Darren B. Taichman, MD, PhD
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From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University.
Assign each of your team members to quietly observe the activities of staff going in and out of patients' rooms for 10 minutes. Did everyone cleanse going in and out of the room?
Invite a member of your hospital's infection control team to discuss how they monitor hand hygiene practices and what they do to try to improve them.
What are the reasons health care professionals continually fail to cleanse 100% of the time? Why is the excuse, “I did not touch anything in the room” not acceptable? Even if true, might it not help to promote thinking that it is acceptable to enter or leave a patient's room without cleansing? How would someone else, particularly someone who looks up to you, know you “did not touch anything”?
The authors suggest practicing “mindfulness” as a team and engaging patients in hand hygiene as a means to improve practices. Try it with your team.
Should we be punished—substantially—if we are caught failing to cleanse our hands? If not, why not? Can we reasonably argue that we didn't know it was hazardous to our patients? Would we permit the routine insertion of central lines without appropriate attention to cleanliness, such as gowning?
Ask each member of your team to think about a patient he or she has cared for who has contracted a nosocomial infection. Might he or she individually be responsible for the harm caused to this patient?
Ask your learners what challenges are encountered in the care of patients with obesity specifically. Encourage your learners to think beyond direct health risks, such as diabetes and hypertension. What about challenges in providing care?
Do we use obesity as an “excuse” (even subconsciously) not to thoroughly examine some patients? Is it possible that at times we treat patients with obesity with less concern or less compassion?
What do your learners think might be the potential explanations for the relative underuse of hospice services among patients with obesity? The authors provide a few potential explanations in the paper's discussion. They note that “there is an established record of negative provider attitudes and implicit bias against obese persons, and these attitudes may continue to influence care for obese persons at the end of life.” Do your learners agree?
What do your learners suggest be done about the problem identified in this study? How can they act in their own practices?
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners whether they think they do a good job screening for and managing hypertension in their outpatients. How do they know? Is there a system in place within your practice to alert clinicians of the need to evaluate blood pressure? Does it work? Do your learners pay attention to it?
What are your learners' targets for blood pressure? Do they vary according to patient variables? Which ones?
How do your learners choose pharmacologic therapy for their patients with hypertension? Use the table in In the Clinic: Hypertension to help review.
Do your learners base their diagnoses and monitoring of hypertension management on measures made in the office? Should they pursue ambulatory monitoring? How would they do so?
Listen to an audio recording of the essay, read by Dr. Michael LaCombe.
Ask your learners if they recall patients who enjoyed being their “guinea pigs” so they could learn to be doctors. Did your learners ever thank their patients for this gift?
Do your learners think serving as “guinea pigs” and assisting medical students and residents to learn helps the patient in some way as well? How?
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Taichman DB. Annals for Educators - 21 March 2017. Ann Intern Med. 2017;166:ED6. doi: https://doi.org/10.7326/AFED201703210
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Published: Ann Intern Med. 2017;166(6):ED6.
Cardiology, Coronary Risk Factors, Hospital Medicine, Hypertension, Nephrology.
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