We are preparing the first OSCE for our first cohort of Physician Associates (https://www.bangor.ac.uk/courses/postgraduate/physician-associate-studies-pgdip). Over the last few months they have had placements in a number of departments of the hospital to learn about disease, diagnosis, clinical examination, risk assessments, physiology etc. Today is their exam: They are understandably nervous. Some of our patients have agreed to assist. They are being examined and a mock-up of their hospital file by their side.
I am working with a patient who is my age but has a chronic respiratory condition. While I am preparing his charts he tells me: “This morning I had only two points on the National Early Warning Score (https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news)! A low temperature gave me one point. My respiratory rate is usually 22, that is two points. The pulse is 80 to 90, that is zero points. My blood pressure this morning was 112/56 mmHg, zero points, the Saturations 94%, one point.” He is obviously interested in his health. He observes the staff, the other patients and himself. He find its odd how we score vital signs. ‘This is the only game you don’t want to score in!’
Yesterday afternoon I spent a few hours in Manchester at the Health-Service Journal’s Patient Safety Congress (https://patientsafetycongress.co.uk/speakers/professor-sir-liam-donaldson). I am meeting with other enthusiasts, visiting the amazing crew from 1000Lives (http://www.1000livesplus.wales.nhs.uk/rrails) and their twitterati, finding colleagues who I had not spoken to for a while. I listen to new ideas and learn about amazing new technology. And observe how professionals from different fields of work are trying to improve safety in healthcare and influence behaviour of those who work in it.
Professor Liam Donaldson holds the keynote ‘James Reason’ lecture. He tells us about the horrible accidents in healthcare that he witnessed and how he has tried to shape the National Health Service in 2000 into ‘An Organisation with a Memory’ (http://patientsafety.health.org.uk/resources/organisation-memory) during his time as Chief Medical Officer. To have a memory would seem a good start, if we want to avoid making the same mistakes repeatedly. This is already part of the culture of my colleagues at RAF Valley (https://www.raf.mod.uk/rafvalley/), where sharing of problems is one way to keep your fellow pilots alive and well. One of the problems that is often overlooked is that memories are not reliable. We shape and colour them depending on our mood and previous experiences. One of the strongest drivers for this distortion that hinders learning from experience is confirmation bias. Once we have learnt something we are tempted to use it to explain everything around us (http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2005.07.028/epdf). In order to over come confirmation bias more than memories are required. Behaviour changes only rarely, and if it does it might be modelled on our heroes or by highly emotional experiences. While most health care professionals that I work with are passionate about their job empathy and emotional learning might reduce as people are working their way up to influential positions in their organisations.
It has been an interesting month for patient held records. I am so excited that NHS Wales will start using PatientKnowsBest (https://www.patientsknowbest.com/) as a platform for patients to take part in the recording of their condition: Initially in a small number of settings but with real potential. And OpenNote has been signed by yet another large US health care system to make physician files accessible to their patients bringing the number of their users to over 15 Million (https://www.opennotes.org/). Waow – that is nearly 5 times the population of Wales!
So there is a lot of NEWS about and more and more in patients’ hands! It remains to be seen whether their memory will be better than that of their healthcare professionals! Or maybe they will run into similar problems with their cognitive bias?
I am interested to understand how confirmation bias might affect patients if they hold their records?