EP 33: Why We Need Effective Communication in Healthcare

This week, the Hope4Med podcast features pharmacist Soojin Jun, co-founder of Patients for Patient Safety US and patient advocate with a passion for patient safety, quality improvement, and health equity. Dr. Jun shares the life-changing experience that affected her family and led to her career in healthcare. We discuss the importance of effective communication in healthcare, not only between patients and providers but also between providers. Miscommunications can cost a life. We also explore how burnout and moral injury can further harm when healthcare professionals are not functioning at their optimal level.

Connect with our guest, Dr. Soojin Jun:
Website: https://www.pfps.us/
I Am Cheese: https://medium.com/i-am-cheese

[00:00:00] Dr. JB: Ever wish for a safe place to have conversations that need to be had? A place where you could say the things that need to be said? Well, welcome to Hope4Med.

[00:00:16] Welcome back to the Hope4Med podcast with me, Dr. JB, as your host. Today’s featured guest is pharmacist Soojin Jun. She is co-founder of Patients for Patient Safety US, she’s a patient activist and advocate, and pharmacist with passion in patient safety, quality improvement, and health equity. She is a believer that empathy and art can heal healthcare. Welcome, pharmacist Jun.

[00:00:42] Dr. Jun: Thank you for having me, Dr. JB.

[00:00:44] Dr. JB: So tell us a little bit about yourself.

[00:00:47] Dr. Jun: Yeah. Currently I am a pharmacist. I work as a pharmacist at a hospital, but my passion projects include Patients for Patient’s Safety US, which is a group of people who are very passionate about patient safety through our lived experiences as a caregiver or as a patient. So we either have experienced medical harms through our own experience or have taken care of someone who we love and have lost them, or they’ve experienced the harm.

[00:01:24] So we are very, very passionate about making sure patients’ voices are heard across organizations in the United States, and we follow WHO’s global patient safety action plan 2021 to 2030. So I know it sounds all grand and everything, but this is something that I’m very passionate and I really care for, although this is a volunteer organization.

[00:01:53] Aside from that as introduced in the intro, I believe there’s so much we have to heal in healthcare in order for us to take care of patients and help them heal through art and empathy. So, that’s who I am.

[00:02:09] Dr. JB: That’s so, so true. So I know that my listener would be very interested in learning your origin story, so let’s start from the beginning. What brought you into healthcare in the first place?

[00:02:20] Dr. Jun: Yes, I was in a totally different field before I became a pharmacist. I was a wedding videographer, believe it or not and so art is something that I’ve always loved and pursued. And all of a sudden, my father gets diagnosed with stage three esophageal cancer, and he is a foreigner. He’s a businessman from South Korea, so he’s been going back and forth from here, the United States and South Korea. And he had to seek care in the United States and as his disease progressed, then he had to navigate this complex healthcare as a foreigner and someone who is unfamiliar with healthcare. It brought a disastrous result in the end.

[00:03:12] He experienced so many gaps. Of course, now we talk about health equity very openly, but at the time, this was 14 years ago when these things that we need to take care of in healthcare were not being addressed openly. So we experienced so many gaps, and as you can imagine how difficult it would have been for someone who’s unfamiliar with the healthcare and complex disease management, on top of medication management, so he was just so distressed. He clearly was not getting better. He had to go to ER multiple times and he wanted to seek care in our country, South Korea. So we booked our flight to go there, all of us including my two toddlers at the time, because I couldn’t let him go by himself and he passed away one week before our flight. So that experience has changed my life and entire perspective of healthcare. And it was a combination of how complex it is, but also our trust in healthcare. We just trusted healthcare that, healthcare professionals and hospitals who are involved will take care of my father, and it was not the case.

[00:04:31] So I was contemplating career change and I chose pharmacy because the reason why he was in ER, multiple times was possibly due to hypoglycemic events from insulin that he was on. So he was never diabetic, but he was diagnosed with diabetes after the diagnosis of cancer. So I chose pharmacy and I became a pharmacist, and I was just so eager for change. And even when I was in pharmacy school, I created a business plan, competed in different business plan competitions with my friends and I was so determined to pursue the idea that I had, and I enrolled in graduate school with the plan for capstone project and clinical trial possibly along the line, and I found I was pregnant. So, not to make it as an excuse to go away from that passion. But I had to devote my time to family planning, taking care of the family. So, I think I’ve always followed my heart and I recently finished fellowship with Jewish Healthcare Foundation, it’s a patient activist fellowship, and I’m continuously seeking ways to improve healthcare and patient experience. But that’s the story, how I ended up in healthcare and still am.

