Expand your mind and bringing new thoughts make the world a better place. We hope you enjoy this event. Purchase a copy for you and all of your friends online. Purchase a copy of the books, keep our bookstore and staffs here the most unusual of times. Thank you so much for your support. We take questions from audience from the comments, be sure to followup on facebook. You can create a watch party to let us know youre here and watching. They will receive the best care possible. Medical science has made enormous strides in decreasing suffering but theres no doubt it can also cause harm. A significant portion there. Medical error and Patient Safety and National Healthcare conversation. Researchers, patients and family, diagnostic systemic and other issues for medical error. The best for the medical categories. It is possible to minimize preventable harm and there should be discourse. What makes this special is perceptive and compassionate nature, analysis their challenging personal touch that makes it highly readable and anyone involved or interested in the patients. Its a clinical professional school of medicine and a professor for more than two decades. What doctors here, feel and other intimacies. Its evolved from medicine, it can be found online. The been working in the experience she shared in the New York Times. This is one of my personal favorites from 2015 and a very happy about this, systemic racism, especially now, we should be looking at the root of the Healthcare Industry and it has helped. An assistant professor at the Medical Center and Medical Center, published novels about race and venison of the american medical association. They have appeared in New York Times from the Atlanta Georgia constitution. It is very special to see him here tonight. I want to thank you for being here. I think we will start off, why this book and why not . We talk about covid19, so why this book and why now . Getting everyones impressions about medical issues, a couple of years ago, they sent me an email about these headlines think medical error was a leading cause of death. Is this really true . Have to say, i really didnt know. If it is true, i feel like i would see that every single day, it doesnt feel like i do. I wondered, are the data wrong . Or are they correct and we are simply blind to it . Trying to answer that question, i began as i was digging into the data from its a hard question to answer. So counting the numbers is very difficult. Somebody dying of cirrhosis and theres an error in the patient dies, thats what piqued my interest. We see that, how does it come about how did it come up . It runs back previous data, it involves taking data into smaller sets and multiplying it to a whole population. 300 Million People, so it is a bigger study, Heart Disease and cancer, it is not that high but it is also not that low but we know errors occur. Even if we never know the exact number, it is happening overall and it needs to be minimized, the harms and errors. Is just your i get that its hard to keep track of it, restarting it but how hard it is for doctors to talk about. Why would a doctor ever talk about errors being made . Our country, theres a lawsuit possible. On the issue, it is the emotional side. Most people in healthcare, patients see that now so even inadvertently, you make a mistake, we are devastated and ashamed and cumulated dont want to talk about it. You think about it, i had a doctor where i, someone told me about a report that i missed something. The patient declined but another patient signed. There were errors calculated. The patient was lucky but the air was still there. What interested me was i didnt say a word to anyone. Why say anything . I didnt tell my attending and i should have. I couldnt imagine saying i almost killed you. It took me 20 years to think about it so or to get to those checklists and we need to think about the emotional side, it is like the under the water, we dont know where they are, how can we possibly fix them . It sounds like youre describing at least the idea of conscientious. Theres guilt and shame. As a trainee, i didnt understand the difference and theres a book called unapologetic, its a book about what happened, it makes you want to fix it and not make the error again. Its about you and its a shame and it devastating. In one second, i wasnt the doctor i said i was. Maybe as good as my peers but saying i am a danger to patients. I realized it was the shame preventing me from talking about it, and correcting errors because theres shame and im sure i made mistakes that could have been prevented. You also talk about how how medicine is involved, theres also another thing in our culture that makes it hard. Over the past 200 years, its captivating with medical machetes. Flattened the 19th century illnesses. Antibiotics, second half of the 20th century, worrying about executing 360 degrees, chemotherapy, blood transfusions, birth control, hiv treatment, saint every dragon. Introductory. The dominant one, and with good reason. Ask yourself if it could be prevented. If you seek victory, theres much space talking about errors and outcomes of the treatment. At best, it fixed with more Research Implications and we dont really talk about it in the news, and i think that is getting on to surgery. He flatlined and they called him and they got it. I dont even know what the error was later, why even bother operating . Remember, the resident in resignation and i was noticing i didnt make any errors. If i do, not telling anyone. Im going to go to the parking lot because i am staying clear. Its a message about medical error. So far, weve focused on the doctor side of it. The patient side of this writing about it patient, didnt want to be in that situation but on the other hand, most patients and families were eager to have this because they wanted it to be for others. Most of the medical errors were on what happened. They go ahead. They need to go to the burn center. He gets there overnight. He eventually got through a couple months