Making Mistakes, Stress management, and leading a healthy medical life..

I recently came across a friend on Facebook with whom I sat the primary exam for emergency medicine (way back in 2005). On scrolling down his wall I also saw that he ran a medical education website with a podcast series had just reached 50,000 downloads.

Curiosity got the better of me, so I listened to a few of the talks and I thought they were fabulous! The ones that I listened to were exactly what most keen registrars (including myself) want to hear;- tricky clinical cases that are delivered in sound-bytes. They were also stories of what happened on the ED floor, what was done, and what was learned – all this delivered with the personal touch of ‘friendly non judgmental conversation’.

Check them out for yourself on;

Emergency Medicine Tutorials 

By Drs Chris Cresswell, Qasim Alam and Andrew Dean-Ballarat, Australia and New Zealand

http://itunes.apple.com/us/podcast/emergency-medicine-tutorials/id441003312?i…

The one that I particularly liked was the talk on “Stress Management” which touches many topics that are close to my heart such making mistakes. The talk also shares the wisdom of accepting that whilst we are doctors we are also ‘human beings’. Other topics in the talk included maintaining a healthy work-life balance with regular exercise, and of course, one of my favorites “navigating difficult consultants”, a necessary skill in the tricky world of medical hierarchy.

With regards to ‘making mistakes’ I think it is worthwhile including two links in this post which really flesh out some important reflections on this topic.

In the current culture of medicine it is so rare for doctors to come out and talk about their mistakes, and how it affected them, which is what motivated me to share the words of wisdom of some of those who ‘care’ enough to do so with this blog post.

The observation that we make lots of mistakes in medicine but rarely talk about them, to me also means we that we are also probably less likely to change our practice as much as we would if we discussed things. This deficit in training is one of the many reasons why I am pursuing a career in medical education and simulation medicine – to help improve the system. It is my theory that the more ‘au fait’ we become with dealing with mistakes and error in a kind and constructive way, the better we will become at delivering compassionate, and transparent, care to patients and their families.

“Making mistakes” in medical care and training?

Unfortunately what is often the end product after undergraduate and post graduate medical training is a perception by practicing doctors that “we always make the right decisions”, and if a mistake is made it is likely to be because of us not knowing enough – thus guilt is a strategy of coping with error, and a resolve to “learn more” after a mistake. Whist personal error may be present, it is rarely the sole factor and most mistakes when looked at in detail, a result of systemic error. So what is really needed is analysis and correction of the systems, rather than looking for individuals to blame.

Whist I tailor my practice and training towards minimizing error – making mistakes is still a fact of life, especially in the fast paced and unpredictable environment of emergency medicine, and this is one of the reasons that I still worry before working shifts in the ED after long breaks – because it is challenging work. So perhaps the parallel goal of education in medicine and Emergency Medicine is to teach doctors how to effectively and compassionately deal with the act of making mistakes and how to communicate better with one another, and patients, about this very sensitive subject?

Talking about mistakes in medicine

Having the courage to talk about ones mistakes is the first crucial step in this important training in compassionate health care, and Dr Brian Goldman gives a phenomenal TED talk on this very topic…

Also it is great to see that doctors are talking more and writing more about their errors, including how these mistakes affected both themselves and their patients. Sharing this kind of reflective wisdom in the public arena is so useful because it tends to give insight to families who have been the subject of similar systemic problems in our over-run health systems, that a) errors do occur, but also b) they often occur at the hands of competent and caring doctors. A wonderful post by a friend, and great doctor, who I know from the International Emergency Medicine scene (practicing in Sweden) illustrates just this. Katrina writes about a patient encounter that caused her to reflect upon the ‘system of feedback’ that is so lacking in our post graduate medical training, which in effect decreases our ability to learn from our mistakes, and learn how to treat patients better:-

Swedish medical students, interns and residents always complain about not getting any feedback on their performance. They are right of course. We have never learned how to give and get feedback and mistakenly take it for criticism. It is part of our culture. We kind of assume that everyone is doing their best and that they will learn eventually

I couldn’t agree more Katrin – and what a great read – thanks for your article!

