Episode 302: Disclosing Adverse Events with David Broussard
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Hello, and welcome back to ACRAC. I'm Jed Wolpaw, and I'm really excited to have with me today Dr. David Broussard, who is the Chair of Anesthesiology at Ochsner Medical Center in New Orleans. He's also a cardiac anesthesiologist, and he has been appointed by the governor to the Patient Compensation Oversight Board for the state of Louisiana. We're going to hear about that, what it means, but we're really... Where this came from, in addition to the fact that I really admire David in general, is that

He came and gave a great Grand Rounds talk for us, and he talked about disclosing adverse events to patients and families, how important that is, how important it is to do it well. This is something he teaches and talks about. I thought it was a fabulous talk and something that people really need to know about anybody involved in medical care. And so I asked him if he'd come on, and I was thrilled when he agreed to do it. So, David, welcome to the show.

- Oh yeah, Jed, thank you so much. Excited to be here with you today. And this is a topic that I'm passionate about and excited to share with a larger audience.

In my role as chair, I noticed early on that especially some of our newer physicians weren't comfortable with these conversations. And unfortunately they occasionally have serious complications even early in their careers. And it could be a very disruptive thing. On a couple of occasions, I saw people start to kind of lose confidence even in their choice of specialties.

And so don't want to see that happen. In some cases, it was even disruptive to their personal lives. And so I want to give every anesthesiologist the tools they need to effectively have these conversations. Can walk away from even serious complications, feeling they had a positive experience of care, still respecting you as a professional, and still trusting in the health care system. And most importantly, they recover well and better from the complication because of it.

I've seen, too, where people have a – which we all will have. We all will have complications. We all will have adverse events just part of being a doctor. And I've seen, too, where people just really get destroyed by it. So I think it's so important to have insight into how to do this well and in a way that hopefully doesn't cause further harm with a provider becoming a second victim.

Let's start by just talking a little bit about your career. You obviously have a lot of pieces to it. You're the chair of a department. You're a practicing anesthesiologist. You have this patient compensation oversight board role. Talk a little bit about each of those and kind of what your day-to-day looks like.

Yeah. So, you know, I still love cardiac anesthesia and I carry a 50% clinical load, still cover nights, holidays, and weekends. I really enjoy doing the cases. You know, I think having that ability to kind of collaborate with high quality surgeons and proceduralists still gets me really excited to come to work every single day.

In my role as chair, one of my favorite things is onboarding physicians to the department. We have a very well thought out process. We go through a lot of things, philosophical topics, as well as all of our kind of protocols and processes in the department. And this is a very important thing that we share with all members as they join our department.

The Patient Compensation Fund Oversight Board, I got appointed by the governor in 2021. I have learned a lot through that process. And I think that role, in addition to previous role as an advocate in the legislature, as part of other professional societies, for example, defending the malpractice cap in the state of Louisiana, you know, are things that kind of inform my passion for this topic.

Fabulous. Well, you're certainly well qualified and excited for you to be able to share what I learned from you with other folks. So let's start with how it sounds like a part of it was with some of your prior work. But was this something that came out of your own experience or where did you decide to say, OK, I really want to kind of pursue this topic and learn more about it?

Yeah, Jed, so there were a few like aha moments along the way that were really important. You know, the first one was that I noticed that kind of the degree of upset in this, if you will, by both the patient and the surgeon and really everyone was.

didn't seem to correlate with the injury at all. So I would see patients that literally had a chipped fingernail and they were just beet red, angry, coming after someone ready to burn down the building. And then other times where a patient would experience a very serious complication and they were surprisingly forgiving about it. So I came to realize that it wasn't really the substance of the medical care

it's not the personalities of the patient or the family, although a lot of times there's a tendency to try to like attribute it to that. It's more, it's the communication around the complication that plays a huge role in the amount of upsetness that ends up occurring with these just in general. And then I would say the other big aha moment is just

kind of acknowledging that as a specialty, we really have a disadvantage compared to other disciplines with regard to when these complications happen. So, you know, if you think about it, when a surgeon has a complication with a patient in the OR,

they've had, you know, often four or five contact points with the patient along the way. Okay. So for example, you know, maybe the patient's primary care physician referred them to the surgeon and then the process said, you know, Hey, I've got this great surgeon. I'm going to send you to, she's really good with patients. I send a lot of my patients to her. You're going to have a great result. So they've already got like a reputational tailwind, right? And then they see the patient in clinic a couple of times, maybe, you know, before

