美国国家公共电台 NPR Leilani Schweitzer: How Can Hospitals Be More Transparent About Medical Errors?

 

GUY RAZ, HOST:

Have you ever been in a situation where you are - you're apologizing on behalf of your hospital?

LEILANI SCHWEITZER: Yes. That's a core part of my job.

RAZ: Wow.

SCHWEITZER: I told somebody the other day that I'm a professional apologizer - kind of what I do.

RAZ: This is Leilani Schweitzer, and her job is all about transparency.

SCHWEITZER: I'm the assistant vice¹ president for communication and resolution at Stanford Hospital.

RAZ: And what does that mean?

SCHWEITZER: So that means that if you or your family member have something unexpected happen in the hospital, chances are I'm going to be talking to you. So I'm going to explain our process of what we want to figure out, how we want to come to understand what happened, what we want to learn. And if we determine it could have been prevented we're going to apologize, and we are going to do our best to make amends³ for what happened.

RAZ: And having a job like that, having a hospital even create a position like the one Leilani has is actually pretty rare because hospitals aren't exactly the most transparent⁴ places.

SCHWEITZER: I think that's a fair statement, yes. Because my role is unique, people hear about it. And I've had people from hospitals around the country who will call me and they'll say things like, I don't know what happened to my husband during the operation, and no one will talk to me. And it really speaks to the voice of people who are looking to find answers.

And they need that to heal. They really do. Whenever something unexpected happens to any of us, we want to understand what it was.

RAZ: And Leilani started doing this kind of work at Stanford Hospital after something tragic⁵ happened to her there. Leilani Schweitzer tells her story from the TED² stage.

(SOUNDBITE OF TED TALK)

SCHWEITZER: The nurse grabbed the recliner and jerked me awake. I heard code blue, and the room filled with people. In that instant, I knew he was gone. The doctors' words attempted optimism, but their faces betrayed them. My 20-month-old son had just died in one of the country's leading hospitals.

That night, when he had been admitted to the hospital, white circles with wires were stuck under Gabriel's bare little chest to monitor his breathing and heartbeat. Every time he made the slightest little wiggle, the alarms would go off - and they're loud. Every time we would almost be asleep, the racket and worry would start all over again. We'd already spent sleepless⁶ days and nights in my local hospital, where he had been misdiagnosed again and again. But now we were in a university hospital for children. Finally, here, I felt safe - and very tired.

And I'm sure the nurse could see how tired I was, and she wanted to take care of me, too. So she did the logical thing. She turned off the alarms on the machine next to his bed, and I thanked her when she did it. I was so grateful for the prospect⁷ of silence and sleep.

Later, doctors and administrators⁸ from the hospital would explain that actually, unknowingly, she had done a lot more. She hadn't just turned the racket off in the room. She turned off all of the alarms everywhere - in his room, at the nurses station and on her pager.

Later, the manufacturers of the monitors would explain - they didn't think anyone would go through the trouble of seven screens to turn off all of the alarms, so they didn't include a failsafe to stop her. They were wrong.

So when Gabriel's heart stopped beating, there was no sound, just quiet. Nothing woke me until several minutes had passed and I was being jerked awake and the room filled with people and panic.

(SOUNDBITE OF MUSIC)

RAZ: Did you - in those moments and then the hours and the days passed, was there anyone who was answering your questions - who was, you know, explaining what was going on to you?

SCHWEITZER: Yes. So now I recognize that the way Stanford treated me was really exceptional. But in that time, I just had no awareness⁹ of that. I mean, after Gabriel died, my sphere of what I could grasp was really quite small.

When I made a call, someone always answered and told me what was happening. The chief nursing officer and then also Gabriel's neurosurgeon, Dr. Edwards - he answered my calls. I never waited for more than a couple hours to have an email response. I didn't realize that I was something most hospitals would be afraid of. I thought that they were taking care of me.