[00:05:58] Dr. JB: I am so sorry to hear about your dad.

[00:06:01] Dr. Jun: Thank you very much.

[00:06:02] Dr. JB: I’m sure that was very heartbreaking.

[00:06:04] Dr. Jun: Yeah, it still is, it still is because I look at patients, when I see patients who are at my dad’s age or even just any patient, I just know how difficult it is from my experience as a caregiver and as a healthcare professional. I feel I have a multi-level of understanding how hard it is to be a patient. So, it is heartbreaking. It is heartbreaking to be a patient and to take care of patients in such a way that we have limited resources and limited ways to help patients, and I’m sure you agree with what I have to say about this.

[00:06:45] Dr. JB: Yes. There’s a lot of challenges from both ends. That’s so true. And so you mentioned that when you were in pharmacy school, you had to come up with a business plan. What was this business going to be?

[00:06:58] Dr. Jun: So it was an idea of pharmacists being a care coordinator for patients. And I put everything that I needed into this plan to properly take care of my father from my experience. It was the app-based care coordinator solution. So the idea was that caregivers and doctors and hospitals, we coordinate care together through the app, and the key was the pharmacists being at the center of this communication circle because I feel there’s so much pharmacists can do in public health. You may know family member or a relative who go to different doctors to seek answers for what they’re experiencing and they end up wasting money. They get the small prescriptions, take what’s prescribed, and don’t feel better. And there’s nowhere to turn for these patients to see where they are at really after what they’ve gone through, because there’s a lot of cultural aspect here too, I feel, that our country, America, values choice so much. So, without really thinking, patients value choice and also giving choices to patients may seem like it’s a good solution, but patients turn to healthcare to be cared and they may not necessarily know, with the complexity we have and ever rising high costs, they really don’t have resources to really design their care. I mean, essentially that’s what it comes down to. There is someone who has to help the patient decide their care with current setting that we’re in, but I felt there wasn’t any. There wasn’t anyone who was doing that. So I felt pharmacists were perfectly situated to be able to do this because pharmacists are the most visited healthcare professional in patient’s lives, when they’re picking up prescriptions, dropping off prescriptions, we’re very reachable through phone call, although with the busy work schedules and the workloads pharmacists have in current community pharmacies, it can be challenging, but we are most accessible healthcare professionals. And we have so much knowledge, we can be more than just dispensers of medications. So, that was the plan.

[00:09:34] And I really didn’t have an app created either, but I was so impressed and excited about how people were excited just to hear that. And I was able to win the competition and also compete in, it was a student-planned competition, but a festival called South by Southwest, it’s a festival of innovators, of music, there’s video, movie, and there’s also healthcare section, so we were able to compete in that competition. And we did not win the competition, but I was able to meet with so many entrepreneurs and innovators in that festival. So it was eye-opening experience that I felt we need more pharmacists to be in places like this, where we talk about innovation in healthcare, but pharmacists have so many barriers and one thing is that we’re not considered as providers under Medicare law, so there is an initiative for pharmacists seeking this provider status currently, and some states allow this, but not all states have this provider status, so we are seeking federal provider status. And I’m kind of going off tangent, but what I realized while I was in that festival was the reason why we were not in this type of festival or in the tops of innovation was because we would not be able to bill. I mean, as much as we look at healthcare and we criticize healthcare being run like business, I mean, that’s the reality. So, that’s how innovation evolves around, and if we can’t bill, innovators and people who are passionate about change, they don’t see how they can make money or how they can survive the business with someone who can not bill. So it’s all interconnected, I felt. And I advocate to future pharmacists and current pharmacists to really advocate for our profession and also be involved with public health because I feel we have so much that we can offer.

[00:11:48] Dr. JB: Along those lines, one could argue that in terms of the care coordination, the patient’s family physician would be the ideal person to really facilitate that. In your experience with your dad, did you find that your primary care doctor was able to be that middle person to really serve in that care coordinating role?

