Patients Safety Quotes

Leave the dishes. Let the celery rot in the bottom drawer of the refrigerator and an earthen scum harden on the kitchen floor. Leave the black crumbs in the bottom of the toaster. Throw the cracked bowl out and don't patch the cup. Don't patch anything. Don't mend. Buy safety pins. Don't even sew on a button. Let the wind have its way, then the earth that invades as dust and then the dead foaming up in gray rolls underneath the couch. Talk to them. Tell them they are welcome. Don't keep all the pieces of the puzzles or the doll's tiny shoes in pairs, don't worry who uses whose toothbrush or if anything matches, at all. Except one word to another. Or a thought. Pursue the authentic-decide first what is authentic, then go after it with all your heart. Your heart, that place you don't even think of cleaning out. That closet stuffed with savage mementos. Don't sort the paper clips from screws from saved baby teeth or worry if we're all eating cereal for dinner again. Don't answer the telephone, ever, or weep over anything at all that breaks. Pink molds will grow within those sealed cartons in the refrigerator. Accept new forms of life and talk to the dead who drift in though the screened windows, who collect patiently on the tops of food jars and books. Recycle the mail, don't read it, don't read anything except what destroys the insulation between yourself and your experience or what pulls down or what strikes at or what shatters this ruse you call necessity.

You get what you expect and you deserve what you tolerate.

no recovery from trauma is possible without attending to issues of safety, care for the self, reparative connections to other human beings, and a renewed faith in the universe. The therapist's job is not just to be a witness to this process but to teach the patient how.

To the person who has anything to conceal—to the person who wants to lose his identity as one leaf among the leaves of a forest—to the person who asks no more than to pass by and be forgotten, there is one name above others which promises a haven of safety and oblivion. London. Where no one knows his neighbour. Where shops do not know their customers. Where physicians are suddenly called to unknown patients whom they never see again. Where you may lie dead in your house for months together unmissed and unnoticed till the gas-inspector comes to look at the meter. Where strangers are friendly and friends are casual. London, whose rather untidy and grubby bosom is the repository of so many odd secrets. Discreet, incurious and all-enfolding London.

Above all, the therapist must be prepared to go wherever the patient goes, do all that is necessary to continue building trust and safety in the relationship.

My Father, the Age I Am Now Time, which diminishes all things, increases understanding for the aging. —PLUTARCH My mother was the star: Smart and funny and warm, A patient listener and an easy laugher. My father was . . . an accountant: Not one to look up to, Ask advice from, Confide in. A man of few words. We faulted him—my mother, my sister, and I, For being this dutiful, uninspiring guy Who never missed a day of work, Or wondered what our dreams were. Just . . . an accountant. Decades later, My mother dead, my sister dead, My father, the age I am now, Planning ahead in his so-accountant way, Sent me, for my records, Copies of his will, his insurance policies, And assorted other documents, including The paid receipt for his cemetery plot, The paid receipt for his tombstone, And the words that he had chosen for his stone. And for the first time, shame on me, I saw my father: Our family’s prime provider, only provider. A barely-out-of-boyhood married man Working without a safety net through the Depression years That marked him forever, Terrified that maybe he wouldn’t make it, Terrified he would fall and drag us down with him, His only goal, his life-consuming goal, To put bread on our table, a roof over our head. With no time for anyone’s secrets, With no time for anyone’s dreams, He quietly earned the words that made me weep, The words that were carved, the following year, On his tombstone: HE TOOK CARE OF HIS FAMILY.

Our own attitude is that we are charged with discovering the best way of doing everything.

We’re making up for what wasn’t done for our patients. What you didn’t provide—schools, jobs, safety.” In truth, though, over the first ten years he and his colleagues rarely had occasion to question the worthiness of what they were doing, simply because they were so busy doing it.

In the past two decades it has become widely recognized that when adults or children are too skittish or shut down to derive comfort from human beings, relationships with other mammals can help. Dogs and horses and even dolphins offer less complicated companionship while providing the necessary sense of safety. Dogs and horses, in particular, are now extensively used to treat some groups of trauma patients.10

Inside, Lexi saw only people on gurneys. Coughing, screaming, prostrate patients, but no doctors. She yelled for help, flapping open each curtain as she ducked through the maze of rooms. But there was no one.

Sometimes life doesn’t make sense. Sometimes there is no good reason for the events that take place. But most times, you’ll realize it will all make sense for a much better reason, if you’re patient enough to wait.

Five times was Athanasius expelled from his throne; twenty years he passed as an exile or a fugitive; and almost every province of the Roman empire was successively witness to his merit, and his sufferings in the cause of the Homoousion, which he considered as the sole pleasure and business, as the duty, and as the glory, of his life. Amidst the storms of persecution, the archbishop of Alexandria was patient of labour, jealous of fame, careless of safety; and

So what steps can a regulator take when it has established that there is a problem? In very extreme cases it can remove a drug from the market (although in the US, technically drugs usually stay on the market, with the FDA advising against their use). More commonly it will issue a warning to doctors through one of its drug safety updates, a ‘Dear Doctor’ letter, or by changing the ‘label’ (confusingly, in reality, a leaflet) that comes with the drug. Drug-safety updates are sent to most doctors, though it’s not entirely clear whether they are widely read. But, amazingly, when a regulator decides to notify doctors about a side effect, the drug company can contest this, and delay the notice being sent out for months, or even years.

Standing on the edge with my patients — abiding with them — means that I must harbor a true awareness that I, too, could lose my child through the play of circumstance over which I have no control. I could lose my home, my financial security, my safety. I could lose my mind. Any of us could.