RAZ: So I know you said your experience with Stanford was an exception. But how do - I mean, how do hospitals normally respond to these kinds of situations?

SCHWEITZER: Oh, they circle the wagons¹⁰. They put their heads down. And now I know that many parents - if they lost a child the way that I did, they most likely would not get that dignity and respect of being told what happened to them. And it's profoundly damaging. And that is something that I don't want people to have to go through. It's a difficult experience for patients and families to go through, and it also really makes it more difficult to make people safer, to learn from what happened and to make sure that it doesn't happen again.

(SOUNDBITE OF TED TALK)

SCHWEITZER: Transparency in medicine can help heal our medical system. By being open and honest when the unexpected happens, we can learn from our mistakes. Unfortunately, hospital administrators don't tend to respond to medical errors with openness and transparency. They react with a legal version of fight or flight - deny and defend. Keep your head down, shut up, and let the lawyers handle everything.

It would have been easy for the university hospital administrators to blame the nurse, fire her and assume the problem had been solved because the bad apple was gone. It would have been typical deny-and-defend behavior for them to ignore my questions, to go silent and hope I couldn't gather my thoughts enough to file a lawsuit¹¹. It would have been a safe bet. But they didn't do that. They didn't prey¹² on my vulnerability. Instead, they investigated. They explained, took responsibility and apologized. It made all of the difference. After the university hospital investigated Gabriel's death and the weakness in the monitors was discovered, all other hospitals using the same equipment were alerted to the vulnerability. Maybe that helped someone else. I will never know. But it still comforts me now.

Gabriel was treated at two different hospitals. He died because of mistakes made at both of them. Accidents that no one wanted to have happen. But how they responded to those mistakes was very deliberate. Both had the opportunity to learn from my son's death and be transparent, but only one did.

The university hospital didn't hide behind legal maneuvers¹³ and dismiss me, but the local hospital ignored me. By going silent, they didn't just humiliate¹⁴ me, they denied Gabriel his dignity. And after more than eight years, that wound is very far from healing.

RAZ: Why do you think the local hospital acted that way? I mean, why do hospitals just shut down and go into this, like, deny and defend mode, you know, instead of just talking to people like human beings?

SCHWEITZER: I think there's a few reasons. I don't think any of us like to admit when we've done something wrong. It can be far more difficult to admit that you've hurt somebody. That's a really difficult component¹⁵. There's shame. There's guilt¹⁶ that's involved. There's fear. And maybe they have a culture that discourages people from speaking up. I think most hospitals probably do.

So there's many layers to overcome to be more transparent. It's far easier to stay in that rut of deny and defend than it is to get out and pull back the curtains and let the sunshine in. This is why people go to lawyers is because they feel that they don't have any other option. People don't hire lawyers because it's an easy or fun thing to do. They do it out of desperation.

RAZ: At a certain point, I mean, some of these hospitals, you know, they have to realize that being more transparent can, not only save them from lawsuits¹⁷, but, you know, like you said, it can can help heal people who are involved, right?

SCHWEITZER: Oh, I think it does. So I've been in many meetings where we explain to patients and families what has happened. And those are difficult things to be part of. But it's a front row seat to the human condition. And I've seen an explanation move the guilt off of a mother's face. I mean, that is the power.

I have seen parents walk into a meeting with a physician where no one can lift their heads to look at each other. And by the end of that meeting, they are embracing. And it is remarkable¹⁸ what understanding can do for people.

RAZ: And you work at Stanford. I mean, you work at the hospital where Gabriel died.

SCHWEITZER: I do.

RAZ: Wow.

SCHWEITZER: I don't work physically¹⁹ in the building, though I am in there frequently. But this is the place where I do my work that I've been given the opportunities to do this work.

RAZ: Wow.