the surgery. They see them on the morning of surgery. So by the time they have a complication in the OR, they've already established a longitudinal relationship. Whereas our relationships are

or almost exclusively ad hoc, right? We meet them on the day of the surgery. And so we need, you know, as a profession to have like some specific strategies to kind of overcome those challenges, if you will. And those are definitely part of the process. Yeah, I think that's such a great contrast between the longitudinal relationship that the surgeons have and the very much not longitudinal relationship that we often have. It's

It is, you know, makes me think about just kind of if someone, you know, your neighbor who you know well, you know, backs their car out and bumps your, you know, your garbage can or something, right? You're like, whatever, not a big deal. I know you. I know it was an accident. If it's some random guy driving down the street, you might be a lot angrier. So relationships matter in so many ways.

So, okay, so you developed this interest, you kind of had these thoughts throughout, you know, your time practicing anesthesia. And then did you, you know, I want you to tell us about the kind of approach you take and the approach you teach. But is that something you developed just from practice, kind of trial and error? Is it something that you, you know, read about research and kind of put together from evidence? You know, how did your approach evolve?

Yeah, it's largely experience and observation based. And I'll kind of mention where some of the tidbits come along the way, if that's okay. And a lot of it starts in the pre-anesthesia evaluation. So, you know, the way I describe it is you want to construct an experience of the sensation of caring for the patient. And so, you know, the way I explain it is that

You know, one of the advantages maybe I had in this process is that my father is a personal injury attorney. And, you know, while he doesn't do very much medical malpractice, he told me a long time ago that, you know, when they were meeting with the family to kind of decide like who they were going to sue, there would be a list of names of doctors and nurses. And inevitably, they'd come to a certain name, let's say Dr. Smith.

And one of the family members, whether it was the son or the daughter or whomever, would say, you know, oh, no, there's no way we can sue Dr. Smith. You know, she cared too much about mom. And so, you know, one of the important things you're trying to do in that pre-anesthesia evaluation is demonstrate that you care about them in an authentic way. And if you can do that, that's worth a lot in this process. So I've developed a number of techniques to try to help that happen.

The first one is to narrate your preparation for their case specifically. And that's not something that was natural at all to me, I'll tell you. But, you know, the way I kind of describe it is like in the post-Scrubs television show era, it's not necessarily a given that you've done your homework and you've prepared for their case specifically.

And so, you know, you have to kind of narrate that for them. So I'll walk in the room, you know, to the patient and say, you know, hey, Ms. Smith, I've been studying about you in a computer. I saw that, you know, five years ago you had a stroke. I saw that six months ago you had a similar surgical procedure. So just kind of revealing a couple little nuggets from their history demonstrates to them in a very real way that you're a committed professional, that you've prepared specifically for their case today

And that's a powerful thing. The second

technique that I recommend in the pre-anesthesia evaluation, and you can't do this one for every single case, but it's something I call manufacturing a second visit. So, you know, many of us have experienced this to a degree just normally in our practice. So let's say there's a patient who's very nervous on that, you know, pre-procedure area, and the nurse sometimes calls and like asks you to order some Versed. So, you know, you go evaluate the patient, you order the Versed. So,

That's one level of caring. But if you then come back 10 minutes later and check on them and say, hey, Mr. Smith, did the nurse give you that relaxin medicine yet? Is it working or not? If it's not, I can order you some more. And from our perspectives, Jed, that can be a very subtle thing, right? I mean, we ordered the Versed anyway, and maybe they don't even need any more. But

But from the perspective of the patient, by, again, kind of generating or manufacturing that second visit, you've demonstrated a whole other level of caring about them as an individual. And I think that's a very powerful thing. Another common example I'll see is like,

you know, with certain types of cases, like maybe in our interventional radiology suite, I often don't know when I'm first seeing the patient, you know, whether they're going to end up with an endotracheal tube or not. I'm just, they have so many different procedures and they're all a little different, right? And so I'll explain both processes to the patient, what we call a natural airway general without a breathing tube, as well as the endotracheal tube. And I'll tell them, you know, hey, look, I don't really know which one is going to be the right one for you today. I'm going to go talk to your radiologist

And then I'll come back and tell you kind of the final decision. But the paperwork's the same. So I'll go through the consent with them and then I'll go talk to the radiologist and then I'll come back 10, 15 minutes later and update the patient. And look, you know, I can spin it as a positive either way. So I might say, you know, hey, good news. Your procedure is really not invasive at all. So you don't even need the breathing tube. So we're just going to keep you asleep with medicine and the IV or vice versa, you know.

