advocate for themselves, Mary’s background created for a unique line of questioning.  The themes were clear – communicate and know your role in the event of an emergency.  While I’ve always considered myself to have an “open” OR where anyone should feel comfortable speaking up, I realized that I could always do more.   After all, every day is a learning opportunity in medicine.  I suggested to Mary that we work together on her surgery day to ensure that all safety protocols are followed, that everyone on the surgical team communicates effectively, and that there is a clear, predetermined MD in charge in the event of an emergency.  She agreed.   

Mary: I arrived in the OR, got on the table, and Dr. Hembree came into the room & stood next to me.  By then, I knew everyone’s name.  Dr. Hembree said, “Are you ready?”.  And I said: “So, Tom, Cindy, Maria, Melanie – I know that you’re all smart, capable, people who care deeply about your work.  I trust you.  I also want you to know that Dr. Hembree and I have talked about patient safety, and there’s something we want to ask you:  if you see anything that you think is unusual, or that you’re concerned about, please speak up right away, even if you’re not sure – the doctors want to know.”  Dr. Hembree agreed “I’m on board with what Ms. Fey is saying.  Please speak up right away – I want to know”.  We then decided we were ready to go….my wonderful OR nurse said, “You can just relax and be a patient now, we’ve got you”.  

Dr. Hembree: On the day of her procedure everything went as planned.  In addition to complying with the standard safety protocols, the team went above and beyond to communicate, know each other by name, and establish a physician leader in the event of an emergency – in this case, the attending anesthesiologist.  Watching Mary advocate for herself before she was put to sleep was admirable.  Not all patients have the courage or educational background to do this, but as practitioners, we should always strive to be as safe as possible during each and every procedure, no matter who the patient is.  Communication is key in this regard.  I learned a lot from Mary and I am glad her surgery was a pleasant experience…and a safe one! 

Editor’s Note: Dr. Hembree has provided his perspective at the request of Mary Fey, and has permission to publish this information in other venues.