SCHWEITZER: It's Gabriel's legacy²⁰. It really is. And so I think about that a lot. I mean, to consider that I work with the legal team who are my dear friends and my close colleagues at the hospital where my son died because of a series of errors, you can't really make that stuff up. It's pretty profound. And, you know, frankly²¹, I think every hospital could have a role like mine. Every hospital has a patient or a family member who's experienced something really tragic and who could help other patients.

RAZ: Leilani Schweitzer is the assistant vice president of communication and resolution at Stanford Hospital. You can see her entire talk at ted.npr.org.

(SOUNDBITE OF SONG, "TRANSPARENCY")

WHITE DENIM²²: (Singing) I just want to be a transparency, a big ol' light shining right through me. I'm beating the lines. Let the people see.

RAZ: Hey, thanks for listening to our show on transparency this week. If you want to find out more about who was on it, go to ted.npr.org. And to see hundreds more TED talks, check out ted.com or the TED app.

Our production staff at NPR includes Jeff Rogers, Sanaz Meshkinpour, Jinae West, Neva Grant, Rund Abdelfatah, Casey Herman and Rachel Faulkner with help from Daniel Shukin. Our intern²³ is Benjamin Klempay. Our partners at TED are Chris Anderson, Colin Helms, Anna Phelan and Janet Lee. I'm Guy Raz, and you've been listening to ideas worth spreading right here on the TED Radio Hour from NPR.

1 vice   

n.坏事；恶习；[pl.]台钳，老虎钳；adj.副的

参考例句：

• He guarded himself against vice.他避免染上坏习惯。
• They are sunk in the depth of vice.他们堕入了罪恶的深渊。

2 ted   

vt.翻晒，撒，撒开

参考例句：

• The invaders gut ted the village.侵略者把村中财物洗劫一空。
• She often teds the corn when it's sunny.天好的时候她就翻晒玉米。

3 amends   

n. 赔偿

参考例句：

• He made amends for his rudeness by giving her some flowers. 他送给她一些花，为他自己的鲁莽赔罪。
• This country refuses stubbornly to make amends for its past war crimes. 该国顽固地拒绝为其过去的战争罪行赔罪。

4 transparent   

adj.明显的，无疑的；透明的

参考例句：

• The water is so transparent that we can see the fishes swimming.水清澈透明，可以看到鱼儿游来游去。
• The window glass is transparent.窗玻璃是透明的。

5 tragic   

adj.悲剧的，悲剧性的，悲惨的

参考例句：

• The effect of the pollution on the beaches is absolutely tragic.污染海滩后果可悲。
• Charles was a man doomed to tragic issues.查理是个注定不得善终的人。

6 sleepless   

adj.不睡眠的，睡不著的，不休息的

参考例句：

• The situation gave her many sleepless nights.这种情况害她一连好多天睡不好觉。
• One evening I heard a tale that rendered me sleepless for nights.一天晚上，我听说了一个传闻，把我搞得一连几夜都不能入睡。

7 prospect   

n.前景，前途；景色，视野

参考例句：

• This state of things holds out a cheerful prospect.事态呈现出可喜的前景。
• The prospect became more evident.前景变得更加明朗了。

8 administrators   

n.管理者( administrator的名词复数 )；有管理（或行政）才能的人；（由遗嘱检验法庭指定的）遗产管理人；奉派暂管主教教区的牧师

参考例句：

• He had administrators under him but took the crucial decisions himself. 他手下有管理人员，但重要的决策仍由他自己来做。 来自辞典例句
• Administrators have their own methods of social intercourse. 办行政的人有他们的社交方式。 来自汉英文学 - 围城

9 awareness   

n.意识，觉悟，懂事，明智

参考例句：

• There is a general awareness that smoking is harmful.人们普遍认识到吸烟有害健康。
• Environmental awareness has increased over the years.这些年来人们的环境意识增强了。

10 wagons   

n.四轮的运货马车( wagon的名词复数 )；铁路货车；小手推车

参考例句：

• The wagons were hauled by horses. 那些货车是马拉的。
• They drew their wagons into a laager and set up camp. 他们把马车围成一圈扎起营地。