[00:12:13] Dr. Jun: No, absolutely not. Which is unfortunate and that would be ideal scenario, but in the current situation where we are at, and even back then, doctors really don’t have time to really sit down with the patient and talk over the medications and even tailor the treatments that they’re getting. It takes such a long time to really get to know the patient, which with the current model, it’s really almost impossible unless patients are so determined to get care from specific doctor that he or she likes to get care from. Unless, now there’s a concierge doctors and there are innovations around the continuity of care so that’s good thing, but for the most part, if we want to use our insurance, if we want to follow along with what’s going on in healthcare, it’s really, really difficult for patients to have continuous care from one doctor.

[00:13:20] Dr. JB: Is that because they don’t have a primary care doctor, or walk me through what you’re seeing.

[00:13:25] Dr. Jun: Yeah. So, once a year we have to change our insurance plan, I think that’s also something that is so broken, even if you work for same employer, every year you have to go through the process of making sure your doctor is covered, making sure the services that you’re seeking will be covered. It’s just a lot, there’s a lot of barriers for patients to stick with one doctor that he or she likes. And I think that’s like number one barrier that I see, and other barriers, average primary doctors who are not concierge doctors, they see 1500 to 2000 patients, in one study I saw, per year and that’s a lot of patients, so it’s quite impossible for one doctor to remember all those patients’ history and what they really see for their care. So I feel that the health system is not designed for doctors to work well with patients in one-on-one basis. Those are the two things that just comes to my mind.

[00:14:34] Dr. JB: Is it okay for us to talk a little bit more about your experience with your dad?

[00:14:37] Dr. Jun: Yeah, sure. Of course.

[00:14:40] Dr. JB: Cause it seems like that was the life-changing and pivotal life experience that really brought you into healthcare, and is one of the driving forces in terms of your patient advocacy work and safety. And so if we go back to when dad was diagnosed with esophageal cancer, what was his healthcare team set up? So he had an oncologist?

[00:15:14] Dr. Jun: He had an oncologist, he had a surgeon he had to talk with, and he had a primary doctor. So when he was in the hospital to get G-tube placed, the primary doctor wanted him to be in the hospital for a little bit more. So I know I’m not sure how this will be looked at, but in order for my dad to stay longer, there had to be another diagnosis, I guess that was the insurances setting. So my dad’s doctor put a new diagnosis on the chart and my dad had to endure that, the care that he really did not want at the end of the day. What he was told was it’s not going to be any different, but he was placed in a different ward, and he was not allowed to have communication with outside. It was just pretty traumatic experience in my dad’s perspective, so he wanted to be out of the hospital like right away after that change was made. So after that he–

[00:16:25] Dr. JB: I’m sorry, I apologize for interrupting, but that change was made so that he could stay longer in the hospital to get the G-tube placed, was that the goal?

[00:16:33] Dr. Jun: So he already had a G-tube placed, but for some reason that doctor wanted my dad to stay a little bit longer in the hospital.

[00:16:41] Dr. JB: But that wasn’t your dad’s wish, he did not want to stay longer in the hospital?

[00:16:45] Dr. Jun: He did not know any better because the doctor told my dad that once the change is made the care is not going to be any different, you’re just moving to a different word. And that wasn’t really the case. So all his belongings were taken from him, and so basically it was like a psychiatric ward. I know it sounds shocking or I don’t know, I guess it depends on how you viewed this story, but…

[00:17:13] Dr. JB: Was the doctor concerned about dad’s safety, I wonder? That’s the only thing I could think of would be, if dad was voicing anything concerning, suicidal or homicidal, then changes like that could be initiated.

[00:17:27] Dr. Jun: Well, I didn’t think my dad was in any danger mental wise, but I just trusted the doctor’s point of view as far as hoping that my dad could stay longer in the hospital because he had the G-tube placed and we were never educated on how to take care of him after the G-tube placed. But I did not think that there was any new diagnosis that was necessary for my dad to stay longer there. So I think there was some miscommunication possibly that I was not aware of, but although my dad must have signed that he would agree with the change of care. What he was told was it’s not going to be that much of a difference. But when he was changed to a different ward, like I said, the experience was pretty traumatic. So, I hope I’m making sense to you.

[00:18:23] Dr. JB: Yeah, so what I’m hearing is there was some kind of communication that happened between dad and his primary care doctor, and if dad was put in a psychiatric ward, which would mean that he would be stripped of all of his belongings, and he would not be able to communicate with the outside world, many times as they try to establish safety concerns or make sure that dad’s gonna be okay. Other than that, that’s the only situation where the healthcare professionals can essentially take away your rights as a patient and hold you against your will, if there is concerns for your safety or other people’s safety, but outside of that, patients always have the right to refuse anything. If they say I want to leave, there’s always the possibility that you could leave against medical advice. Cause I don’t want you to leave, you want to leave, so you leave against medical advice, but we can’t force you to stay against your will.