You think you're lost. You think you're headed for disaster. But this isn't true. Quiet your mind. Be patient. Let go.

twisted form of Omerta, the Sicilian code of silence, and frankly, it’s protected many a bad doctor and some true butchers.

James Reason reminds us, “Errors are largely unintentional. It is very difficult for management to control what people did not intend to do in the first place.

Lean is about the total elimination of waste and showing respect for people.

We start by establishing inner “islands of safety” within the body.22 This means helping patients identify parts of the body, postures, or movements where they can ground themselves whenever they feel stuck, terrified, or enraged. These parts usually lie outside the reach of the vagus nerve, which carries the messages of panic to the chest, abdomen, and throat, and they can serve as allies in integrating the trauma. I might ask a patient if her hands feel okay, and if she says yes, I’ll ask her to move them, exploring their lightness and warmth and flexibility.

You understand—in my life Three—and Three alone have glimpsed—that the need to set down words—what I see, so—but words too, words mostly—words have been all my life, all my life—this need is like the Spider’s need who carries before her a huge Burden of Silk which she must spin out—the silk is her life, her home, her safety—her food and drink too—and if it is attacked or pulled down, why, what can she do but make more, spin afresh, design anew—you will say she is patient—so she is—she may also be Savage—it is her Nature—she Must—or die of Surfeit—do you understand me?

There is no justifiable reason why any man, woman or child on this planet should ever have to endure a single day without access to nutritious food,clean water,adequate shelter,healthcare,education and safety.

Wilson-Donovan wanted to move ahead as quickly as possible to clinical trials on patients, which was why it was so important to test Vicotec’s safety now before the FDA hearings in September, which would hopefully put it on the “Fast Track.” Peter was absolutely sure that the testing being concluded by Paul-Louis Suchard, the head of the laboratory in Paris, would only confirm the good news he had just been given in Geneva.

Attachment begins early but grows slowly. There are no shortcuts. Verbal guarantees of safety or nurturance carry no more weight than those for hair-replacement systems and miracle slicers. A therapist must prove trustworthy over time. Only consistent experiential demonstrations, in times of both quietude and turbulence, convince the child. Though all children love to be wined and dined, the safety, understanding, warmth, and containment of therapy are what foster trust and ultimately seduce the child patient.

At the very least, to set our healthcare workers, patients, and patient caregivers up for success, we must modernize the systems that guide their work and enable their voices to be heard—especially when they see opportunities to prevent harm and improve care environments.

Insecure and unfulfilled people cannot help but be jealous. Only inner security and individual fulfilment as a person will reduce jealousy until, one day, it disappears. It will be replaced by a calm confidence, a steady happiness, a strong resilience, and an interesting, beautiful life. If we keep our eyes on our own path in life, we will lose the egotistical pride which frequently accompanies success and also makes us vulnerable to a fall. When things go well, we will be grateful. When they do not, we will be patient. We will accept success with ease and perspective, and failure with tolerance.

In these pages, we keep returning to one foundational principle: providing the possibility of emotional/relational safety for our people, be they patients, children, partners, friends or strangers. We are able to make this offer when they are experiencing their own neuroception of safety, not continuously, but as the baseline to which we return after our system has adaptively moved into sympathetic arousal or dorsal withdrawal in response to inner and outer conditions. When we neuroceive safety, we humans automatically begin to open into vulnerability, and the movement of our "inherent treatment plan" (Sills, 2010) has a greater probability of coming forward. When we have a neuroception of threat, we adaptively tighten down at many levels, from physical tension to activation of the protective skills we have learned over a lifetime (Levine, 2010). In that state, our innate healing path will often wisely stay hidden until more favorable conditions arrive.

Don't get caught up in a vortex of 'should haves'. Regret is Fear's big sister. The one that should never be let in the door. Watch Regret from the safety of an interior window, watch her stand there on the stoop beneath the light waiting, patiently, always patiently, to be let in, her long hair prematurely gray, stiff with cold.

In therapy, to meet the needs of traumatized survivors of war and torture, the patient is requested to repeatedly talk about the worst traumatic event in detail while re-experiencing all emotions associated with the event. Traumatic memory, they say, is cleared by narration of whole life; from early childhood up to the present date ... this book is my therapy. I am awash with living memories.

Many of us in healthcare entered the profession because we wanted to help, heal, and serve. At our core, we have compassion, empathy, and a drive to help people live their best lives. Recognizing and implementing actions to prevent patient and employee harm has the greatest potential effect on the quality of care delivered in our health care system, just as preventative care and wellness efforts slow or stop the progression of disease.

Perhaps counterintuitively, monotasking getting there can also help improve our social relationships. We think we should respond to messages from friends and family as quickly as possible—but strong friendships are generally based on qualities deeper than response time. Overall responsiveness is important, but good friends should be patient, appreciate your full attention when you have it to give, and value your safety and that of others around you.

Frontline nurses came up with and implemented two more elements of the patient safety system: Safety Action Teams and Good Catch Logs. Safety Action Teams were self-organized groups of nurses who met to identify and reduce potential hazards in their clinical areas. Second-order problem-solving indeed. The Good Catch Logs were a way of celebrating near misses: by documenting good catches, nurses identified additional opportunities for process improvement.

The modern patient safety movement replaces “the blame and shame game” with an approach known as systems thinking. This paradigm acknowledges the human condition—namely, that humans err—and concludes that safety depends on creating systems that anticipate errors and either prevent or catch them before they cause harm. Such an approach has been the cornerstone of safety improvements in other high-risk industries but has been ignored in medicine until the past decade.

