This is a topic I think about frequently. After watching Dr Brian Goldman’s TED talk on doctors making mistakes, I decided to write about it again.
Similar to Dr Goldman, and most medics, I took studying seriously. An overachiever from a young age, I worked hard to be near perfect. 100% was the goal in every assignment and test, anything less than the mark was akin to failure.
Medical school was no different. I worked hard to be “good” at what I did and I did well. Graduating medical school with Honours Class I and the University Medal, the idea of making mistakes in medicine was far from my mind.
It wasn’t something really spoken about in my training, besides one or two lectures in the whole five years of studying where we examined the “swiss cheese model”. It felt far removed, speaking about pilots, it was never something that was going to happen to me.
Going into medicine to help people was the aim, the idea of harming someone wasn’t on my radar.
Similar to the rest of my life, I felt if you tried hard enough you could be perfect.
Going into internship, I knew it wouldn’t be easy. My main dread was the overtime, new responsibility and fear of bullying or harassment (an unfortunately common experience for a lot of us docs). The idea of making the wrong decision or negative patient outcomes was not on that list.
I approached internship how I approached life in general, giving my 110% and always striving for the best care. Similar to Dr Goldman, it seemed to work well at first, until it didn’t.
The decline began slowly at first, if I was to pin point the moment I went from holding it all together to things unravelling it would be after my psychiatry rotation.
Right or wrongly, I felt the physical health of all those mental health inpatients was my direct responsibility. The psychiatric trainees were far removed from it and would spend most of their time in their offices. I shouldered the burden. I did well. One day there were three code blues simultaneously on my ward, two were new inpatients and the other had self-harmed.
I remember moving from one code to the next, I had called for back up, but I cannulated those ill patients myself and continued to monitor them after the fact. One was sent to intensive care, the other two remained in my care. Another day, I was the sole doctor at work for the entire level (with around 60 patients in my care) as a junior with half a year of work experience.
It all slowly added to my load. By the end of the term I was burnt-out, I didn’t realise at the time, but I had all the signs. Compassion fatigue, exhaustion and reduced professional capacity. The day I had 60 patients I broke down in front of everyone at work.
My four-week holiday afterwards didn’t fix it. I came back on relief, a term where you cover the whole hospital after hours. Night shifts, evenings, weekends. This is when my first major mistake happened. It was a missed bowel obstruction and ultimately the patient did not survive. Though logically, it wasn’t all on me as there were many people involved in this person’s care and it slipped by everyone, I took it hard.
Describing my headspace after the mistake is challenging. It was a whole body sensation where your stomach drops to the floor, your mouth goes dry, heart beats faster and you cling to anything in your mind to try explain away what you did. Guilt, shame, fear.
I felt I was the worst doctor in the world, how could have I made such an error? Unlike Dr Goldman, I shared with those that would listen. First a few trusted colleagues, they just seemed plain uncomfortable and the way they looked at me made me think my thoughts were right. It was just me.
Then I spoke to head of intern education, sharing what had happened. They assured me that I was fine, that nothing I did actually contributed to anything, and that these things happened. My supervisor at the time said the same thing, but also added, “it never gets easier”.
I figured if I worked even harder, double-checked everyone’s work including my own, and physically saw all the patients on that never-ending electronic “tasklist” I could avoid it ever happening again.
But I couldn’t. Soon, I saw every task and review as an error waiting to happen. My fear grew and so did my exhaustion and burnout. Even when I caught things correctly after hours, patients still died. It felt like I was trying to stop every drop of water fall off a cliff, but everything kept slipping through my hands. Anything less than perfect was added to my mental list of things I messed up on, the shame and guilt grew.
After a few more weeks of punishing myself for my mistakes I realised I needed a break. I could barely bring myself to show up to work everyday, it seemed a monumental task. So I asked for a week off…request denied, not enough staff.
So I kept going.
The way I felt inside was my secret shame. It didn’t seem to get easier. At the time I thought it was just me, that I was a bad doctor, and only bad doctors make mistakes.
But that’s the furthest from the truth. All doctors make mistakes, because we are human. No one presents like the textbook. People come to us with a long list of vague complaints that we need to try make sense of, often while we manage fatigue, hunger, thirst or burnout.
Where does this history of shaming mistakes come from? Why is it so taboo? How can we be open, like Dr Goldman, about our mistakes? So that medical students and doctors know it’s not about ‘if’ or working harder, it’s a matter of when and how we can manage that.
My dream is to move the medical culture from shaming to sharing, so that we can all learn from it openly. As well as allow medics to talk about it, get the help they need and realise they’re not a bad doctor or person for it.