[00:19:21] Dr. Jun: So which he did. So he was out of that ward like after two days.

[00:19:25] Dr. JB: Okay.

[00:19:26] Dr. Jun: So, what I’m trying to say is he was not informed the way he should have been informed, I feel. The expectation that he had was quite the contrary from what he was told. So he wanted to be out of there right away, but because of administrative process, whatever that the hospital has to do, it took us longer to get him out of there. And after he passed away, we got a bill of, I can’t remember the exact amount of the bill, but it was more than $25,000. A stay that he never really was informed properly, first of all, and I feel we had to write letters to the hospital to get forgiveness of the bill because it was not something that he wanted.

[00:20:14] Dr. JB: And do you think that any of this had to do with other barriers, like language barriers?

[00:20:21] Dr. Jun: Yeah, language barrier. Also this assumption that I think many patients have that, and this is something that I had as a caregiver too, that we trust healthcare professionals to do their best to care for the patients. Although what I’m trying to say is not, I’m not condemning healthcare professionals, that they are not taking care of patients, I just feel there has to be more open communication that patients feel safe to speak up. Also, that healthcare professionals have to do all they can to communicate what is being expected and what is going to happen to the patient. And I feel in this specific situation where we were at, none of us had that experience. Then we were billed for it and we had to fight for forgiveness of that. I mean, it was a traumatic experience for my dad while in the hospital, to be in a psychiatric ward when he was normal, I mean, in our eyes, he had no issues with executive functions and making decisions, even when he went to a nursing home afterwards. And that was the next place where we were after the hospital. So, I’m not necessarily condemning the doctor either, and I think there’s some cultural– so he was a Korean doctor, so cultural assumptions or understanding, as a doctor’s point of view. I want to say that he made the professional judgment what’s best for my dad as a doctor, as a Korean doctor who has same cultural heritage, he probably may have seen the hoops that we have to go through to get the care. The next step was nursing home, so to get the care to that facility, which was not easy also, maybe that was why I never got a clear explanation of why from him. But I really don’t want to condemn anyone, but it’s just the lack of communication, gap of communication with healthcare professionals and the patient was what brought all this experience to be quite disastrous.

[00:22:37] Dr. JB: So you guys, as family never really understood why dad was put in the psychiatric ward either, or the reasoning behind that.

[00:22:44] Dr. Jun: Right.

[00:22:45] Dr. JB: And it’s, sometimes with nursing homes, depending on insurance coverage and whatnot, there’s a certain amount of days that patients have to stay in the hospital to be able to be placed in a nursing home, and so I’m not sure if maybe that played a role. After the fact, were you ever able to go back and try to get some explanation from that doctor?

[00:23:09] Dr. Jun: No. No, we did not.

[00:23:12] Dr. JB: And then how did that experience with that doctor affect, you, your dad, and your family moving forward? Did you guys continue seeking care from that primary care doctor?

[00:23:22] Dr. Jun: Well, we did continue with that doctor because he was specialized in geriatrics and he was Korean and that’s important for, I feel, the different ethnic background whose primary language is Korean. Although my dad was pretty fluent in English, there’s a lot of things that matter in healthcare, so I think cultural synchronicity is important for patients with different ethnic backgrounds. Not just because of the language, but culture, cause there’s just so much that in a very short amount of time that we have with the doctors, there’s so much you can, you have to explain why you are doing the things the way you’re doing, as far as taking care of yourself, your diet. There’s so much that different culture has effects on how patients live. So I guess patients like to get care, and this could be an assumption, some patients may not have a strong preference, but I think it makes total sense that patients want to communicate better with the doctors, so naturally they may seek healthcare who share the same ethnic background.

[00:24:37] Dr. JB: No, it allows for a instant bond to be created.

[00:24:42] Dr. Jun: Yeah, exactly. The doctor himself was very good with the limited encounters I had, but one thing that really did not make sense was when my dad came back from the ER visits with the hypoglycemic events, I called the primary and wanted to make appointments, and he said we didn’t have to. So that was something that was puzzling. And at hindsight, I did so many wrong things as a caregiver because I did not know any better, and I trusted. And that was a huge mistake that I advocate that patients need to not assume that what you’re told is everything. So I am all for patient empowerment and patients getting multiple opinions about their disease states and especially before getting procedures. And I know I’m speaking with you, you are a doctor, I’m not telling patients to mistrust necessarily, but in the setting that we’re in where it’s so hard for doctors to take care of patients properly and patients to get the care properly, there’s some homework that patients have to do before they make critical decisions in their healthcare.