In patients with histories of incest, the proportion of RA cells that are ready to pounce is larger than normal. This makes the immune system oversensitive to threat, so that it is prone to mount a defense when none is needed, even when this means attacking the body’s own cells. Our study showed that, on a deep level, the bodies of incest victims have trouble distinguishing between danger and safety. This means that the imprint of past trauma does not consist only of distorted perceptions of information coming from the outside; the organism itself also has a problem knowing how to feel safe.

It was approaching night, the conversation having taken up the better part of a day. Out of the fragile light a fourth perezoso spoke, the olders and wisest of them, who had to descend to the forest floor on business no more than once every two or three weeks, but then required many hours to accomplish what was necessary. He said, "The truth is this. Dropped casually from the safety of our beloved branches, our shit would be merely shit. Hard and shapely as our patient nature makes it, it is still shit. But when we plant it in the ground where the jaguar walks, it becomes precious as jewels.

No doubt there are other inferior clinics out there. Poor care, overpricing, and rude staffers can be found in every medical field. But you don’t find people using examples of it to inveigh against an entire specialty—railing against the greed of orthopedic surgeons (average 2012 salary, $315,000) or calling for surprise inspections of dentists because every year a few people die from preventable errors during dental procedures.8 Only in abortion care do the few bad providers taint all the others—and taint them so much that opponents can pass laws that would virtually shut down the entire field in the name of patient safety. No

if our attention is what we're going to do next to accomplish a specific goal (often decrease a symptom) rather than openness to what the other person is bringing to the moment, we have stepped into our left hemispheres and out of relationship- and our patient will feel that as a kind of subtle abandonment. This interchange will likely happen below the level of conscious awareness and yet lead our person to step back a bit internally, awaiting the arrival of true presence, without agenda or judgement, so that safety can arise in the space in between. At that moment, the healing power inherent in this co-organizing/co-regulating relationship arrives. We have been returning to this crucial distinction in these pages, as much as possible with ongoing compassion for the challenge we experience as we open to the right remaining consistently in the lead.

In 2013 a study published in the Journal of Patient Safety8 put the number of premature deaths associated with preventable harm at more than 400,000 per year. (Categories of avoidable harm include misdiagnosis, dispensing the wrong drugs, injuring the patient during surgery, operating on the wrong part of the body, improper transfusions, falls, burns, pressure ulcers, and postoperative complications.) Testifying to a Senate hearing in the summer of 2014, Peter J. Pronovost, MD, professor at the Johns Hopkins University School of Medicine and one of the most respected clinicians in the world, pointed out that this is the equivalent of two jumbo jets falling out of the sky every twenty-four hours. “What these numbers say is that every day, a 747, two of them are crashing. Every two months, 9/11 is occurring,” he said. “We would not tolerate that degree of preventable harm in any other forum.”9 These figures place preventable medical error in hospitals as the third biggest killer in the United States—behind only heart disease and cancer.

We could have dramatically reduced COVID fatalities and hospitalizations using early treatment protocols and repurposed drugs including ivermectin and hydroxychloroquine and many, many others.” Dr. McCullough has treated some 2,000 COVID patients with these therapies. McCullough points out that hundreds of peer-reviewed studies now show that early treatment could have averted some 80 percent of deaths attributed to COVID. “The strategy from the outset should have been implementing protocols to stop hospitalizations through early treatment of Americans who tested positive for COVID but were still asymptomatic. If we had done that, we could have pushed case fatality rates below those we see with seasonal flu, and ended the bottlenecks in our hospitals. We should have rapidly deployed off-the-shelf medications with proven safety records and subjected them to rigorous risk/benefit decision-making,” McCullough continues. “Using repurposed drugs, we could have ended this pandemic by May 2020 and saved 500,000 American lives, but for Dr. Fauci’s hard-headed, tunnel vision on new vaccines and remdesivir.

McCullough observes that, “We could have dramatically reduced COVID fatalities and hospitalizations using early treatment protocols and repurposed drugs including ivermectin and hydroxychloroquine and many, many others.” Dr. McCullough has treated some 2,000 COVID patients with these therapies. McCullough points out that hundreds of peer-reviewed studies now show that early treatment could have averted some 80 percent of deaths attributed to COVID. “The strategy from the outset should have been implementing protocols to stop hospitalizations through early treatment of Americans who tested positive for COVID but were still asymptomatic. If we had done that, we could have pushed case fatality rates below those we see with seasonal flu, and ended the bottlenecks in our hospitals. We should have rapidly deployed off-the-shelf medications with proven safety records and subjected them to rigorous risk/benefit decision-making,” McCullough continues. “Using repurposed drugs, we could have ended this pandemic by May 2020 and saved 500,000 American lives, but for Dr. Fauci’s hard-headed, tunnel vision on new vaccines and remdesivir.

All Night, All Night Rode in the train all night, in the sick light. A bird Flew parallel with a singular will. In daydream's moods and attitudes The other passengers slumped, dozed, slept, read, Waiting, and waiting for place to be displaced On the exact track of safety or the rack of accident. Looked out at the night, unable to distinguish Lights in the towns of passage from the yellow lights Numb on the ceiling. And the bird flew parallel and still As the train shot forth the straight line of its whistle, Forward on the taut tracks, piercing empty, familiar -- The bored center of this vision and condition looked and looked Down through the slick pages of the magazine (seeking The seen and the unseen) and his gaze fell down the well Of the great darkness under the slick glitter, And he was only one among eight million riders and readers. And all the while under his empty smile the shaking drum Of the long determined passage passed through him By his body mimicked and echoed. And then the train Like a suddenly storming rain, began to rush and thresh-- The silent or passive night, pressing and impressing The patients' foreheads with a tightening-like image Of the rushing engine proceeded by a shaft of light Piercing the dark, changing and transforming the silence Into a violence of foam, sound, smoke and succession. A bored child went to get a cup of water, And crushed the cup because the water too was Boring and merely boredom's struggle. The child, returning, looked over the shoulder Of a man reading until he annoyed the shoulder. A fat woman yawned and felt the liquid drops Drip down the fleece of many dinners. And the bird flew parallel and parallel flew The black pencil lines of telephone posts, crucified, At regular intervals, post after post Of thrice crossed, blue-belled, anonymous trees. And then the bird cried as if to all of us: 0 your life, your lonely life What have you ever done with it, And done with the great gift of consciousness? What will you ever do with your life before death's knife Provides the answer ultimate and appropriate? As I for my part felt in my heart as one who falls, Falls in a parachute, falls endlessly, and feel the vast Draft of the abyss sucking him down and down, An endlessly helplessly falling and appalled clown: This is the way that night passes by, this Is the overnight endless trip to the famous unfathomable abyss.