I talked to the radiologist, he said, "You definitely need the breathing tube." So the good news is you're gonna be totally asleep the whole time. So I can spend either one as a positive, but again,

Like sort of, you know, making that commitment to get additional information and then circling back 10 minutes later to kind of update them on the final anesthetic plan. Manufacturing that second visit, you're almost like creating that longitudinal relationship within a single patient encounter that kind of simulates what that advantage may be that the surgeon had.

Yeah, I love that. And it seems like it's such a great way to also just kind of show that you care. I mean, I remember when I had a procedure and, you know, obviously I'm an insider, but even so, I'm sitting there in pre-op and you have no idea what's going on. You know, like it seems like it's taken a long time. No.

And nobody comes to say to you, like, here's where we are in the process, right? It's probably going to be another half hour, 45 minutes, or it's almost ready, or it's going to be a while. I'm really sorry. You know, it's kind of like I think of it as when you're at a restaurant and you've ordered your food and it's not coming. And, you know, if the waiter comes over and says, I am so sorry, you know, they're backed up in the kitchen. Here's some bread. You know, we'll get it out to you as soon as I can. Yeah.

even if it takes a long time, at least you're like, oh, well, I got it. It's not a big deal. I understand what's going on. But if nobody comes and you're just like, I don't know what's happening, the frustration builds and builds. So it seems to me like even for whatever reason, just coming by, giving an update, you know, here's what's going on can make a big difference and make people feel like you care. That's exactly right, Jed. And I'm glad you brought that up. I should have mentioned this myself. So

I remember years ago, they had us do like a self-reflection exercise about patient experience. And it was a guided thing. But ultimately, that's what I stumbled into is that when you get upset, it's when you think that these people don't care. You know, you can have a substantively bad experience.

And as long as you think they care and they're doing the best, you know, your example is one that I use. The other one I'll use is a ride in a taxi cab, right? So, you know, you're stuck in traffic. You're going to be late where you're going. As long as you think that cab driver is like doing his best and hustling and, you know, trying everything he can to get you there on time,

you're generally okay with it. It's when they give some flippant answer and demonstrate that they don't care, that's when you get mad. And so constructing that experience of caring is super important in this process, which kind of brings me to the last technique that I recommend, which is figuring out what matters most to the patient. So with experience, I can tell you, Jed, that almost every patient, when they're going into surgery, they're worried about one or two things, okay?

And if you can get really good at figuring out what that is,

delivering on that concern. And then most importantly, and you have to apply intention to this process is circling back with them later in the recovery room or the next day on the floor. First of all, remind them of that thing that they were worried about. And I can tell you just that they feel very special. They're gonna light up, they're excited that anyone, much less the doctor kind of remembers what they were worried about. But then you can take the opportunity to kind of narrate for them how you shepherded that issue to success.

That's an incredibly gratifying interaction and demonstrates that you care about them as an individual and their specific concerns. And that's worth bold, you know, and believe it or not, on some of those patients, you'll have a complication. And so when you've done that other thing, it's going to be really helpful.

Yeah. Yeah. It makes a ton of sense. Again, just going to this narrative of how can we demonstrate that we care when we have the disadvantage of not seeing someone over time to show that we care, right? And so this, these are little ways within a short period of time that you can do it. Do you try to always see your patients post-op so that you can do this and just in general to kind of see how they're doing? Absolutely. It's,

- You know, a lot of times, so I was doing residency interviews earlier this morning, Jed, and a lot of times when like a med student or a resident talks about interacting with patients, they tend to focus on that pre-anesthesia evaluation, right?

you know, meeting patients in their most vulnerable moments, gaining their trust quickly. You know, those are real, and I'm not taking away from those, but I can say with experience that the most gratifying interactions with patients can and I believe should happen in the post-anesthesia phase of care. That helps us out. It'll help, you know, keep you motivated through, you know, long weeks and decades of a career kind of thing. But I've got a great example that I think nicely demonstrates both

kind of the manufacturing a second visit as well as figuring out what matters most to a patient.