later. The family were devastated. They wanted to know what happened. It took them years to find the information because it was a bad outcome. If you think about it, you want the chance to mourn and grieve but instead, those years of fighting, there was a compounding ever. Heres something one can do, never question but the number one thing patients and families wanted was a promise and demonstration that they could do better for the next patient. The way in which people and finding out if theres a medical error, tell us about the misconceptions and the general public, he watched a tv show, can you just sure about that . In the u. S. , we have this perception that everyone get their day in court, everyone deserves their side. Ideally, that is the case but not always that. If you think about it, you have experts and there is a high chance of winning and winning a large settlement. So the way they take on cases, severe outcome, death or severe disability the cost treatment are very high. If in fact, they have their day in court, the malpractice serves, if your error didnt cause major harm, even if its a legitimate error, if its not public, you will not get your day in court. So very you patients get that. The patients who do get their day in court, its not a day, it usually drags on for years and years. Even if you win the case, theres typically agony for both sides, it is just a terrible wound that is never healed. You see most cases where settlement order trial. Whats happened in the u. S. , the ones that do court to court, typically the patients when the case. It is a difficult thing to prove that. After proof that the error was negligent, theres a negligence cross bad outcome. We cant prove it, the patient dies, you have to prove that death is quite difficult to do. It doesnt really help, there new problems. The more important thing, the patient get some kind of restitution. Dont necessarily go to court, the conversation in an administrative court. You get some kind of settlement. The make it separate from the legal system. Any patient can sign a petition. Many more patients have conversation but the truth is, it doesnt have to be big. Bad outcome in childbirth and the child needs round the clock care. They get a personal amount. In the u. S. ,. One thing is a vaccine. Very small profit margin so doesnt take much in the way to get sued to make money and doing it. Many vaccine manufacturers pulled out because it wasnt worth the risk. It is a very real possibility they wouldnt have enough vaccinations for the American Public so they came together so they would have a Compensation Fund so anyone with an injury they think is related to vaccine, to get a possible settlement in all the vaccine makers contribute to the fund so it keeps it out of the court system. Because of the way for injury, they have a cooperative fund. It is not going to happen until congress does that. Actually get their day in court. Were talking about that system. But switch out, how do we get ourselves out of this . April 1 was such a nightmare. Imagine if it happened, many great things about the emr. We would never know about that. Preventing medical error, one example is when we have an outbreak in one of the common outbreaks in the hospitals is an infection that spreads on contact and eradicates it. You can be tough to do with whats going on. It contracts with every patient you at the hospital. They attract every interaction, one area of the hospital but hadnt had it, we could have enabled them to find it and solve the arms. On the other hand, give all kinds of other things. One example the medication ale alert, any kind of prescription, theres so many and some of them are ridiculous. Every female, you could be in your 60s, it makes me angry because they have this liability and the doctor checks it off so they are not responsible. That makes me frustrated. Then you have this other. One more. I think the third patient of the day and i noticed a big difference. Apparently the update, minor things were out of order. Whats automatically new there was spanish. There is a long list of languages. Somehow another leg which had been added. Number 42. But spanish is number 41. All of a sudden, there was Food Allergies and environmental allergies. Medication, Food Allergies, even for allergies were there. I said to myself, its not that i think the text free environment is important but i typically ask patients. But now, went out of the room they entered, latex gloves were in the middle of the room and everyone was speaking caribbean. The medical history number 18 from they summed it up to something else. The automatically, the couldnt take it out. They had this history attached to the chart forever. [laughter] how do we make the best of this and make this work . Theres a lot of things we can do. There are things like a checklist. Procedural things like central lines, and seek intervention but it works with that kind of thing. Like diagnostic error, you cant really checklist how we think. When it comes to that, i think we have to consider with doctors and nurses, if we have the emr is often useless. Talk with the patients. Listen to the patients speak about the patients. I think the three biggest things minimizing diagnostic error, we want to minimize error, how do we do medicine . Spent time with the patient to speak about it and talk with them because the compensation from the last conversation. These are the biggest things. Ive heard patients complain about the doctor looking at the screen and not them. There are so many things, 3 00 a. M. , and ever get there. I think we can reconfigure the system. We can actually talk with our patients. Its a cultural shift that we are making error, we speak about that and think about that, i was intrigued by this article, the cultural shift you see, doctors typically but now, that is disloyal. Changing the culture and think about what we do. We have an error or inadvertent thing that is disloyal. It is our commitment to talk about. If we want to know about