In July 2018, a safety crisis rocked the global drug supply—and seemed to prove Baker’s point. Regulators in Europe announced a harrowing discovery: the widely used active ingredient for valsartan, a generic version of the blood pressure drug Diovan, contained a cancer-causing toxin known as NDMA (once used in liquid rocket fuel). The drug had been made by the Chinese company Zhejiang Huahai Pharmaceuticals, the world’s largest manufacturer of valsartan active ingredients. In the United States, over a dozen drug manufacturers, all of which used the Chinese ingredient, recalled their products, as did dozens more manufacturers around the world. The Chinese company tried to defend itself by explaining that it had altered its production process in 2012 to increase yields of the drug, a change that had been approved by regulators. In short, the change had been made to maximize profit. Some patients had been consuming the toxin for six years. As the FDA tried to reassure consumers that the risk of developing cancer, even from daily exposure to the toxin, was extremely low, a second cancer-causing impurity was detected in the ingredients. Though the valsartan catastrophe seemed to take the FDA by surprise, it shouldn’t have. In May 2017, an FDA investigator had found evidence at the plant in Linhai, China, that the company was failing to investigate potential impurities in its own drugs, which showed up as aberrant peaks in its test results. The investigator designated the plant as Official Action Indicated, but the agency downgraded that to VAI. In short, the company was let off the hook—only to wind up in the middle of a worldwide quality scandal less than a year later. By

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Thakur’s findings were not news to Ranbaxy’s top executives. Just ten months earlier, in October 2003, outside auditors started investigating Ranbaxy facilities worldwide. In this case, the audits had been ordered up by Ranbaxy itself. This was a common industry practice: drug companies often hired consultants to audit their facilities as a dry run to see how visible their problems were. If the consultants could find it, they reasoned, then most likely regulators could too. The fact-finding mission by Lachman Consultant Services left Ranbaxy officials under no illusion as to the extent of the company’s failings. At Ranbaxy’s Princeton, New Jersey, facility, auditors found that the company’s Patient Safety Department barely functioned and training was essentially “non-existent.” The staff had no written protocols for investigating patient complaints, which piled up in boxes, uncategorized and unreported. They had no clerical help for basic tasks like mailing out the patients’ samples for testing. “I don’t think there’s the same medicine in this medicine,” was a common refrain from patients. Even when there were investigations, they were so perfunctory and half-hearted that expiration dates were listed as “unknown,” even when they could easily have been found from a product’s lot number. An audit of Ranbaxy’s main U.S. manufacturing plant, Ohm Laboratories in New Jersey, found that the company, though required to report adverse events to the FDA, rarely did so. There was no system to capture patient complaints after hours, and no global medical officer to ensure that any potential negative consequences for patients were being monitored. The consultants from Lachman urged Ranbaxy to address these problems globally. Ranbaxy’s initial reaction to the findings was to question the number of hours, and the resulting invoice, that Lachman had sent for its work.

I’m sorry, I should have realized you’d be hungry. If you let me give you intravenous fluids, it would help.” The moment she put the glass down, she retreated to her computer desk. He ignored her comment. Why do you not feed? The question was asked casually, curiously. His black eyes were thoughtful as he studied her. From her position of safety across the room, Shea watched him. The weight of his gaze alone broke her concentration, took her breath away. She was feeling far too possessive of this patient. She had no right to tangle her life around his. It was frightening that she was reacting so uncharacteristically to him. She had always felt aloof, remote, detached from people and things around her. Her analytical mind simply computed facts. But right now, she could think only of him, his pain and suffering, the way his eyes watched her, half-closed, sexy. Shea nearly jumped out of her skin. Where had that thought come from? Knowing she wouldn’t want to think he was reading her mind at that precise moment, Jacques did the gentlemanly thing and pretended merely a casual interest. It was nice to know she found him sexy. Smugly he lay back with his eyes closed, long lashes dark against his washed-out complexion. Despite the fact that his eyes were closed, Shea felt as though he witnessed every move she made. “You rest while I shower and change my clothes.” Her hands went to her hair in a futile effort to tidy the wild thickness of it. His eyes remained closed, his breathing relaxed. I can feel your hunger, your need for blood nearly as great as my own. Why would you attempt to hide this from me? With sudden insight he let out his breath. Or is it that you are hiding from your own needs? That is it--you do not realize it is your hunger, your need. The gentleness in his flooded her body with unexpected heat. Furious that he could be right, she stalked into the bathroom, shrugged off her robe, and allowed the warm shower to cascade over her head. His laughter was low and taunting. You think to escape me, little red hair? I live in you as you live in me. Shea gasped, whirled around, grabbed frantically for a towel. It took a moment to realize he was still in the other room.