You know, I don't know about you all, but when we're staffing our outside areas, for example, our concurrency ratios tend to be a bit higher. So we generally don't have residents in those rooms. So we've developed what we call an outside area rotation for our residents where they're kind of buddy up with a staff and follow us around these outside areas and learn the unique considerations, you know, of these different areas. Like, for example, the EP lab and the endoscopy lab and other things. Yeah.

And so this was a few months ago. I'm with one of our residents on his outside area rotation. And we had a little downtime between, you know, seeing patients. And so I was giving him actually this talk on communication around complications and kind of some patient experience concepts.

And my phone rings and we get called to go pre-op the next patient. So we go up there and it's a 70-something-year-old patient and his wife, the man is having a defibrillator placed that day.

And they're both very, like, healthy-appearing, kind of 70-something-year-olds, obviously very intelligent and high-functioning. And, you know, in the course of our interaction with the pre-evaluation, stumbled into the fact that they were entrepreneurs in the oil business, very successful couple, owned some businesses. And actually, I have a brother-in-law who's a high-up executive in the oil industry. So we kind of had this personal connection around that.

But, you know, when I'm done with my evaluation and talk, you know, we have digital consents on the iPad. So as I often do, try to make a point of contact with the family member. I hand the iPad to the patient. And while he's kind of putting a signature on it, I turn to his wife and I said, hey, you know, you seem like you have fallen along pretty close. Did everything I said make sense to you? Do you have any questions for me?

And she said, oh, just one, Dr. Broussard, can I have a copy of the consent? And then a light bulb went off. I was like, okay, like this is the thing, like this is what matters most to her for whatever reason. So I said, oh yeah, I'll get that for you. So I step out of the room and I looked at my resident. I said, hey, did you see that? And he's like, what are you talking about? I said, the consent, like that's what matters most. Okay, like let me show you.

So I walk over to the nearest printer. It kind of takes me a few minutes because we don't often use the paper consents anymore. And I print out a paper consent, staple it together,

walked back in the room and hand it to her. And I kind of go through it with her. I said, look, you know, here's the consent form here. It describes the different types of anesthesia that's possible. This is what your husband having. Here's the different complications. We talked about the main one I'm worried about for him. That's described here. You know, here's your copy. Do you have any questions? And, you know, when I handed it to her, she said, oh,

Dr. Broussard, she said, thank you so much. She said, I really appreciate this. I feel so much better now knowing that you're taking care of him. And so, you know, I'm not saying that to be trying to brag or something. I'm just making the point that like when I was able to figure out what mattered to her and deliver on that, that's a very powerful connection and is worth a lot in this process.

Yeah, that and what I love about that is that I think a lot of people would have probably kind of filed that in the back of their mind, like, OK, she wants to consent, like maybe I'll ask the nurse to do it or right. Like I got other things to do and would have thought of this is not that important. But what you're saying is that these little things often are what establish you as a trustworthy, caring individual. And that is really important.

The point is that sometimes these things that matter most will be very medically germane, you know, so a very common one is like they've had nausea before and they're worried about the nausea. OK, but then other times they'll be a little more kind of tangential. And I'll admit I'm embarrassed to say this, but, you know, 15, 20 years ago, we used to be kind of cynical about some of those things and be like, oh, that's weird.

You know, now I appreciate that. That's a gift when they reveal that to you, because that's usually pretty easy to deliver on and is a very powerful connection and can be some of your most gratifying patient interactions. Yeah. Now, let's say that, you know, they don't bring something up like that. Do you ask? Do you ever say like, you know, is there something that you really want me to pay attention to or something really important? Like, how do you elicit it if they don't make it quite as obvious as that patient did?

No, I do. So at the end of the consent conversation, I'll pause if they haven't brought anything up or I haven't been able to decipher any kind of special concerns. And I'll just say, you know, hey, any other special concerns or things that you want me to focus on while we're taking care of you today?