[00:25:58] Dr. JB: I think one of the themes that you’ve been saying over and over again is the importance of communication and clear communication, and there’s nothing wrong with that, right? That’s actually really important because the person who is actually the expert of their body is the patient.

[00:26:15] Dr. Jun: Right.

[00:26:16] Dr. JB: And knowing how to be able to communicate your needs is essential because if they’re not communicated well, then there will be some miscommunication from both ends. Another theme that I’m hearing is also communication not only between provider and patient, but provider to provider. So that we ensure that the patient is receiving the best care possible with all the specialists that are involved in the patient’s case. And unfortunately, that also doesn’t happen,

[00:26:49] Dr. Jun: Right. Yeah. I used to work in a hospital where we have like outpatient pharmacy, we have urgent care. So all these doctors are kind of at the same place, but they still won’t talk to each other, you know? And in our record system we use Epic and we were all connected, so our hospital system had connected health records from pharmacy to the point of hospital. But, although we have a system that can cater to that, communicating with each other who saw this patient, our current model does not necessarily support communication along the providers who saw the patient, even with the tools that allows that.

[00:27:36] Dr. JB: Why do you think that is?

[00:27:37] Dr. Jun: Why do I think that is? Because, so many barriers, so I think insurance coverage is a big thing. Point of care coverage is the biggest issue I see, pay for service is the model that we have currently, except for a very few other models out there, like patient centered medical home, there is a team assigned to a patient, which is happening but at a very slow rate. So that’s one thing and really, there’s no time for doctors to devote extra time to see where this patient has been other than the place where you’re at. So that’s another barrier I see. Patients may not also, this is another communication issue, patients may not also communicate where they have been, what they had been doing, seeking outside of the care that you’re seeing right now, so that’s another barrier I see. So it’s on both ends and it all kind of goes around the system that it’s not patient-centered care necessarily.

[00:28:46] Dr. JB: So if it’s not patient-centered care, what centered care is it?

[00:28:50] Dr. Jun: I’m not sure. I’m not sure, I really don’t know how to call our healthcare really, because I don’t see, I don’t really see health, I don’t really see care. For many chronic patients that we see, I mean, especially if the patients have different ethnic backgrounds, minorities, language barriers, social determinants in health, other disparities that we see, really where is health and where is care?

[00:29:21] Dr. JB: Wow. That’s such a powerful yet stinging statement, ” I don’t see health and I don’t see care.”

[00:29:31] So you are a pharmacist. And so you went into pharmacy thinking that, ah, this is my way to bring health and bring care to healthcare. So what did you experience when you became a pharmacist? Were you able to do that?

[00:29:47] Dr. Jun: It can be a mixed answer, but short answer is no. In current setting where we are at– so I, I worked as an outpatient pharmacist, so in that setting, we would get prescriptions from the doctors and I had some ways to connect with care. So there are services called medication therapy management that’s offered by pharmacists in community setting which patients can utilize through their insurances or out of pocket, if pharmacies cater to it, but so through that kind of service, so it’s a service that you sit down with a patient, you go through the medication, you can go through the lifestyle changes they have to make, but the way we get paid through the insurance is also point of service, right? Everything is point of service. So, they pay maybe like once a year, and I guess nowadays, insurances have their own pharmacists who conduct medication therapy management. So for some chronic diseases, they offer like four times a year, but still there’s a lot of limitations.

[00:30:52] Lifestyle change and diet change is so difficult, and there’s a lot of things that patients have to change in order for them to change lifestyle and diet. It’s not very simple. So although pharmacists may be able to help managing medications, if there’s no continuous follow up, I don’t see this practice model can change patients’ progress in getting well.

[00:31:22] So that’s what I did, but I also worked as a population health pharmacist. So we get patient lists from insurances and even within the healthcare system that we were in, they could refer patients to our service, which is telephonic medication therapy management. So I would talk to the patient, I would reach out to the patient, we also would work with the patient navigators who are nurses and we kind of coordinate care together. And this was more of a experimental model that I know it has grown, but I still felt there was so much I couldn’t do because I felt like I had to be physically there with the patient to be able to really see what’s going on with the patient.

