Tackling the uncomfortable subjects—such as total transparency with patients regarding payment or medical errors—is a large part of TEDMED 2014, which began Wednesday and runs through Friday in San Francisco and Washington, D.C. 
Physicians, health care leaders and innovators took on these tough topics at the annual health and medicine edition of TED, encouraging listeners to be open and honest with themselves in the practice of medicine in order to enhance the doctor-patient relationship.
Medical errors are often discussed in hushed tones, said Patricia Horoho, the surgeon general of the U.S. Army and the first nurse to hold that position. But what if clinicians were more open about making errors?
“The problem isn’t that we err—the problem is that we ignore the errors,” Horoho said. “As individuals, we need the confidence, the integrity and the courage to speak up …. Health care is a team sport, and if collectively, together, we decide enough is enough and our system isn’t working, we can change it.”
This shift in thinking requires turning upside down the current way medical students and residents are trained, the way physicians communicate with patients and how physicians practice. For example, Danielle Ofri, MD, PhD, a physician at Bellevue Hospital, professor at New York University School of Medicine and editor-in-chief of the Bellevue Literary Review, shared a memory from medical school of hearing an attending physician chew out a resident for allowing an error. It made her, as a student, feel like she shouldn’t discuss her mistakes.
The attending physician “was trying to get us to perfection—but the message we got was that anything short of perfection was failure,” Dr, Ofri said. “The current culture is zero tolerance of medical error … to think of [mistakes] as foreign is to misunderstand the nature of error.”
Dr. Ofri’s call for more transparency was echoed by Leana Wen, MD, an emergency physician at George Washington University, where she is director of patient-centered care in the department of emergency medicine. Dr. Wen called on physicians to break down the barrier that occurs when they put on their white coats.
“It’s not just patients that are scared. Doctors are scared, too,” Dr. Wen said. “We’re scared of patients finding out who we are and what medicine is all about.”
Dr. Wen shared research on what patients want to know about their doctors. Most patients did want to know that their physicians were competent and making evidence-based decisions, but the vast majority had individualized preferences that were important to them. For example, one patient wanted a doctor with similar reproductive rights values. Another patient was seeking a doctor who believed in prevention first.
“Being totally transparent is scary,” Dr. Wen said. “You feel naked, exposed and vulnerable. But that vulnerability, that humility, it can be an extraordinary benefit to the practice of medicine.”
Watch TEDMED live from your computer or personal device through Friday, or watch the program on demand through Sept. 16. Visit the TEDMED 2014 website and enter invitation code “TMLicAMA14” to participate. Video of the above speakers now can be found on demand at the TEDMED site.
The AMA is a global institution partner of TEDMED 2014.
