You make mistakes, mistakes don’t make you. Maxwell Maltz
Let’s go back to where we started - the night I nearly killed my patient.
Time is a teacher and a healer
I was never given the opportunity to discuss this case in a non-critical forum, and the other residents were not given a chance to learn from my mistakes either. The only silver lining was that I read and learned everything I could about the management of severe PIH, and became so well-versed on this topic, that the other residents would ask me for help when they had to treat a patient with PIH.
All doctors have had a similar experience during their training, but this was the elephant in the room which no one was willing to discuss at that time. In fact, Dr Albert Wu has described the doctors and nurses who harm their patients as a result of their mistakes as being “the second victim”. The truth is that all doctors make terrible mistakes, and this is part of learning to become a doctor. Some are so scarred by these errors that they lose confidence in their abilities, and quit medicine.
With the passage of time, I have now learned to be kinder to myself. The truth is that medical errors will keep happening until we bring them out in the open and talk about them. However, because making an error is so shameful for a doctor, all we want to do is hide it. As doctors, if we make a mistake, this failure to take care of our patients is something we internalize; it is us - we are the error, and this can be hard to live with. The shame is so powerful that most doctors will never come forward and discuss their errors.
When only perfection will doIt’s partly the socialization of doctors which makes it so ha
rd for us to admit a mistake. We tend to pick perfectionists as medical students, knowing that the medical system is not for the faint of heart. Then they’re trained to become perfect. There’s no place for a “good enough” doctor – you are either excellent or terrible, which means there is no margin for error. Being perfect is tough, and you can’t spoil your image by discussing your errors.
Doctors are not alone in harboring expectations of perfection, and patients too expect their doctors to be flawless . As doctors, we are trained to take charge – to be the captain of the ship. That means you take personal responsibility for every single thing that happens to the patient in your care , whether or not it was your fault. You are responsible, and the buck stops with you.
When a complication occurs, the first feeling that envelops you is one of sadness, because you’re a healer and seeing people suffer makes you feel sad. This is compounded by the shame that you actually caused that suffering, followed by the fear that you are going to somehow be ostracized, sued, and humiliated publicly. Then comes the anger because you feel very alone and wonder why the system isn’t supporting you in this difficult time for you as a professional. Soon the panic sets in , as a result of all these emotions.
A ray of hopeThe good news is that hospitals are now realizing that they need to do a better job of supporting physicians when things go wrong. Dr Jo Shapiro, MD, helped start the Center for Professionalism & Peer Support at Boston’s Brigham and Women’s Hospital in October 2008, to offer emotional support to peers involved in cases of patient harm.
“When there’s any kind of adverse event that we hear about, one of us will make an outreach call to the physician involved,” says Dr Shapiro. This simple gesture gives doctors a chance to speak confidentially with a colleague, about the guilt, fear and shame that often accompany adverse events. “We also validate what they are feeling. We tell them that the suffering they’re feeling means that they care. We wouldn’t want people not to care.”
After an error, we need to support everyone post the event. Not only do we need to treat patients and families in a more humane fashion, we need to be equally kind to the doctors and nurses involved as well. Medically Induced Trauma Support Services (MITSS, www.mitss.org) was founded to assist in healing the relationship between clinicians and patients who have experienced an error together. MITSS also provides insights to the public to prevent errors from happening.
Strategies for helping the “”second victim” cope with error and
* Be open about error and its frequency. Senior doctors should talk openly about their personal mistakes.
* Stories can be a very effective teaching tool.
* Accept that a need for support is not a sign of weakness.
* Clinicians have to be resilient but almost all are grateful for the support of colleagues when disaster strikes.
* For a particularly profound reaction, perhaps to the death of a child, formal psychological intervention may be valuable.
* Teaching hospitals have to continue to teach junior doctors, but they should be supervised properly. Particularly in surgery, the use of simulation and models will help trainees learn new procedures with fewer risks to patients.