[00:32:08] As a pharmacist, my answer, and that was the reason why I worked as a patient advocate for a little bit to change that, change how I could take care of patients, to have some context, not telephonic, not just telephonic. There was some video, teleconferencing capability, but this was also, there was a lot of barriers to set that up for older patients who really don’t understand technology or have access to technology. So, I didn’t really find, I guess, ways I could practice as I wanted, so that’s why I’m being passionate. I feel like I’m kind of everywhere, advocating for patients, but really my focus is wellbeing of patients. Nothing else, nothing more. And when you have that crystal clear focus on patients, you get burnout. You get burnout, you get moral injury, because you know your purpose of being who you are as a healthcare professional is being compromised. And I know this, your podcast is about all about that, so I really love what you advocate for.

[00:33:20] Dr. JB: So along those lines, have you experienced burnout?

[00:33:23] Dr. Jun: Yeah, of course, of course. As a personal burnout, many pharmacies in retail settings and community pharmacies, it has been only a couple years or a few years that we started getting like assigned break. We used to be spending 8 to 12 hours all day without proper backroom lunch break.

[00:33:46] Dr. JB: Wow.

[00:33:47] Dr. Jun: And when I share this, a lot of people say, isn’t that illegal? If the law and the setting does not allow you to have a break, like what else can you do? There were multiple attempts from pharmacists organizing, requesting rights to get proper breaks over the years, but it has been turned down and, it really took us a long time for big chains like Walgreens and CVS to really have assigned time for breaks. And who wouldn’t get burned out? Who wouldn’t, right?

[00:34:23] I work in a hospital and I guess in the hospital setting, there’s so much you can get burned out from. I guess this one example can be, with COVID, and this is happening everywhere, short staffing affects pharmacy too. Not just nursing, it’s not just nurses. There’s a lot of talk about shortage of nurses, but in hospital setting we have short staffing too. So that’s something that anyone, I think, it’s not about who you are, anyone will get burnout from it. And in that setting, how can you take care of patients properly?

[00:35:00] Dr. JB: Exactly. Exactly. Because when you start having these symptoms of burnout, medical errors go up.

[00:35:09] Dr. Jun: And I mentioned it also that it becomes a moral injury that you question why you’re there. Why, why am I here? You question your purpose. So it affects your entire being, not just the care that the patients are receiving, your entire being is compromised. And it may sound like I’m exaggerating, but so many healthcare professionals, so many people I know as pharmacists question this.

[00:35:36] And this is something that I decided to talk about in this podcast because I think it’s important for people to hear, what can happen as burnout and moral injury. One of the founders in Patients for Patient Safety US is a director of movie called Bleed Out, and his mom experienced bleeding for a routine hip replacement surgery because a medication was not stopped properly.

[00:36:06] So a medication called Clopidogrel used to be stopped before, even if it’s a minor surgery, and she ended up bleeding. And the cascade of what he experienced, what she experienced, I mean the fact that the medication was not stopped, the incident that it was not stopped and she bled is only one incident, but the incidents that she experienced and he experienced as a caregiver, it’s all documented in this movie. And I happened to be at a conference for patient safety and I was watching this movie, and I ended up finding that this happened at the hospital where I worked at. And it was really difficult for me to process this because, one thing was that where my dad was getting care merged with our hospital, our hospital system, so I already had very complex feeling about the merger. And I was an employee at the system and I see this movie as a healthcare professional who is passionate about patient safety at a conference, and I just broke down after watching the movie. And I went to the director and I had to apologize on behalf of our healthcare system, although I was not anyone who could do anything big for that family, I felt obligated to apologize for what he experienced and what she experienced.

[00:37:35] We immediately connected, and after I came back, I wrote letters to the board and the CEO of the healthcare system, and because I wanted to do something to support his family and he was planning for a movie screening, local movie screening in Milwaukee, I wanted to support his movie but I felt conflicted internally as an employee of the system where I can be viewed as, why are you doing this? This is about healthcare system that you work at. So I had really difficult time processing all this and I had to quit my job.