11 lawsuit   

n.诉讼，控诉

参考例句：

• They threatened him with a lawsuit.他们以诉讼威逼他。
• He was perpetually involving himself in this long lawsuit.他使自己无休止地卷入这场长时间的诉讼。

12 prey   

n.被掠食者，牺牲者，掠食；v.捕食，掠夺，折磨

参考例句：

• Stronger animals prey on weaker ones.弱肉强食。
• The lion was hunting for its prey.狮子在寻找猎物。

13 maneuvers   

n.策略，谋略，花招( maneuver的名词复数 )

参考例句：

• He suspected at once that she had been spying upon his maneuvers. 他立刻猜想到，她已经侦察到他的行动。 来自辞典例句
• Maneuvers in Guizhou occupied the Reds for four months. 贵州境内的作战占了红军四个月的时间。 来自辞典例句

14 humiliate   

v.使羞辱，使丢脸[同]disgrace

参考例句：

• What right had they to bully and humiliate people like this?凭什么把人欺侮到这个地步呢？
• They pay me empty compliments which only humiliate me.他们虚情假意地恭维我，这只能使我感到羞辱。

15 component   

n.组成部分，成分，元件；adj.组成的，合成的

参考例句：

• Each component is carefully checked before assembly.每个零件在装配前都经过仔细检查。
• Blade and handle are the component parts of a knife.刀身和刀柄是一把刀的组成部分。

16 guilt   

n.犯罪；内疚；过失，罪责

参考例句：

• She tried to cover up her guilt by lying.她企图用谎言掩饰自己的罪行。
• Don't lay a guilt trip on your child about schoolwork.别因为功课责备孩子而使他觉得很内疚。

17 lawsuits   

n.诉讼( lawsuit的名词复数 )

参考例句：

• Lawsuits involving property rights and farming and grazing rights increased markedly. 涉及财产权，耕作与放牧权的诉讼案件显著地增加。 来自辞典例句
• I've lost and won more lawsuits than any man in England. 全英国的人算我官司打得最多，赢的也多，输的也多。 来自辞典例句

18 remarkable   

adj.显著的，异常的，非凡的，值得注意的

参考例句：

• She has made remarkable headway in her writing skills.她在写作技巧方面有了长足进步。
• These cars are remarkable for the quietness of their engines.这些汽车因发动机没有噪音而不同凡响。

19 physically   

adj.物质上，体格上，身体上，按自然规律

参考例句：

• He was out of sorts physically,as well as disordered mentally.他浑身不舒服，心绪也很乱。
• Every time I think about it I feel physically sick.一想起那件事我就感到极恶心。

20 legacy   

n.遗产，遗赠；先人(或过去)留下的东西

参考例句：

• They are the most precious cultural legacy our forefathers left.它们是我们祖先留下来的最宝贵的文化遗产。
• He thinks the legacy is a gift from the Gods.他认为这笔遗产是天赐之物。

21 frankly   

adv.坦白地，直率地；坦率地说

参考例句：

• To speak frankly, I don't like the idea at all.老实说，我一点也不赞成这个主意。
• Frankly speaking, I'm not opposed to reform.坦率地说，我不反对改革。

22 denim   

n.斜纹棉布；斜纹棉布裤，牛仔裤

参考例句：

• She wore pale blue denim shorts and a white denim work shirt.她穿着一条淡蓝色的斜纹粗棉布短裤，一件白粗布工作服上衣。
• Dennis was dressed in denim jeans.丹尼斯穿了一条牛仔裤。

23 intern   

v.拘禁，软禁；n.实习生

参考例句：

• I worked as an intern in that firm last summer.去年夏天我在那家商行实习。
• The intern bandaged the cut as the nurse looked on.这位实习生在护士的照看下给病人包扎伤口。