Some of these bots are already arriving in 2021 in more primitive forms. Recently, when I was in quarantine at home in Beijing, all of my e-commerce packages and food were delivered by a robot in my apartment complex. The package would be placed on a sturdy, wheeled creature resembling R2-D2. It could wirelessly summon the elevator, navigate autonomously to my door, and then call my phone to announce its arrival, so I could take the package, after which it would return to reception. Fully autonomous door-to-door delivery vans are also being tested in Silicon Valley. By 2041, end-to-end delivery should be pervasive, with autonomous forklifts moving items in the warehouse, drones and autonomous vehicles delivering the boxes to the apartment complex, and the R2-D2 bot delivering the package to each home. Similarly, some restaurants now use robotic waiters to reduce human contact. These are not humanoid robots, but autonomous trays-on-wheels that deliver your order to your table. Robot servers today are both gimmicks and safety measures, but tomorrow they may be a normal part of table service for many restaurants, apart from the highest-end establishments or places that cater to tourists, where the human service is integral to the restaurant’s charm. Robots can be used in hotels (to clean and to deliver laundry, suitcases, and room service), offices (as receptionists, guards, and cleaning staff), stores (to clean floors and organize shelves), and information outlets (to answer questions and give directions at airports, hotels, and offices). In-home robots will go beyond the Roomba. Robots can wash dishes (not like a dishwasher, but as an autonomous machine in which you can pile all the greasy pots, utensils, and plates without removing leftover food, with all of them emerging cleaned, disinfected, dried, and organized). Robots can cook—not like a humanoid chef, but like an automated food processor connected to a self-cooking pot. Ingredients go in and the cooked dish comes out. All of these technology components exist now—and will be fine-tuned and integrated in the decade to come. So be patient. Wait for robotics to be perfected and for costs to go down. The commercial and subsequently personal applications will follow. By 2041, it’s not far-fetched to say that you may be living a lot more like the Jetsons!

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Angie’s persistent focus on patient safety and education sets her apart from the profit-driven businesses that dominate the market. She is the first person-in-the-know on new discoveries in the field, always up to date on this ever-changing industry.

In the past two decades it has become widely recognized that when adults or children are too skittish or shut down to derive comfort from human beings, relationships with other mammals can help. Dogs and horses and even dolphins offer less complicated companionship while providing the necessary sense of safety. Dogs and horses, in particular, are now extensively used to treat some groups of trauma patients. 10

Oh, and what about the nurse? She was fired and charged as a criminal. That’s Newton, too. If there are really bad effects, there must have been really bad causes. A dead patient means a really bad nurse. Much worse than if the patient had survived. So much worse, she’s got to be a criminal. Must be. We can’t escape Newton even in our thinking about one of the most difficult areas of safety: accountability for the consequences of failure.

A stock is not just a ticker symbol or an electronic blip; it is an ownership interest in an actual business, with an underlying value that does not depend on its share price. The market is a pendulum that forever swings between unsustainable optimism (which makes stocks too expensive) and unjustified pessimism (which makes them too cheap). The intelligent investor is a realist who sells to optimists and buys from pessimists. The future value of every investment is a function of its present price. The higher the price you pay, the lower your return will be. No matter how careful you are, the one risk no investor can ever eliminate is the risk of being wrong. Only by insisting on what Graham called the “margin of safety”—never overpaying, no matter how exciting an investment seems to be—can you minimize your odds of error. The secret to your financial success is inside yourself. If you become a critical thinker who takes no Wall Street “fact” on faith, and you invest with patient confidence, you can take steady advantage of even the worst bear markets. By developing your discipline and courage, you can refuse to let other people’s mood swings govern your financial destiny. In the end, how your investments behave is much less important than how you behave.

For some patients tapping acupressure points is a good anchor.23 I ask others to feel the weight of their body in the chair or to plant their feet on the floor. I might ask a patient who is collapsing into silence to see what happens when he sits up straight. Some patients discover their own islands of safety—they begin to “get” that they can create body sensations to counterbalance feeling out of control. This sets the stage for trauma resolution: pendulating between states of exploration and safety, between language and body, between remembering the past and feeling alive in the present.

The seeds of change were planted in the early 1990s when the NIH began requiring that both sexes participate in human research. But this initial effort fell short because the NIH didn't require researchers to compare males and females, or to analyze enough participants of each sex to be able to establish whether there were differences in the ways male and female patients with the same condition present, or the effects of sex on the safety and efficacy of a drug or treatment regimen. It wasn't until 2014 that the NIH required that all animal research consider sex as a biological variable. This led to an explosion in work directly comparing the two sexes to establish whether significant differences exist.

If the eating disorder is concretized by the "not-me" ED, the patient is allowed the safety to look around comers, to follow this "other self' into the kitchen; the bathroom; yes, even the bedroom; to observe. Shame and blame are reduced; curiosity is enhanced. Conceptually this is interesting. Many patients are able to observe once allowed to look. They know well who they are at these moments. Relationally, however, they have never been entitled to look, and, as a result, self-observation and understanding have been thwarted by relational constraints and consequent immediate behavioral enactments. Ongoing, the patient is asked to consider what alternative behaviors can replace eating, purging or restricting. If the patient weren't thinking about food or weight, what else would she be thinking about? What else is needed? As the patient begins to consider concrete alternatives to symptomatic behavior, "contracts" are developed between patient and therapists.

There should be no learning curve as far as patient safety is concerned.” But that is entirely wishful thinking.

