Medical error is a name we put to human mistakes in medicine. Mistakes that can lead to a range of consequences, some severe. In medical school we don’t get taught about the very real future of us making mistakes. We have heard of the stories, but think “that would never happen to me”.
But, what about when it does?
It happens to everyone
Mistakes happen. Every single doctor has made an error. There is a huge spectrum of mistakes from near misses, to incorrectly prescribed medications, missed diagnoses, or even wrong legs being amputated.
Even the best doctor is not immune to missteps. So why do medics not speak of it when it’s actually inevitable?
I think being more aware of this fact and how to process it is essential for any ‘good doctor’.
My first error
When I was involved in my first major medical error I was inconsolable for a long time. It was an elderly patient that ended up with a misdiagnosis and after a few months they passed away. There was a whole chain of errors that led up to that outcome, and no one was particularly to blame (multiple health professionals were involved), but it still stays with me.
Writing about it is very difficult. I agonised over this error for months, I still think about it. What if I had discovered the diagnosis? Would he still be alive? Or would it have still ended up the same way? One of my colleagues told me that they had seen that case happen a few times, saying it was quite common. The medical indemnity lawyer reassured me that it was nothing to worry about. In medicine, the errors that occur are often not when one thing goes wrong, but a series of errors that line up. What they call – the swiss cheese model.
Despite all these facts and external reassurances, it still didn’t help with my guilt.
Photo from Sketchplantations
The support and advice I was given
My seniors reassured me. Saying that nothing I did contributed to the events that unfolded and that these types of errors are not blamed on an individual, but the system as a whole.
A senior surgeon told me, “this is your first mistake but it won’t be your last. I’d like to say it gets easier but it doesn’t.”
I was astonished. Everyone acted so nonchalant from my peers, to my seniors, counsellors and the lawyer. Without batting an eyelid, they said these things happen and will continue to happen. I heard their advice, but couldn’t believe it.
I was at the point of breaking, and could not sleep, eat, or enjoy life.
My work was becoming more and more demanding, and I was not coping. I became very fearful of making another error, and looking back I was in the midst of severe burnout. I asked for time off, a week even.
No luck, I was denied time off and given a number for a crisis hotline. Everyone expressed their sympathy, but doctors are expected to just work through it.
Things go wrong even if you do everything right
After this event I became very scared of making a mistake again. I thought by sheer willpower I could avoid any future errors. Unfortunately, this is impossible. Medicine is not a perfect science. Things can go wrong no matter your best efforts.
As Dr Gawande writes in his book Complications:
The fact is that virtually everyone who cares for hospital patients will make serious mistakes, even commit acts of negligence, every year. For this reason, doctors are seldom outraged when the press reports yet another medical horror story. They usually have a different reaction: That could be me. The important question isn’t how to keep bad physicians from harming patients, it’s how to keep good physicians from harming patients.Dr Atul Gawande – Complications
How do we keep good physicians from harming patients and why don’t we speak about it more openly?
Some things that could help would be better staffing, less overtime, and more senior support. Working your 100th hour with little sleep will affect your performance.
I believe we need to set up a support system for medics after negative patient outcomes happen. These events can really affect our emotional and physical health, with many physicians experiencing suicidal ideation afterwards or symptoms of PTSD.
If burnout is a risk for doctors and patients, we can’t ignore the signs or calls for help from our colleagues.
How to heal
- Try not to dwell on the ‘what ifs’, it won’t help the patient or you. Focus on the now and what you can do in the present moment
- Speak to someone about it – friends, family, seniors, co-workers
- Seek professional help – if you don’t already, find a great counsellor and/or GP
- Be kind to yourself – light a candle, go for a walk, eat a nice meal
- Forgive – yourself and others
- Learn from the mistake, and what you will do differently in the future
- Write about it – sometimes this is easier than saying it aloud, maybe pen a journal entry
- Give it time
- Your emotional reaction is valid, let yourself feel it and don’t let anyone minimise how you’re feeling
- Speak to your lawyer – call them and have a chat. Sometimes knowing the facts can make you feel at ease, instead of imaging worse case scenarios