And sometimes that works. You know, they'll say, oh, my shoulder, you know, I had surgery two weeks ago and I'm really worried about, you know, so like sometimes that will. And then other times they'll say, no, really nothing. But you can tell by the look on their face that they appreciate that. Like it can be a transformative statement, even in of itself, that demonstrates how much you care about them as an individual. I found that to be pretty powerful.

Yeah, yeah. So I'm imagining the difference between even just saying, all right, and kind of as you're walking out, like, if you have any questions, let me know, right? As opposed to kind of making eye contact, making it feel like you have nowhere else to be and saying, you know, is there anything I can do? Is there any special concerns, anything you want me? Right? Those two things are very different and convey a very different message. Stay with us. We'll be right back.

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maybe what we'll call prophylaxis. So these are things that if you do, they establish a relationship where, you know, to the extent that we can, that may help if something bad happens, that instead of them saying, well, you know, I'm going to sue that anesthesiologist, that they maybe feel like, listen, this is someone I trusted and I still trust. And, you know, but that's only part of it because...

Because if something bad happens now, the question is, how do you handle it in a way that both helps the patient to work through that and hopefully makes it a not terrible experience for you as the provider? Yep. So the first one is to try your best to lead on the communication, Jed. So and unfortunately, again, that's not always possible. You know, sometimes you're dealing with the complication in the operating room. Sometimes you're extubating the patient next door. Right. And the surgeon kind of just steps out and goes to tell the family about it.

And I think this is what used to happen sometimes with those younger staff in our department is they would, you know, they'd be tied up for a few extra minutes. The surgeon goes tell the family about it and then they pass the surgeon in the hallway. This is what I call, I've come to call the trap because the surgeon says, oh no, I already told them about it. It's good. Okay. And I can tell you that, you know, even the most intelligent, well-intended surgeon, you

probably threw you under the bus just a little bit. I mean, even if they didn't intend to, okay? Just the bottom line is no one can explain our business as well as we can. So you want to try your best to lead on the communication around the complication. But even if you can't be there for that first mention by the surgeon, you need to circle back quickly thereafter and go over it with the family from your perspective. Make sure the

that relatively early in the process, they were exposed to the proper kind of description of what occurred. And that's not natural. Like people are gonna try to talk themselves out of it. So especially when the surgeon told them, oh no, it's good, they're gonna start to second guess themselves. They'll say, oh, I don't know what to say. I'm not good at these conversations. I might make it worse. Like the surgeon said, it's good. I might make it bad. But you really cannot talk yourself out of it. You've got to go back

So one of the points I like to make to try to help convince people to go do it is that, you know, even if the surgeon explained it nearly perfect, the bottom line is if it was a serious complication, they were probably so shell shocked they didn't hear half of it anyway. So they need it to be repeated. And the other thing is you want to establish a point of contact with them so they don't feel abandoned. And so that's very important to try your best to lead on the communication process.

And like I said, even if you can't be there the first time, you need to follow up very soon thereafter.

Yeah, I mean, it's so tempting, right, not to do it because, A, it's scary, right? You're afraid they're going to be angry or they're going to ask you questions you don't know the answer to. And so it's so easy if the surgeon says, I've done it or I will do it, to be like, great, then I don't have to. But clearly, as you've said, and I agree, you know, we are then putting our whole situation in someone else's hands. We have no idea what the surgeon is going to say or how that will be interpreted.

So really important. So, okay. So you want to make sure you talk to the patient or family. And so-

Then let's say when you're actually having the conversation, you know, kind of what is the template? And so we worked hard to develop a template that could basically be applied to nearly any complication. And so, you know, the first point I should mention, though, is that you want to have what I would call optimal transparency. So, you know, there's such a thing as too much information, but at the same time, you know, if push comes to shove legally, nearly everything's going to come out. And so you want to err on the side of disclosure.

But as far as like the basic structure of the conversation, the way I describe it is you want to describe your awareness of the complication as a possibility, what you did to try to prevent it from happening in the first place.