Later abuse or other traumas did not account for dissociative symptoms in young adults.40 Abuse and trauma accounted for many other problems, but not for chronic dissociation or aggression against self. The critical underlying issue was that these patients didn’t know how to feel safe. Lack of safety within the early caregiving relationship led to an impaired sense of inner reality, excessive clinging, and self-damaging behavior: Poverty, single parenthood, or maternal psychiatric symptoms did not predict these symptoms.

This is how we know that Anthony Fauci was well aware of remdesivir’s toxicity when he orchestrated its approval for COVID patients. NIAID sponsored that project. Dr. Fauci had another NIAID-incubated drug, ZMapp, in the same clinical trial, testing efficacy against Ebola alongside two experimental monoclonal antibody drugs. Researchers planned to administer all four drugs to Ebola patients across Africa over a period of four to eight months.10,11 However, six months into the Ebola study, the trial’s Safety Review Board suddenly pulled both remdesivir and ZMapp from the trial.12 Remdesivir, it turned out, was hideously dangerous. Within 28 days, subjects taking remdesivir had lethal side effects including multiple organ failure, acute kidney failure, septic shock, and hypotension, and 54 percent of the remdesivir group died—the highest mortality rate among the four experimental drugs.13 Anthony Fauci’s drug, ZMapp, ran up the second-highest body count at 44 percent. NIAID was the primary funder of this study, and its researchers published the bad news about remdesivir in the New England Journal of Medicine in December 2019.

Compare ivermectin’s safety record to Dr. Fauci’s two chosen COVID remedies, remdesivir (which hospital nurses have dubbed “Run-death-is-near”), and the COVID vaccines. Over 30 years, ivermectin has been associated with only 379 reported deaths, an impressive death/dose reporting ratio of 1/10,584,408. In contrast, over the 18 months since remdesivir received an EUA, about 1.5 million patients have received remdesivir, with 1,499 deaths reported (a dire 1/1,000 D/D ratio). Meanwhile, among recipients of COVID jabs in the US during the ten months following their rollout, some 17,000 deaths have occurred following vaccination, a reported D/D ratio of 1/13,250. Ivermectin, therefore, is thousands of times safer than remdesivir and COVID vaccines. The science also indicates that it is far more effective than either.

Messieurs and Mesdames, I am a student of psychology. All through this case I have looked, not for the bad-tempered man or woman, for bad temper is its own safety valve. He who can bark does not bite. No, I have looked for the good-tempered man, for the man who is patient and self-controlled, for the man who for nine years has played the part of the under dog. There is no strain so great as that which has endured for years, there is no it resentment like that which accumules slowly.

The moment he spoke in Telugu with them, something in the room changed. There was a new sense of comfort in the air, a sense of ease and safety. It was the feeling of assurance that came with being surrounded by their own people.

in predictive ability to randomized placebo-controlled trials.33 Furthermore, Risch observed that it is highly unethical to deny patients promising medications during a pandemic—particularly those which, like HCQ, have long-standing safety records.

The report acknowledges that, “The BMGF developed a model of chloroquine penetration into tissues for malaria.”69 BMGF’s unique dosing model for the studies deliberately overestimated the amount of HCQ that necessary to achieve adequate lung tissue concentrations. The WHO report confesses that, “This model is however not validated.” Gates’s deadly deception allowed FDA to wrongly declare that HCQ would be ineffective at safe levels. The minutes of that March 13, 2020 meeting suggest that BMGF knew the proper drug dosing and the need for early administration. Yet their same researchers then participated in deliberately providing a potentially lethal dose, failing to dose by weight, missing the early window during which treatment was known to be effective, and giving the drug to subjects who were already critically ill with comorbidities that made it more likely they would not tolerate the high dose. The Solidarity trial design also departed from standard protocols by collecting no safety data: only whether the patient died, or how many days they were hospitalized. Researchers collected no information on in-hospital complications. This strategy shielded the WHO from gathering information that could pin adverse reactions on the dose.

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While it’s natural to move quickly from one thought to the next, strong emotions take a while to subside. Thoughts are all electricity. Emotions add chemistry. Once the chemicals that fuel emotions are released, they hang around in the bloodstream for a time—in some cases, long after thoughts have changed. So be patient while the chemistry catches up with the electricity. Allow people time to explore their path and then wait for their emotions to catch up with the safety you’ve created.

The answers are perhaps as varied as the questions one asks, but a common theme that comes through in discussions with caregivers on the front lines and those who think a great deal about patient safety, is our failure to change our culture. What we have not done, they say, is create a “culture of safety,” as has been done so impressively in other industries, such as commercial aviation, nuclear power and chemical manufacturing. These “high-reliability organizations” are intrinsically hazardous enterprises that have succeeded in becoming (amazingly!) safe. Worse, the culture of health care is not only unsafe, it is incredibly dysfunctional. Though the culture of each health care organization is unique, they all suffer many of the same disabilities that have, so far, effectively stymied progress: An authoritarian structure that devalues many workers, lack of a sense of personal accountability, autonomous functioning and major barriers to effective communication. What is a culture of safety? Pretty much the opposite! Books have been written on the subject, and every expert has his or her own specific definition. But an underlying theme, a common denominator, is teamwork, founded on an open, supportive, mutually reinforcing, dedicated relationship among all participants. Much more is required, of course: Sensitivity to hazard, sense of personal responsibility, attitudes of awareness and risk, sense of personal responsibility and more. But those attitudes, that type of teamwork and those types of relationships are rarely found in health care organizations.

n the treetops, this powerful vision was built for speed—seeing and reacting quickly. On the open grassland, it was the opposite. Safety and finding food relied upon slow, patient observation of the environment, on the ability to pick out details and focus on what they might mean. Our ancestors’ survival depended on the intensity of their attention. The longer and harder they looked, the more they could distinguish between an opportunity and a danger. If they simply scanned the horizon quickly they could see a lot more, but this would overload the mind with information—too many details for such sharp vision. The human visual system is not built for scanning, as a cow’s is, but for depth of focus.

