On Friday I went to the Maryland Patient Safety Conference as one of the Armstrong Institute clinical patient safety fellows. I missed Rudy Giuliani’s keynote because I was busy taking care of patients in the hospital. Rudy, of course, is a well known patient-safety expert. Or at least I hope so, because I doubt he spoke for free.

What I did catch, though, were two very interesting talks on aspects of safety and quality which are near and dear to me. Keith Berge of the Mayo Clinic spoke about opioid diversion. Opioids are among the most commonly prescribed medications, and they have street value. Thus they are stolen, oftentimes by health care workers. Sometimes those health care workers are our patients too.

Berge’s presentation was remarkable for its unvarnished, pithy, piquant quality: stories of prostheses used to provide clean urine for witnessed drug tests; mug shots of convicted felons now serving jail time. “Some people say, you are criminalizing a medical problem [of addiction],” he said. “I say, you are medicalizing a criminal problem!”

Both are true, of course: criminal liability must be prosecuted but does that not limit the responsibility of the provider to understand the disease of addiction. In my setting, Johns Hopkins, we need to find those who are diverting opioids but at the same time we need to (a) find help for those addicted, (b) write fewer prescriptions in cases when the medicines don’t work and (c) not ignore pain treatment as we try and address substance abuse.Maryland Patient Safety Center

The second talk was by Jason Wolf, an organizational development specialist and a masterful user of anecdote. Patients, he claimed, are now the masters of the health care system, because they have the power of choice. Leave aside the naivete (many patients have no power to choose anything, much less health care). Wolf’s idea is that health care organizations can flourish in the market only if they provide patients with unforgettable experiences through superlative customer service. He told a couple of stories to this effect. A nurse goes out of her way to escort a patient on discharge to his car, even when the patient forgets where his car is and then the car happens to be parked in by another car. When the nurse finally returns to her unit, she is applauded for going the extra mile. Stories like these make you wonder: what about all the sick patients who need taken care of when the team is a man (or woman) down? Doesn’t safety and reliability matter as much as superior service?

When you’re at a big conference, you feel the crowd around you swept up by these talks, and you try to find the nuggets of useful information among the questionable suppositions.