Having been to the Society of Acute Medicine conference last week, I then went out with my friend Tino (@tinocap) to a talk by Mark Kermode which was basically promoting his new book, and was therefore all about films and film criticism. Afterwards, Tino challenged me to write a blog which somehow linked the talk to medical education or something like it. So here goes…
At the talk, Kermode spoke about a lot of things – people he did and didn’t like, films which changed the way he looked at cinema as a format, and reserved a fair portion of criticism for modern cinemas with their popcorn, huge screens, no ushers and no ticket kiosks (just stalls selling food where you can also get a ticket)
Within all of this though, there were a couple of themes which seemed to make sense in terms of how we work in hospitals, and one which related to the SAM conference was:
Be in the right place to appreciate a story (and think about it…)
Kermode ranted (his words) about the growth of multiplex cinemas – and how these started out in some places as simply divides along the original big screen, which left the audience being able to see their own film, but with sounds spilling over from the other screens – which sometimes disturbed the tense moments of a thriller, or tender finale of a love story. But the obvious link to the paper thin curtains with which we ‘shield’ patients from others when we discuss their most intimate details (they don’t stop sound at all you know…) is not the one I made.
Instead – it was the importance Kermode placed on the need for people to be in the right setting to appreciate the story that was being told to them by the director. He was passionate in his assertion that well cared for cinemas, with projectionists making sure the film was racked correctly, that the sound levels were right and that the film ran smoothly from start to finish struck a chord with me.
When we are on call, we are asked to take in complex stories from patients, synthesize information from the spoken word, other sources (relatives / ambulance sheets / drug histories) and from our own examination and make a diagnosis. This diagnosis often sets the theme for an admission, and the first impressions can be very difficult to turn around subsequently (especially if the initial diagnosis was made by someone senior). This area of medical error has not been highlighted a lot in the patient safety literature, despite there being fairly good evidence to show that it is a problem. This review summarises the evidence well, and indicates some strategies which could combat the problem. In the realm of cognitive errors, I think that this idea (Dr calls for diagnostic cockpits) is one which goes straight to the heart of the matter, and reflects the point that Kermode was making – if you are not in the right environment and receiving information in the right way, then understanding the story is difficult. You will miss details (the vital clue in a thriller?) be unaware of subtle plotlines (expressions on faces) and ultimately might well miss the point of the film.
So, when you are next on call, trying to diagnose a complex case, or tease out the subtleties of a history – don’t forget that all of the noise and bluster might be putting you off. If at all possible, think a little about how you think, and perhaps find a quiet spot where you can concentrate for a few minutes, before putting down your final diagnosis, which will set the tone for your patient as they enter the hospital and undergo investigations and treatments put in place as a result of the first screening of their history…