But then, unfortunately, it still happened. Mention the things you did to maybe mitigate the consequences for the patient. So that's just a basic structure to the conversation that can be applied to just nearly any complication. The other kind of template aspect is

you know, sort of disclosing what we know now, what we think we're going to figure out in the near future. And then here's some other things we may never know the answer to. And that structure to the conversation sets the stage for follow-up visits, which is a super important kind of third aspect to this. We'll get into a moment, but

That's the basic conversation. And then, you know, at the end of that initial conversation with the family, Jed, it's super important to establish a point of contact when when patients and families seek what's called a legal remedy or basically like try to file a lawsuit.

it's often because they feel abandoned. Okay. So you cannot let that happen. So a lot of times what I'll do at the end of that first day is I'll give my cell phone number to the nurse at the bedside. Okay. And I'll tell the family, Hey, you know, if you think of other questions later,

or if other family members show up that want me to explain it to them again, have your nurse call me. She has my cell phone. Call me and I'm happy to go over it with them or answer any questions you come up with. And I can tell you in many years of doing this, Jed, no one's ever called. But maintaining that point of contact lets them know that you have not abandoned them, that you're still in it with them, that you're going to be an ongoing presence in this process and I think is worth a lot. And

And then, you know, the third big aspect, and then I'll give another kind of clinical example, is what I call establishing a rhythm of follow-up. So this is not a one-and-done process. You know, if the patient gets admitted to the hospital, you want to go see them every single day, basically. And, again, this is something where you're going to try to talk yourself out of it. After the second or third day, like, you might be thinking, oh, you know, I've already –

answer all their questions. That's going to seem weird if I go back or like they seemed happy yesterday. If I say something slightly wrong today, I might make it worse again or something like that. So you're going to try to talk yourself out of it. You really should not. I mean, basically you want to go see them pretty much every day unless the issue is just like entirely resolved. But for the most part, that's the better thing to do. And again, like

as a talking point to help convince people to do this, one of the ideas is that you're kind of keeping the record straight. So when a patient gets admitted, especially after a complication, little bits of misinformation are going to pop up from time to time if they're in the hospital several days. And unfortunately, sometimes it'll be just like grossly erroneous stories that some

you know, maybe a surgery resident just concocted in their mind that's just totally disconnected from the truth. And so you going back to follow up, visit them in the hospital each day as your opportunity to keep the record straight. And I've had that happen where a patient or family like, oh, I heard that such and such happened. I was like, you know, no, remember what we talked about yesterday? I was there when it happened. This is what went down. And, you know, kind of go through the whole explanation with them again.

Because if a surgery resident kind of concocts this like cute story, then unfortunately the nurses hear them tell that story and then the night nurse repeats it to the morning nurse who then repeats it to the next night nurse. And then next thing you know, that story takes on a life of its own. So you need to be kind of managing that information a little bit tightly going forward when the patient gets admitted.

And that's another good reason to follow up and see them every day when they're in the hospital. Same thing applies if they get sent home. So, you know, I'll typically call them several days in a row following a significant complication, making sure that they're okay until it's like basically totally resolved.

And so the same kind of principle applies to outpatients as well. And when you do those follow-up visits, it's an opportunity also to kind of follow up on the template aspects of, remember how we said like, you know, here's what we know now, here's some things we'll figure out because

Oftentimes, you know, maybe a chest X-ray comes back or some lab result. And so you can tell them, hey, you remember when we talked yesterday right after the complication, I said that we didn't know this yet. And so in the meantime, here's some results that have come back. And so you can kind of, you know, fill in the gaps from that initial conversation, which again, you know, prevents them from feeling abandoned, lets them know you're still in it with them. And so that gets me to another example, if I can. Yeah, please. Yeah.

This was in the EP lab, and it's a teenage patient who was having some kind of like ablation procedure, and it was supposed to be really quick. It was supposed to be like a 45-minute case, and for various reasons ended up being about a five-hour procedure.

And, you know, I think, you know, I'll take some ownership of it, but our team that day, we didn't really appreciate kind of the transformative change in the duration of the surgery. And this is what we call a natural airway general case where, you know, especially on a really quick one, we don't get as focused on the eye care maybe. And, you know, unfortunately, this teenager woke up in the PACU with

pretty significant bilateral corneal abrasions and his eyes were just like beet red angry and uncomfortable. And so the family was understandably upset based on kind of the appearance of their teenage son. And so, you know, I explained to them, you know, I brought them back over to the bedside with me, explained to them exactly what happened, you know, hey,

you know, this is something that can happen from time to time with patients with longer cases. We typically lubricate and tape their eyes. We weren't expecting this to be a long one. Unfortunately, it ended up being a little bit longer. You know, we tried our best to prevent it, but unfortunately, we fell short and

And so, you know, likely his eyes dried out and functionally have what we call like basically a corneal abrasion. And, you know, we're going to know that that's definitely what it is when I put these eye drops. And so I went over to the Pixis machine myself, got out the fluorescein eye drops and

And I had the parents just watch me put these drops in their son's eyes. And I said, look, if I put these in and he gets better, then that confirms our diagnosis. And sure enough, two drops in each eye and the kid immediately, oh, my God, it's gone. Thank you. I'm so much, you know, it's fixed.

