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[[ Dr. Gary Eric Kalkut-Chief Medical Officer, Montefiore Medical Center ]]
[Good morning. I'd like to start with a story.]
[I was a medical student at Boston University in 1980,]
[and there was a new senior physician who had come to BU]
[who had been the Chairman of Medicine of a large medical center, actually, in Tennessee.]
[I had a chosen elective where we walked around the hospital ]
[and did physical examinations on people with interesting physical findings.]
[I had never met this guy, he'd just arrived--this was August I think--]
[and I met him in the lobby of the hospital--this was at BU--]
[Boston City Hospital was there, now called Boston Medical Center, University Hospital--]
[we met in the lobby, and he said to me, ]
["Son, you're the luckiest medical student in this place. I'm the best physician in America."]
[He started taking me around, and we felt spleens, and we looked at rashes.]
[We smelled ammonia on people with cirrhosis of the liver,]
[listened to heart murmurs, looked in eyes--did all sorts of things.]
[It was a wonderful experience for me.]
[It was hard for me to tell at the time whether he was the best physician in America,]
[Over a period of four weeks, I got to know his approach,]
[and even though I can now always feel a spleen, I can hear very faint murmurs,]
[I can identify rashes--what he taught me was something else.]
[It was how we approach people at the bedside.]
[He always sat down. He never rushed.]
[He always listened, and he took his time.]
[What is this that I'm hearing? ]
[ He said something at the end of that month-long elective about the approach to patients.]
[How to make people feel comfortable. How to make people feel respected.]
[How to make sure the curtain was always closed before you did anything.]
[How he always introduced himself. That was the lesson of that.]
[In fact, feeling spleens, listening to murmurs, all of that is great,]
[but at that time in Boston, there was a single CT scanner in the city of Boston--one.]
[We now have CT scanners, portable ones, in the intensive care unit, ]
[and I don't care how good your ears are, or how good your hands are,]
[you can see things on a CT scan that are difficult to feel.]
[But the purpose of a physical exam--or one purpose of it--]
[you still can find things without question--is to engage a patient, touch a patient,]
[make someone feel comfortable]
[As Bob said earlier, it is about anxiety--high anxiety.]
[It's about vulnerability. It's about fear. It's about the unknown.]
[I'm talking about people coming into the hospital who are sick.]
[So, how do you address that?]
[One way to address it, is to do what this physician did]
[--is to get down at the patient level.]
[Two weeks into this elective, he took me into an empty room]
[--wasn't sure what was going on--and he gave me a gown, and he said, "Put it on and lay down."]
[So, it was an empty bed. I was a medical student, and I had a stethoscope.]
[I laid down, and he brought in some doctors,]
[and they started talking to me, interviewing me,]
[and I was looking up at them, and it was completely different.]
[I had always been looking down. Now, I was looking up.]
[They were poking me. They were prodding me.]
[It was a totally different experience. I felt depersonalized.]
[Again, it's taking that perspective.]
[So, for me, design which is a five-century experience in the hospital]
[is about addressing those concerns that patients, and families and, frankly, staff have]
[about all those issues that come up.]
[What is this machine? What--you told me we were going at three o'clock?]
[It's seven o'clock. I haven't gone for my test yet.]
[Somehow, every stage of the way, from the bedside]
[to the hallway, to the common areas, all through the hospital environment, ]
[needs to address those issues in patient care.]
[It's about--for us--signage. Every day--Montefiore is a large place,]
[I'll show you in a minute--every day people are looking at a piece of paper ]
[and wondering where to go, and I look at the signs]
[--there's blue zones and yelow zones and silver--can't figure out where the hell to go. ]
[We actually ask people now--and our staff are pretty good about it--]
[stop, talk to the person, walk them to where it is because if you say, ]
["Go left, go right, down the stairs and across to these elevators,"]
[they're never going to get there. Our signs needs to be better. Our maps need to be better.]
[I also think it relates to doctors and the words that people use.]
[The language because people hear different things, particularly in a moment of vulnerability.]
[How that language is used--not traditionally something of design--]
[is very important for how--not only doctors but nurses, techs talk to people.]
[What they say because people will hear all sorts of things,]
[and when there's mixed messages, it gets very confusing, and it just enhances]
