(MedEd)itorial: The Medical Errors of Our Ways

  • /Reviewed by: Amy Rontal, MD
  • We’re all human, and humans make mistakes, right? Well, that may be true; but in medicine, it’s hard to get anyone to talk about them.  

    Recently, I made a mistake with one of my patients that caused me to seriously question my competence as a physician. Although everything turned out fine in the end, I lost a few nights of sleep debating whether my colleagues could have a made a similar mistake and whether I even have the right to be practicing medicine in the first place. I know a lot of doctors, who collectively have several thousands of years of medical practice, and none of them ever talk about serious mistakes they’ve made that could have caused a patient great harm.

    According to an article that came out in the British Medical Journal in the May 3, 2016 edition, medical errors kill about 250,000 people per year, accounting for the third leading cause of death in the United States. While that number has been debated, it certainly appears that many of my colleagues can and do make mistakes with potential harm all the time. Additionally, the BMJ article does not discuss mistakes that do not ultimately cause harm. Obviously, this makes the actual number of errors much larger.

    This got me thinking. If doctors are making mistakes all the time, why did I feel all alone with nobody to talk to about a mistake of my own? Why was I questioning my competence after a simple error that turned out to be nothing, when literally hundreds of thousands of these errors are made every year, sometimes costing people their lives?

    The Culture of Medicine is Punitive

    There are likely several reasons this happens. Firstly, the culture of medicine is quite punitive and this begins from the first day of medical school. I’ve written about this before regarding depression and suicide in the medical profession. Physicians are terrified of showing any kind of weakness for fear of repercussions. These may take the form of actual punishment by hospital or health systems, or it may take the form of ridicule from one’s peers. Of course, the litigious nature of the environment in which we practice doesn’t help either.

    Another obvious reason that it’s difficult to talk about personal medical errors is simply that nobody else is talking about them. Nobody wants to be the first to admit to their friends and colleagues that they made an error that could hurt or even kill someone. This is how I felt when I made a mistake. Some of my best friends are other physicians. However, none of them has ever confided in me after making a dangerous mistake. I had to actually start thinking about what is known on a national scale in order to realize I wasn’t the only one who could do something like this.

    Finally, the personality of the types of people who pursue medicine as a career path is often the same type of personality that makes discussing our own mistakes difficult in the first place. All of this creates a toxic environment in which people feel alone and isolated when they make a medical error that likely happens across the country many times per year.

    So How Do We Deal with Mistakes?

    With all of this in mind, I’d like to suggest a better approach for dealing with medical errors. I am not going to discuss systems approaches to dealing with these errors, as there are people who are much wiser and more qualified than myself already dealing with this problem. I am going to address the personal aspect of medical errors. How should an individual deal with his or her own personal medical mistakes?

    The first thing that we must come to terms with is that we are going to make mistakes. We are human beings. There is no way around that. In addition, because of the nature of our work, some of these mistakes may be dangerous. This does not make us terrible people or even terrible doctors.

    Does that mean it’s okay to make a mistake? Well, yes and no.

    While it doesn’t make you a bad person or a bad doctor, it’s certainly okay to feel bad about it temporarily. It’s also very important to realize that, while to some degree they are unavoidable, we need to take every opportunity to learn from our mistakes so that we do not repeat them and so that we make less of them over time. In other words, it is not okay to just shrug them off.  This requires a mental flexibility that does not come easily to everyone. Yes, it is a big deal, but nevertheless, we have to find a way to take something positive from these experiences, use them as learning opportunities, and then move on.

    I also think that sometimes it’s important to be able to talk about it. Talking can help us learn from our mistakes, but it can also alleviate the feelings of loneliness and isolation that come with feeling like you are the only one who’s ever messed up. For me, it was important to find a colleague with whom I felt comfortable enough to admit my mistakes. If you can’t find a colleague you trust, talk to a friend or family member.

    Lastly, if you are an individual who thinks that you have not made any dangerous mistakes, think again. Statistically, it is nearly impossible, and you are doing yourself and your patients a disservice by not admitting it to yourself when it happens. You run the risk of putting subsequent patients in danger by not learning from your mistakes and you rob yourself of the personal and professional growth that become possible from making such an admission.