I believe this particular part of 1 Corinthians 7 is an important practical resource. Each partner in marriage is to be most concerned not with getting sexual pleasure but with giving it. In short, the greatest sexual pleasure should be the pleasure of seeing your spouse getting pleasure. When you get to the place where giving arousal is the most arousing thing, you are practicing this principle. When I was doing research for this chapter, I found some old talks that Kathy and I did together. I had forgotten some of the struggles we had in our early days, and some of the notes reminded me that in those years we started to dread having sex. Kathy, in those remarks, said that if she didn’t experience an orgasm during lovemaking, we both felt like failures. If I asked her, “How was that?” and she said, “It just hurt,” I felt devastated, and she did, too. We had a great deal of trouble until we started to see something. As Kathy said in her notes:   We came to realize that orgasm is great, especially climaxing together. But the awe, the wonder, the safety, and the joy of just being one is stirring and stunning even without that. And when we stopped trying to perform and just started trying to simply love one another in sex, things started to move ahead. We stopped worrying about our performance. And we stopped worrying about what we were getting and started to say, “Well, what can we do just to give something to the other?” This concept also has implications for a typical problem that many couples experience in their marital relationship—namely, that one person wants sex more often than the other. If your main purpose in sex is giving pleasure, not getting pleasure, then a person who doesn’t have as much of a sex drive physically can give to the other person as a gift. This is a legitimate act of love, and it shouldn’t be denigrated by saying, “Oh, no, no. Unless you’re going to be all passionate, don’t do it.” Do it as a gift. Related to this are the differences that many spouses experience over what is the most satisfying context for sex. While I am not saying this is universal, I will share that, as a male, context means very little to me. That means, to be blunt, pretty much anytime, anywhere. However, I came to see that that meant I was being oblivious to something that was very important to my wife. Context? Oh, you mean candles or something? And, of course, Kathy, like so many women, did not mean “candles or something.” She meant preparing for sex emotionally. She meant warmth and conversation and things like that. I learned this, but slowly. And so we learned to be very patient with each other when it came to sex. It took years for us to be good at sexually satisfying one another. But the patience paid off. Sex

At the time of a response, it is paramount that you as a responding paramedic respect the command structure and follow orders to the greatest extent possible without compromising personal, team, or patient safety.

Graham developed his core principles, which are at least as valid today as they were during his lifetime: A stock is not just a ticker symbol or an electronic blip; it is an ownership interest in an actual business, with an underlying value that does not depend on its share price. The market is a pendulum that forever swings between unsustainable optimism (which makes stocks too expensive) and unjustified pessimism (which makes them too cheap). The intelligent investor is a realist who sells to optimists and buys from pessimists. The future value of every investment is a function of its present price. The higher the price you pay, the lower your return will be. No matter how careful you are, the one risk no investor can ever eliminate is the risk of being wrong. Only by insisting on what Graham called the “margin of safety”—never overpaying, no matter how exciting an investment seems to be—can you minimize your odds of error. The secret to your financial success is inside yourself. If you become a critical thinker who takes no Wall Street “fact” on faith, and you invest with patient confidence, you can take steady advantage of even the worst bear markets. By developing your discipline and courage, you can refuse to let other people’s mood swings govern your financial destiny. In the end, how your investments behave is much less important than how you behave.

Clinical handovers are high-risk situations for patient safety. Errors lead to delays in diagnosis and treatment, unnecessary tests and treatments, incorrect patient treatment, increases in the length of hospital stay, patient complaints, and malpractice claims.

Although the handover report is crucial to ensuring patient safety and continuity of care, it is surprising that most training programs neglect to focus on or develop this skill.

First Do No Harm,24

unique to three areas: medical, pharmaceutical and basic research. Medical ethics covers informed consent, doctor-patient confidentiality, and organ donation, to name a few. “Outsourcing Medical Studies—and Ethical Quandaries—to Africa” by David Biello delves into the lack of medical ethics boards in Africa and how this affects participant safety

Mistakes, on the other hand, result from incorrect choices. Rather than blundering into them while we are distracted, we usually make mistakes because of insufficient knowledge, lack of experience or training, inadequate information (or inability to interpret available information properly), or applying the wrong set of rules or algorithms to a decision

No problems is a problem.

In the lean approach, companies are taught that prices are set by the market and that one way to improve profit margin is to reduce costs. This thinking flies in the face of "cost plus" thinking, where we look first at our own costs and set prices based on our desired profit margin. The reality is that most companies whether manufacturers or hospitals, do not have market power to set prices as they wish.

Gwendolyn Galsworth writes that the purpose of visual management is to reduce "information deficits" in the workplace. She writes that "In an information-scarce workplace, people ask lots of questions, and lots of the same questions, repeatedly- or they make stuff up.

