Looking Forward

Sunday, March 01, 2015 11:33 AM

Dissecting care through interactive discussions

by CMS and COPIC staff report

Most medical professionals are curious individuals who thrive on problem-solving and determining what is best for their patients. In the pursuit of answers, they understand the importance of established knowledge, but also recognize the need to consider situational factors. They enjoy opportunities to analyze past cases, discuss patient encounters, interact with experts and share their own experiences with others.

Interactive case review at this year’s Spring Conference

The Colorado Medical Society and COPIC have collaborated to develop one of these opportunities – an interactive case review session for the upcoming CMS Spring Conference, May 1-3 in Vail. Using fictitious medical liability cases that draw upon current medical trends and incidents, attendees are given facts and medical records beforehand to formulate their own opinions. The session starts with the cases being presented by defense attorneys, followed by interactive discussions in small groups that are facilitated by physician risk managers from COPIC. The small group discussions will focus on the cases in terms of appropriateness of care, medico-legal issues, patient behavior and other related aspects. This session also allows attendees the unique opportunity to interact with health law defense attorneys that partner with COPIC.

This type of case review received positive feedback from past participants because it allowed them to be actively engaged in the conversation and examine care from all angles – medical, legal and ethical. And while the review does follow a structured format, unplanned discussions often emerge and lead to interesting questions and innovative ideas.

Why are case reviews such an effective way of learning? They force us to apply our knowledge in new ways and often introduce opposing perspectives to solving a problem.

A 2011 Advances in Health Sciences Education article(1) highlighted how interactions between medical professionals with different experiences contribute to the ability to address problems that arise in diagnosing and treating patients. Per the article: “Consultation with knowledgeable colleagues is a powerful strategy to solve these problems. In these consultations, differences of opinion concerning patient care may also trigger further thinking and lead to substantiated changes in approach.”

Breaking barriers

The Spring Conference is built around the theme of “breaking down barriers to better patient care,” and one of its main goals is to develop ideas to address the critical issues facing physicians. The ideas that come out of the case review will serve as invaluable insight. The discussions will help attendees to examine their own concerns and provide further understanding of the challenges health care providers face.

The learning opportunity a case review provides has also been utilized by COPIC in its medical resident training program. In Patient Safety in Surgery(2), Alan Lembitz, MD, a contributing author and COPIC’s chief medical officer, outlines key factors used in the analysis of a medical liability claim:

• Origin of error
• Type of error
• Contributing factors (human, system, biologic and inherent)
• Preventability assessment and strategies

He points out that these factors are essential in the review process, but the most important discussion focuses on the effect on the provider and patient. It is vital that residents look at all elements of care, not just medical knowledge, as they prepare for their careers in medicine.

In his book, Complications: A Surgeon’s Notes on an Imperfect Science, Atul Gawande says: “We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line.” Gawande is right about medicine being an ever-evolving world; however, we do know that learning from past outcomes to improve future results is a foundation for better health care.

1 Adv in Health Sci Educ (2011) 16:81–95
2 Stahel P, Mauffrey C. Patient Safety in Surgery. 2014 Edition: Springer; c2014