the error, we have to change the environment or we could just make it easier you talk honestly about what is going on with a patient. You talk about the Current Situation with covid19 and repurchasing things, talk a bit about that and this other thing about medical error. What went wrong, ive never seen anything like this in my life. Not everything is like that. If you think about the harms or covid19, talk about that. Its a reflection of society. Our society has the american individuals, there is just many ways. They couldnt social distance, the couldnt stay home whether they are an essential worker, they have no choice but to work. So the data from this populations is striking. Its preexisting that preceded this. There is more medicine. She went i think as nurses we cannot change the whole society we recognize that. I think we can use our collective voices and certainly after what weve witness i think our voices are more heard now. We seen it in a way the public has not seen we owe it to our patients and society to stand up and say this is not okay. Look what our society has lost and whether reflecting what society has done. And these things and of occurred in our community. We have this misnomer where it is respect for healthcare workers. And may be more than we have in the past we should not be shy about using our voices. He said that for years now, on we get to the session entering question session you mentioned the idea of how to prevent the quest and you talk about medical students can you talk about the simulation programs and how they can be a big part of the next step can you talk more about that expense . Guest its trial and error learning with the simulation its like okay its time to learn. It was terrifying. And i never thought about what is it mean to the patient to they have any idea about how much i didnt notice a Teaching Hospital less excuse for everything. I think honestly, its a terrible thing. We dont need be practicing on patients. Im glad we have simulation that the procedures we can start a central line and intimated all these procedures we should not be giving people bad news the first time with the actual death of a Family Member we should not be trying it out then. So simulation is very critical that we had a Training Ground for the Difficult Conversations these procedures so that the first time were not doing it on a patient. Specially when youve never done it before and as long as we were member will make it to the real thing, there is a real person under there. This is real for them. People are living their lives. Thats when there is the famous book about the cancer the doctor this many patients on his rounds. I kind of her memory that phrase when youre working for 20 hours and see 50 patients but for that one patient is the crisis of their life and we need to remember that. See when that is a great lesson. You tell the stories about trial and error it may be think about being an emergency one time being asked to fix a face laceration. The patient wasnt intoxicated he was an africanamerican man he said you guys experimenting on may some way . Its like should i have been the one to do that in that particular situation . Facial laceration with another part of your body and maybe think about that whole idea. Also goes to the conversation about the structure of medicine and healthcare and how things are fed up. So i know ive asked a lot of questions is anything you want to get to. Guest i think theres a q a with a lot of questions they are so lets get going with that. Host great. Alright john asked the question. Unmute yourself. [laughter] thank you. [laughter] so first off thank you both so much that was an incredible discussion. So the first question is from nicole. Nicole asks if theres more medical errors in rural areas and if so its been done to solve this problem . Stomach that is an excellent question i think we do not know. But we dont have is a National Database for that. With the patient assistance to set up to be a way to collect data and as a way for us to improve medical care. You can see civil a lot of us here about unnecessary pressure and lets focus on that. So we dont have that. So the answers we do not know. I think rural medicine has a number of challenges including not enough staff. Very hard to attract staff in those hospitals in the rural hospitals. And many of them have closures due to Financial Issues and lack of staff. The critical situation there. So one big issue is a database to tracking disorder know where the problems are and how to address them. Guest right but Florence Nightingale is the measurements out there if you dont collect the data you never know. She did not endear herself she was under that one of the first statisticians and we had the 200th anniversary in a National Celebration of that they should all be there certain information with whats going on so we know we need to fix something. As a medical student permitting and medical errors petrifying so as medical students that it conversations about medical errors in clinical how can they work towards changing this . Hopefully we can start by saying lets talk about medical errors. And when you have your first error. Think the whole issue as starting the top and coming down so when the chair of medicine or they talk about these or when i made an error heres what i did. Its the only way to know the medical errors will occur and if we pretend we will have no medical errors, its better to own it. I hope there are mentors will lead the discussion. If they dont, and someone can say hey im really scared of making my first error can we talk about before it happens . Hopefully theyll have that conversation with you. Host the topic of medical errors is exactly to describe we want to be useful experience for the student to see that. Another way to talk about the experience is being a patient who sees the error sees that as well so that is helpful thing to have for the students. So the next question will be from me. So as doctors, or as a patient, how can