Grand Rounds Report: Building Pyramids at Bayview

by Academy of Clinical Excellence on September 25, 2009

I recently attended the Department of Medicine’s Grand Rounds at Johns Hopkins Bayview Medical Center. Drs. Hellmann, Trost, and Ziegelstein presented a talk entitled “Building Pyramids at JH Bayview: A young man with chest pain”.
The presentation focused on Mr. N, 49 yr old man, who was driven to the Emergency Department by his wife with chest pressure, sweating, nausea. Within minutes, he was diagnosed as having an acute myocardial infarction (heart attack) and he was whisked away to the ‘cath lab’ to have his coronary artery opened up with a stent.
The presenters allowed the patient and his wife, both of whom work at our institution, to tell their stories so that all in attendance could feel as if they truly know them as people – their children, their jobs, their vacation plans, how they work out together at the gym… They modeled the importance of knowing the patient with the disease rather than simply focusing on the disease that the patient has.
It has been shown that shorter elapsed time, from presentation until the opening of the blocked artery, can be the difference between life and death. Mr. N and his wife were amazed with how efficiently things proceeded. Dr. Trost explained the processes that have been put into place to allow the ‘Percutaneous Coronary Intervention (PCI) Program’ to realize the clinically excellent care that they offer – meeting or exceeding benchmarks in guidelines. The collaboration of the entire PCI team, both within the Division of Cardiology and beyond (with the EMTs, the ED, hospitalists…), was emphasized. The success of the program, which may be most accurately assessed by seeing full recovery in patients like Mr. N, is a source of pride for all members of the PCI team.

When asked if anything could have been done better during the brief hospitalization following the procedure, Mr. N told the audience that while walking the hallways as a patient in a gown with an IV pole in the step down unit, doctors passing him would avert their eyes and not say a word. He wished that they would have acknowledged his presence, and said “Good morning” or “How are you today?”.

In closing the session, Dr. Hellmann asked us all to thank Mr. & Mrs. N for coming and sharing their story by acknowledging the patients that we pass in our travels through the institution.
Getting to know our patients as people and connecting with those walking through the hospital are practices related to humanism in medicine, one of the domains of clinical excellence.
Walking back to my office from Grand Rounds, smiling at and saying hello to everyone I passed, did not taking any longer than usual.
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