And but even with that, I'll tell you, Jed, I could tell that the patient, the family, they weren't comfortable, you know, because they were supposed to be going home. And and I think from their perspective, they thought like his vision was in danger or something. And this is on a Friday afternoon. And so, you know, I don't know about you, but like our ophthalmology department, we have an algorithm that we always follow for corneal abrasions and basically, you know,

It rarely involves them coming to see the patient at the bedside because it's pretty clear what it is and they're low risk, obviously. So that makes sense. But in this case, they were going home and I could tell the parents still weren't comfortable, despite my reassurance that, you know, if the eye drops work, that we confirm the diagnosis. I could tell they didn't really trust that an anesthesiologist could definitively tell them that their son's eyesight was not in jeopardy because it looked bad.

And so I called up the ophthalmologist and I said, look, I need you all to come see him at the bedside. And they weren't excited about it, but they did ultimately come.

And gave the family the reassurance that they needed that, you know, hey, this is honestly a minor complication as bad as it looks. It is a corneal abrasion. It is not endangering his vision. We're going to have him use some antibiotic drops for a few days. And they were comfortable, you know, at that point and ultimately went home. So then, you know, the next day it was like a Saturday. I called and I told the mom, I was like, I'm going to,

know call you and follow up and make sure he's doing okay so on saturday i called the family sure enough mom said oh yeah he's like 80 better you know he's gonna he's we really appreciate everything and i said look i'm gonna call you i'm not working tomorrow on sunday but like i'm gonna call you on monday and i want to make sure that he's doing good you know so i go get it's fine so monday i call her again and sure enough he was 100 better by that point you know following up that he did he has taken the antibiotic drops you know making sure he's getting that important follow-up care

And then the mom just was over the top with expression of appreciation for, you know, the experience that they had had despite this complication, you know, so. Yeah.

Yeah, I mean, that makes a ton of sense. And, you know, again, what you're demonstrating is that despite the fact that something bad happened, you care and you're in you're invested in making sure that this gets better and helping in any way you can, whether that's bringing the ophthalmologist down to see them, making sure they have the drops they need checking to make sure it's getting better. So all that makes a ton of sense.

Is there – when you – you had gone over this kind of algorithm of tell them what you did to prepare, how you tried to prevent it, and then what – the fact that it happened, but what you did to kind of mitigate it, and then what you're going to do to follow up, right?

And so, you know, in this sense, it's like, look, we usually do this stuff. We pay attention to the eyes. Here's what kind of went different and how we fell short. Here's what we're going to do now. And here's, you know, what we expect the course to be. And so that's kind of how this played out in that case.

That's right. You know, unfortunately, even though we didn't do a great job, I think the transparency up front, the tangible caring with the sort of visual demonstration of me going to get the eye drops and putting them in his eyes with them at the bedside, you know, all of those little elements sort of, again, generates an experience of care that they really appreciate. And, you know, in some cases I've seen patients

you know cases that i got involved with that should have been like the most forgettable cases of my career like ones that i forget about and just you know very little significance but then because of this sort of either little complication that happens or figuring out what matters most it becomes a very gratifying memorable episode for me as well so it's it's great for the clinicians

Yeah, I always remember I had a case a couple of years ago of a guy who I mean, I don't know for sure what happened, but I think what happened is that when we were suctioning his mouth at the end of the case, I think we must have got the uvula into the suction cannula because it was super bruised and just felt really hurt. It was a...

he ended up going to see an ENT who, you know, kind of took a look at it and was told him it was going to be okay. But then let me know, you know, Hey, just FYI, you know, this, this patient came to see me and I called the guy. And the first time I called him,