[00:38:13] And I work in a different system now, but I wanted to share it. I don’t think I’ve shared it publicly, anywhere else, but now I work with him as a patient safety activist. I think it’s so important for healthcare system to realize how much moral injury they can cause for what they’re not doing after something goes wrong with patient’s family and caregivers. So, I told– his name is Steve, the movie director– I told Steve that I’m gonna, I’m going to share this, are you okay with it? And he’s like, go for it. Cause you are free to say whatever you want to say. But I worried, that what he would think if I publicly say something about his case, but it’s all in the movie. And we are so determined that change has to occur for wellbeing of healthcare professionals, but also for patients.

[00:39:09] Dr. JB: Yeah. There’s a phrase called vicarious trauma that healthcare professionals experience when things don’t go well, don’t go as planned. And of course we never want to take away anything from what the family experiences, what the patient experiences; however, with that said, so many other people also get affected from that. And I think going back to essentially, one of the themes from this conversation is the important role of communication.

[00:39:39] Dr. Jun: Definitely.

[00:39:41] Dr. JB: You take it out of the healthcare context, communication in relationships can save marriages sometimes. But it’s really important and something that we just don’t do that well, and we need more work and more training to really be able to effectively communicate.

[00:39:59] Dr. Jun: Yeah.

[00:40:00] Dr. JB: As well as communicate that mistakes happen. Right? Because as a healthcare professional, I understand we’re scared, because I do not believe that healthcare professionals intend to cause harm.

[00:40:11] Dr. Jun: No, no,

[00:40:13] Dr. JB: It’s always first do no harm.

[00:40:15] Dr. Jun: Right, right.

[00:40:17] Dr. JB: But harm sometimes occurs. And in those moments when harm occurs, how do we communicate that?

[00:40:26] Dr. Jun: So there are ways to do that. There are studies out, there are also tool called Candor offered by AHRQ that is shown to be very effective in reducing the healthcare cost, lawsuits, and the moral injury that patients and caregivers experience, So it’s a timely communication of the harm that occurred, and it benefits all parties involved, but there are only so many institutions that have, that are willing to spend resources and train people to practice this way, but it is shown to be very effective.

[00:41:11] There are, I know there are advocates who advocate for healthcare systems that caused the harm because they were properly treated and the harm was communicated with open and clear communication. So there are ways, it’s just that there’s so much blaming, shaming, a lot of psychological fear affecting the whole change to not occur, but it is shown to be effective and cost cutting. So I’m not sure who’s going to be listening to the podcast, if you are in a healthcare system and you are an administrative role, please, please spend time and money to train people in this. It lessens the further harm. There’s a harm and then there’s further harm after that if mess is not cleaned up properly, and it can affect the families and caregivers for lifetime.

[00:42:12] And there’s just so many people who don’t know how to speak up about their experiences. I have a like online publication medium platform and I have a publication called I Am Cheese where we envision that all of us be an extra cheese, so this is from like a seasonal model of patient safety incident happening, that we can be extra cheese slice that we can prevent harms from occurring. And healthcare system has to be proactive in being that extra cheese, even after harm has occurred. I cannot stress this enough. It’s so damaging to the families and caregivers and even generations to come afterwards and not to mention the public health. How do we trust healthcare? When stories like this gets released, how are you going to mend the damage? It’s even more catastrophic. I mean, if you think about it, it gets bigger and bigger. So why not be proactive in preventing, but also when harm occurs, clean up the mess right away. That is the right way to take care of patients and be accountable for what has happened, so trust can be reestablished. Then, the scars can be healed. A lot of all this is psychological issues that we fear so much, but it needs to be dealed with. Like you said, it’s a relationship. If we don’t heal, we cannot get better. We cannot mend the relationship.

[00:43:48] Dr. JB: So true. So if my listener wanted to find out more about the projects that you’re involved in, how could they do that?

[00:43:58] Dr. Jun: So I am in LinkedIn, you can just type my name, patient safety activist, I think that’ll bring me and our website of Patients for Patient Safety US is www.PFPS.us. So when you go to that website, if you want to be involved in how to make your organization to be safer with perspectives of patients safety activists, please reach out. There’s a form you can fill out and we’ll reach out back to you to have a conversation on how we can help your organization. And if you are a patient safety activist, you can be trained to be an activist with us. So there are multiple ways. And I’m also on Medium, if you type I Am Cheese, I have a online publication, we accept any healthcare stories that are worth listening. And we accept it in any language. So if your language is Korean, I speak Korean, I can translate the story into English. My hope is better communication and anything to do with communication and healthcare, I’ll be there. I’ll be there to help.

[00:45:16] Dr. JB: Yeah. Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some. Each one, teach one. I’m done.