lessons from the super bowl

Monday, February 6, 2017

At Super Bowl half time, the New England Patriots adapt to the reality of their situation, losing by 25 points and to win, they will have to overcome the greatest deficit in the game’s history. At the same time, the Atlanta Falcons will have to maintain the performance and momentum that allowed their lead to accumulate. The Patriots adapt and prevail and there are lessons in patient care that can be learned from the game.

A sure thing doesn’t exist

Patients and families always ask about the odds of what might happen next. Whether it is a heart attack, stroke, infection or surgery, people want the future predicted. Statistics can help guide decision making and suggest who might do better or worse, but until the dust settles, nobody really knows. Ultimately, the patient will do well…or they won’t.

The Patriots overcame the largest deficit ever to win the Super Bowl. They weren’t supposed to win. In-game statistics suggested that the Falcons had a greater than a 97% chance of winning with less than 5 minutes to go.

Every doctor has a had a patient who was doing well, recuperating from a procedure or recovering from an infection, when minutes later, without warning, they crash: blood pressure drops, heart and breathing rates spike, the patient becomes unconscious and quickly dies. No reason, no warning…bad karma.

There’s always hope

The corollary to an unexpected patient crash is the patient who seemingly has no chance of recovery and almost miraculously wakens to walk out of the hospital. Ironically, while these experiences can give hope to patients, families and doctors, the reality is that patients who are in end-of-life situations most often die.

Sports fans almost never give up hope, whether their team is down by 25 points or needs a miracle to make the playoffs, hope springs eternal. Many Patriot fans, including President Trump, were reported to have not watched the last half of the game because of the presumed forgone conclusion.

The issue in medicine is that sometimes care can be futile, causing pain and suffering for the patient. It can be very difficult for a doctor to present that situation to the family, especially if a crisis arises quickly and there has been no time to prepare. The doctor remembers that one patient, years ago, who miraculously survived.

It’s usually more than one thing

When a patient does poorly, it is usually more than one event that causes the situation to deteriorate. The body’s many systems are closely intertwined. An illness or injury causes the body to turn on its response systems but some diseases inhibit the body’s ability to react. Diabetics and patients who take medications that decrease immunity may have a hard time generating a response to infection and stress. Some heart medications inhibit the body from reacting to blood or fluid loss. Every patient is unique and as the body ages, it loses gradually its ability to overcome the stress of illness or injury.

Sportswriters, radio talk show hosts and a variety of analysts and experts try to define the one play that allowed the Falcons to collapse, but it was more than a Ryan fumble, or an Edelman catch. Perhaps it was a well-placed Patriot kickoff or a sack in the last few minutes of the game. More likely, it was a combination of all. Each by itself is not a catastrophe, but together, they changed the tide of the game.

Medicine is the same way. Patients can tolerate one or two system failures but keep adding malfunctions and the body reaches a point of no return. When things go bad, the body is programmed to sacrifice less important organs, to allow the brain to survive. The body is happy to maintain circulation to the vital organs (think heart, lung, liver, kidney and of course brain) to the detriment of all else. If one or more of these organs is already compromised, the body has a decreased ability to respond and recover.

Finding the scapegoat

The Patriots won as a team and the Falcons lost as one as well. There may have been individual efforts or decisions that were in the spotlight, but many events had to occur both good and bad, that resulted in the outcome of each play. Tom Brady might have been given time to throw a pass because of an exceptional effort by a lineman. A defensive player may have occupied two blockers to allow a teammate to make a tackle. The purpose of film review is to find the small things that can lead to big differences both  positive and negative and game plan fro the future.

When a patient develops a complication, a similar review happens in the hospital. M&M rounds, morbidity and mortality, demand that adverse patient outcomes be presented in an open forum for discussion. It is a learning environment, where medical care is reviewed to see whether warning signs of impending badness were missed, whether the outcome was inevitable or whether the patient just had bad karma. Bad outcomes can happen, even if everybody does the right thing, but the review has to happen. Medical care can’t get better unless doctors ask why.

Sport is life

We learned many lessons from this historic Super Bowl and not surprisingly, they are as applicable to medicine as they are to football. And just as likely, they apply to everything else in life just as well.

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