You know, he was clearly not happy. You know, I mean, he didn't like yell at me or anything, but he was like, yeah, it really hurts. And like, you know, and I told him, I was like, this is what I think happened. And I'm, you know, I'm terribly sorry that it did happen. It can be a complication. You know, I'm glad you saw the ENT. You know, I'm going to keep checking on it. And when I called him the next day, I don't think he thought I was going to call again because I think he thought that first time that I was just kind of checking a box, like check on it. When I called the second day, it was like totally different. He was surprised.

like a different guy. He was, he was so grateful that I was calling again. And I think it sent the message like, oh, you weren't just doing the like checkbox. You call, you actually are, are you care? You're, you're continuing to call me. And I called him several days, like you said, several days until he said, told me that his throat felt a lot better. And I, you know, I think that makes a big difference.

Yeah, that's the power of what I call the rhythm of follow up. It's not a one and done. That's right. Yeah. Yeah. It's almost like I think, you know, if it's it may be even worse if it's just a one and done. Right. It's like because then it makes it feel like you just have a checkbox that says follow up with the patient. Right. As opposed to you really care. So I think that that's that makes a huge difference. Yeah.

You know, I'm thinking about this idea of kind of showing we care, and this is different in the sense that it's more extreme. But, you know, not long ago, I'm sure you remember, you know, when we would have to do CPR, let's say in the ICU, you know, we never, ever let patients' families be in there for that. And now we frequently do let them stay for that. And it really makes a difference because I think they see how we are doing everything and sometimes –

It's not enough, but they at least see that we cared and we were kind of going all out both physically and mentally and everything. And it has been shown to actually be better for families. They can find better closure and find better trust in the system if they know and were able to see that we did everything. So however you can demonstrate that you care is really the key thing here. Absolutely.

All right. So anything else, David, we've kind of gone through how to prep so that you're, you're establishing trust and a relationship in case something bad happens. And then when something bad happens, how to show, make sure you're showing that you care how to talk to the patients about it and then how to follow up. Any other, any other pieces of this here that you want to go over? So much. This has been great. Let's turn to the portion of our show where we make random recommendations. Anything you would recommend the audience check out for fun?

Yeah, so I'm big into movies, Jed. And for one of my favorite movies, my entire life has been the movie Contact with Jodie Foster. It was a Robert Zemeckis film. Always loved it. It's got a lot of great like life themes to it. And it's based off a Carl Sagan novel, which I just recently read after, you know, decades of that being one of my favorite movies. And so that's what I'm going to recommend is a Carl Sagan novel, Contact.

Awesome. Yeah, I have not read the book, but the movie is fabulous. And so I will put that book on my list for sure. We are recording. This won't be released for a little while, but we're recording it right before Thanksgiving. And so I'm going to recommend what we do every Thanksgiving. And my kids love this is we make a pumpkin cornbread stuffing and it's very easy. You can take any stuffing recipe, but for the bread portion.

Pick up, find a box of cornbread, you know, whatever you, however you make cornbread, find your cornbread, you know, mix, box, and then make the batter, but put about a half to three quarters of a can of pumpkin puree and just mix it in. And it makes, that's all you got to do differently. And it makes it delicious and really, really fun. And my kids absolutely love it. So one thing they, every year they say, we have to make the pumpkin cornbread stuffing. So whether it's for Thanksgiving or not, check out pumpkin cornbread stuffing. It's easy to make. Definitely.

David, thank you. Thank you. Thank you so much for coming on the show. All right. Have a good one. All right. Hopefully you got as much out of that as I did. That was really fantastic. Let us know what you thought. Go to the website, acrac.com, where you can leave a comment. Others can learn from what you have to say.

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Even if it's just a dollar or two that you pledge, it makes a big difference and we really appreciate it. You can also make donations anytime by going to paypal.me slash akrak or looking up Jay Wolpaw on Venmo. Thank you so much to those who have already made donations and become patrons. We really appreciate it. Thanks as always to our fantastic Akrak crew. Sonia Amanat is our tech lead and Sophia Wu is our social media manager. William Mao is our production assistant.

Thank you so much for the great work that you do. Our original ACRAC music is by Dr. Dennis Kuo. You can check out his website at studymusicproject.com. All right. That is it for today. For the ACRAC podcast, I'm Jed Wolpaw. Thanks for listening. Remember, what you're doing out there every day is really important and valued.

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