Earlier in the day, Coast Guard helicopters had arrived and volunteered to spend an hour transporting healthy people to safety (they didn’t have enough space for seriously ill patients on stretchers). “Part of the disaster was natural, but a big, big part of it was man-made and poor decision making,

abortion will continue. Many opponents claim to be taking the moral high ground. However, by depriving them of their civil rights, opposition to abortion hurts women and is thus unethical. It condemns women to mandatory motherhood. This attitude is not new. The systematic maltreatment of women has been institutionalized by governments and religions for several millennia.56 57 58 The clarity and cogency of the argument against abortion should be sufficient to sway public opinion. However, over the past four decades, this has not been the case. Opponents of abortion have resorted to eight murders,59,60 arson, firebombing,61 intimidation of women and clinicians,62 governmental intrusion into the physician-patient relationship,63 imposition of obstacles that deter and delay abortion, and increased costs.64,65 A broad campaign of deception and chicanery, including crisis pregnancy centers and disinformation sites on the Internet,66 has influenced decisions about abortion and its safety. Without the smokescreen about abortion safety, the ongoing attack on women and health care providers might be recognized for what it is: misogyny directed against our wives, sisters, and daughters. Ironically, the same political conservatives who oppose “big government” and its interference in our daily lives are sponsoring anti-abortion legislation mandating more intrusion of government into the private lives—and bodies—of American women. While the ethical dimensions of abortion will continue to be debated, the medical science is incontrovertible: legal abortion has been a resounding public-health success.18,19 The development of antibiotics, immunization, modern contraception, and legalized abortion all stand out as landmark public-health achievements of the Twentieth Century.

Sylvan heard her stumbling along behind him as they made their way down the side of the mountain and every instinct he possessed shouted that he needed to go back and help her. Needed to hold her in his arms and carry her to safety. But he forced himself to go on. She doesn’t want me, doesn’t want my help or my touch. It was true and he knew it. The rejection he could handle. But the fear in her eyes… Sylvan clenched his jaw. Goddess, that she could ever think I would hurt her. The very idea was like a fist in his gut. He would rather be hurt himself, would rather be wounded a thousand times over than allow her to get a single scratch. Should have left her alone. Shouldn’t have healed her. That was what scared her the most, waking up and seeing me bending over her with my fangs out. But he had been so worried. And besides, it was impossible for him to see her hurt and not want to heal her. He had told her once, the second time they met, that as a doctor he had no emotional attachment to his patients. But it was different with her—so very different. And those few moments before she’d woken up completely, before she’d started fearing him, had been beyond compare. He

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So be patient when exploring how others think and feel. Encourage them to share their path and then wait for their emotions to catch up with the safety that you've created.

She asked a question. “Was everything as safe as you would like it to have been this week with your patients?”5 The question – genuine, curious, direct – was respectful and concrete: “this week,” “your patients.” Its very wording conveys genuine interest. Curiosity. It makes you think. Interestingly, she did not ask, “did you see lots of mistakes or harm?” Rather, she invited people to think in aspirational terms: “Was everything as safe as you would like it to be?

The emotions of patients are encoded in their behavior. It’s an easy task to recognize a crying person as sad. But a compulsively attentive patient, documenting every lab result and asking well-formulated questions about antibiotic choices, is less easy to decode as anxious. I myself didn’t recognize my own anxiety at the time. I believed I was appropriately adapted to my environment. An environment that required intense vigilance and anticipation of some impending cataclysm. The casual complacency I observed in others struck me as horribly naïve. Every solicitation to “just rest” filled me with contempt. I knew what would happen if I left the watchtower untended. I would die. I believed it was entirely up to me to ensure my own safety.

No one knew how many people were hurt by negligent care—that is, substandard care.

How many people were harmed by medical treatment in hospitals? What percentage was caused by errors ? By negligence ? Of those harmed by negligent care, how many sued? What were the costs of medical injury —not just for those harmed by bad care, but for all patients, including those who suffered nonpreventable injuries? How were these costs paid for? All was unknown. All was potentially knowable.

several studies of overuse of healthcare services and was leading a study of underuse.

I wanted to work on quality improvement; injury and costs were clearly quality issues. At the time, I had not thought much about medical errors

States required hospitals to report deaths but rarely investigated their causes. The Joint Commission asked hospitals to report “sentinel events” (serious injuries), but few hospitals did. Surgical departments had M&M meetings, but neither other departments nor the hospitals kept tabulations or continuing records of iatrogenic injuries. Medical injury was largely invisible, and hospitals and doctors liked it that way.

We finally settled on “adverse event .” We spent many hours debating its exact definition and ultimately agreed on “an unintended injury that was caused by medical management rather than the patient’s underlying disease.” The important point was to distinguish harm caused by treatment from harm caused by disease, independent of whether there was an error or negligence . We knew that making this judgment would be difficult for doctors, as it indeed proved to be.

The most common source of injury caused by treatment in the hospital, of course, is a surgical operation,

We would focus on adverse events that could potentially trigger a malpractice suit. These were injuries that resulted in some degree of disability, temporary or permanent, including death, or were sufficiently severe to prolong the hospital stay.

In our sample of 30,121 records, we found that 1133 patients had suffered an adverse event , which computed to a serious injury rate of 3.7%, a bit lower than what the Mills study found. Twenty-seven percent of AEs were judged to be due to negligent care. From these data we estimated that in 1984 there were 98,689 adverse events in New York hospitals, of which 13,451 (13.6%) were fatal [3].

Adverse event rates were higher in large academic medical centers than in community hospitals, but the fraction due to negligence was much lower.

more than two-thirds of the injuries seemed to be potentially preventable.

documentation issues were more common in small private hospitals, where records were less standardized and notes were sparse because only the patient’s physician writes progress notes. In teaching hospitals, by contrast, there are multiple notes by residents, medical students, and nurses as well.

On balance, we believed that our rates, shocking as they were, underestimated the true extent of harm . In fact, later studies would bear this out.

then nationwide 1.3 million patients were injured by medical care in American acute care hospitals that year, and 180,000 died

This meant that of the projected 180,000 deaths each year, more than 120,000 were potentially preventable.

The results of the study were published in two papers in the New England Journal of Medicine in February 1991 [3, 4].

we estimated that the total lifetime cost of adverse events in New York State in 1984 was $3.8 billion