doctors regain the trust of patients that have been maybe not severely mistreated but have had issues with trust and not having care conductors how can a doctorpatient gain that respect and that trust again . Guest thats a very good points. The first thing that a wise clinician or dr. Should do and figure out what was the source of what happened. Between staff and patients are that is extremely rare. So just people trying to list they tell you what happens and you cant tell its never going to happen again but if you at least listen and acknowledge i think the patient sees that as a sign of respect. In the gifts tell them if something doesnt seem right let me know im willing to hear have someone reach me. Thats my fillets hell try to visit it. We are a fallible system think thats the first step up like the doctor said i agree. We need to recognize these things will happen. Ill think anyone sets to be perfect. But they do and she did tell them it was hypothetical for the patients who are ahead of that air with the doctors ready to or not the doctor told the patient that should keep the doctor and now i know i can trust them. If they tell me that i shouldnt trust my dr. Most understand they just dont want to be kept in the dark or lied to. Jackie asked how can we reduce the victims of medical error question works so great question. Simple things one is medical history many patients dont know their details. Its good to keep a one page summary of your medical issues, medications 50 pages but get the basics and have that with you. And then when you go to see your doctor or nurse, they will ask the same questions but some patients have 50 questions but bring the top drink three things you want to talk about. Tell the doctor before you start say i want to make sure we get to these three things. And then when youre in the hospital try to keep a list of whats going on what medications are getting, why youre getting them. You may be too sick to do that if you have a family friend with you that helps a lot. But dr. Should be able to answer questions that is their job. Were not sure whats going on. Could also be a patient advocate. We need someone thats there for you and you asked for that number and you call them and they will help you navigate the system. So peter asks if you can describe system and workers comp. In the remedy. So the system is a system in future to go that route you can. But also its very expensive. Most while the system its easy to use its free it does not cost any money, that enters much lower. Its often the most people find it more userfriendly the system. Joslin asks is there any data on how to effectively communicate errors to patients customer so yes there is. We want to start out with whats the patients understanding of whats going on. The things we need to clear up how many did tell the patients exactly what happened. More patients will choose not to sue if they can get the information. Most the time it has of patients not getting answers. I think the hospital tells them upfront what is happened they dont want to see nobody wants to see a lawsuit. That is very helpful. Also to let the patient know what the hospital or what you are doing to fix the problem. Some errors cant be fixed. You can fix the system to make errors less likely for you can show the concrete steps and efforts by the hospital to looking to make things safer, patients are much more satisfied. They want that more than a lawsuit. And as a 30 year go student about to start rotations can you give me the top two recommendations to protect myself and my patients customer. Good luck. Fact that you are metaphysical student gives you more time sir take the time to read the chart read up on it you are not in a rush. And then when you finishing whatever you do ask the patient this anything ive missed is there anything you need to tell me . Or think of got the straight and summarize for the patient and the patient may save you know about that part wrong and this is it. And they let you know and ask the questions make it much less likely that you will miss something. On the something with you or theyll talk to the attending before they take any further steps. So another question from me as a former patient some people will know what that is how do you think the standardized Patient Program that so many universities are using these days can help improve patient communication and reduce medical error . Thats ridiculous i only have back pain how crazy can that be . I will tell you they are lockedin they are great. I had when this morning a medical student try to obtain consent they were all over the patient. So unrealistic theres a nurse waving really even you noticed its real. So if you have the chance to have these pressure of the conversations and have a chance to talk with the patient after words. I think its a really merchant away to break the news with the medical error, how to get consent how to talk about in the right care which are all things we need to practice. Some patients get the chance of practice over and over. Some things underutilize in some ways . What can they help with . About after medical you have. I think its a great idea. Think its extra especially when the conversation starts with a diagnosis. Learning how to make a diagnosis is very complicated. When things go wrong and how to talk patients about that how to approach whether they do dialysis in all of those things more often than not the problem is you have to make time for the doctors and nurses to do this means having clinic sessions and making times on the rounds to get this to the patients i was going to ask. [inaudible] its theres a lot of things to talk about its interesting conversation that we have about the role. Its important to the theres the good old days of everybody working hard makes different with each generation. Some patients stay in the hospital for five weeks he could stay overnight and sleep and now you cant. He cant even compare not sleeping is just not a good thing. Most of us can get up the energy to put in an ivy but what really suffers is emotional if you havent angry patient or angry colleague and thats only make more errors. You see when doctors and nurses get that way but we have to hand over the care. Every time we leave the smes got to the care the transitions of care are really big potential for error. When you transition care i think we have to find that safe spot for the system. And if they work too much for going to be overtired so you have to go through trial and error but its to Pay Attention to that before he did not at all. Weve covered a lot of things theres a lot more for the people out there are some encouraging you to read the book. Theres a lot more weve only scratched the surface here this a lot of talks about solutions and it can begin today say its been enjoyed talking to you i thank you. Thank you guys for everything. This is a fantastic book so a lot of down time will your home its a good book to read. Host book is for sale we will ship them to anywhere in the country on behalf of us i think you both so much for doing this event. It was really fantastic, and for every one watch if you enjoyed this you can share it, make sure your friends can watch it. And join us next time for another adventure. Thank you good night guys thank you. Thank you. Thank you. So your watching book tv on cspan2 top nonfiction books and authors every weekend. Book tv, television for serious readers. During a virtual Altar Program sponsored by haymarket books, talked about Global Politics and the covid19 pandemic. Here is a portion of her talk. The first case of covid was on the fifth of january. Between then and midmarch, nobody paid any attention. There were other things to do theres huge political crisis because of the movements there were massive protests sometimes up to 8 Million People in the streets. Most led by muslim women. Completely nonviolent. [inaudible] people come out to defend diversity to help the slower resistance. This moment happened with a massacre with hindu religion and backed by the working class there were about 50 People Killed because people were prepared for this attack and fought back. The happened when trump was here. So he was here the last week of february. You have people, Million People in the streets. But then on the 13th of march. But on the 24th of march at night the Prime Minister came on booktv and said the country is 8 00 p. M. Until midnight said there would be a lockdown. Mass transport would not be available. So the next day we were part of an experiment people climbed into the outskirts into buildings they were actually factories there is construction it was the 24th of the month there was no mass transport and who are basically. [inaudible] who they came to work in the city to supplement their income. So they began this trackback home like hundreds. So suddenly they said this kind of a biblical exodus of people walking of men and women and children walking to get to the villages. I had a media card so i went out and walked to the border with security i spoke to them there were videos i dont know if you saw them of people being brutalized. Not just beaten summer cotton hose down some had been walking for days were stopped and told they must go back to where they came from they were spreading the virus. Some people were walking in the villages in that situation remained as such right now. You have a hunger crisis, then you have this Health Crisis and you have the hated crisis in the muslim community. New have a knockdown where the Prime Minister of this huge country literally ordered this lockdown. But now the real problem is how do you undo that the situation turned into a way thats hard to know how to come out of her. To watch the rest of this discussion visit our website, booktv. Org and search the title of her book, my seditious heart. Here is a look at some books being published this week. Even though its release is being challenged, for former National Security adviser john boltons new book, the room where it happened is scheduled to be widely available on tuesday. In five days, Robin Hood Foundation ceo, wes moore and journalist erica greene look at the protest against Police Brutality in baltimore in the wake of the death of freddie gray in april 2015. And Newt Gingrich argues why donald trump must be reelected also been published this week in jesus and john wayne history professor explores white evangelicals have championed president trump. Reuters catharine looks at how the cage agree brought putin to power. We look at the ins and outs of voting and america, look for her and it upcoming sunday evening q a program on cspan. Find these titles this coming week wherever books are sold and watch for many of the authors in the near future on book tv, on cspan2. And good evening from book tv. Beginning now it is a series of programs of Pulitzer Prize winning biographer and historian, David Maraniss hes the author of a dozen book including bustling biographies on barack obama, bill clinton, and vincent varney. Mr. David maraniss is associate editor at the Washington Post he began their 1977 and he received the Pulitzer Prize for National Reporting in 1993 and in 2007. He has appeared on book tv over 30 times and in fact book tv has traveled the world with mr. David maraniss and his wife linda. Coming culpable revisit his trip to kenya when he was doing research for his research for barack obama. Well show you his history of detroit in the 1960s. But first in 2002 we accompanied David Maraniss to vietnam when he was doing research for his book they marched into sunlight its a book about the vietnam war its a winner of the J Anthony Lucas pride and a finalist for the Pulitzer Prize. Here is David Maraniss. This is a rubber Plantation North of saigon in vietnam. Thirtyfive years ago members of the armys 20th infantry regiment known as the black lines were ambushed here in the battle, 61 were killed, many were injured. This is the university of wisconsin and madison 35 years ago antiwar students tried to keep