Thanks again to Katrin, Brain and Chris for your reflections on making mistakes and leading a healthy medical life – you guys inspire me 🙂

 

 

Too much to think about?

Think a little,
But not too much,

For when you think too much,
You worry,

And when you worry,
You forget to ‘try’,

And instead you cry,

The tears of fear,
Instead of letting solutions appear!

13-6-12

 

I wonder if the concept of “too much to think about” is something that is floating around in the universe at the moment, affecting more than just me? The reason I ask this is that this moring when I woke up the above poem came to me, and the moral of that story is that perhaps it doesn’t pay to think too much? Now before going to be I recieved an email from a friend with this great music video/song with the chorus of “too much to think about” – in the song titled “Statistician’s Blues”.

I like the theme of statistician’s bluesStatistics have been a real source of blues for me over the PhD journey (click here to read about it!), but I must say that it has also led to some good things such as understanding some of the data i’ve been working on a bit better, and working with some cool statisticians! Either way I love this guy Todd Snider’s song – it’s a real winner – thanks Todd! (and thanks Celie for sending it to me 🙂

And if you don’t believe that there are some cool statisticians out there – check out this Swedish professor called Hans – what a passionate dude, and a very interesting talk!

Interesting interview from the “Godfather of Emergency Medicine”

I was just about to go to sleep at 5am after doing my research when I check the Life in the Fast lane’s list of recommended medical blogs. I clicked on a blog called “residing in the ER” and ended up watching a 3 minute video clip which was an interview with Peter Rosen, known for being the chief editor of one of the most highly recommended text books of Emergency Medicine (“Emergency Medicine: Concepts and Clinical Practice). The truncated interview that follows is taken from an in-progress documentary called “Heal Thyself”, and from what I can gather from this clip, explores a physicians struggle through the realities of modern medical practice that perhaps lead to “burn out”. 

The inteview illustrates this physician’s passion for treating patients, with care, and his inspiration of knowing “what to do” in the delivery of acute care. One of the things that moved me perhaps the most was the wise message given as a strategy to avoid burn out – which was  to “revitalise your ideals” and to connect with the “gift of affection”. However, as I watched this video I couldn’t help wondering “have the current systems of medical care changed so much that it is having effects on even the most passionate within the profession?”

I think the answer to this question is “maybe” as the pressures in hospital medicne and particularly emergency medicine are high, and increasing. Why is this? I think it is to do with the mismatch between the expectations of society, the legal system, hospital manangement, and what the doctors themself expect should constiute health care. 

I have had a special interest in burn out for many years now becuase I have always considered myself to be quite an enthusiastic and caring doctor, and, I am very keen that these qualities do not “burn out” – yet although the challenge is worthy, I feel the road is rocky, in todays high pressured hospital environment, and consequently today’s ‘training’ enviroment. Reading what is out there on the blogosphere I started to realise that I was not alone, and now seeing this clip from Peter Rosen it appears that this sentiment perhaps could be in association with esteemed company.

It has been of great interest to me to try and find tools to avoid burn out, and to maintaining the passion whilst walking the difficult path of training and medical practice. In my view the solution lies in “taking care of oneself” – and for me that involves, ensuring rest and satisfying the soul, through the journey of training. But I guess everyone’s path is different? Nevertheless, the concept of “Healing Thyself”, the proposed title of this documentary (from which the above video clip was taken), is of paramount importance if we are to be able to heal others, and this is something I certainly teach or mentor to those more junior than I whenever possible.

Perhaps those of us who are in medical education are familiar with the CanMEDS principles which are thought to strategically address some of these challenging situations created by modern health care – thorugh a more well rounded training of doctors. I think this is a very noble cause, one that I am very enthusiastic about – and the You Tube clip below shows some of these goals nicely played out with acting and music:-

However, whilst I’m optimist by this framework of training, I believe that at the same time there needs to be the development of “collaborative” common-sense expectations of health care delivery, that involve the ‘entire’ society, as a whole, if we are to avoid the mismatch from persisiting.  

 

Physician Heal Thyself


Physician Heal thyself,

Or you will feel like you are stranded on the shelf,

There is pain you seek to heal, 

But try not to deny what you feel,

 

How can it not affect me,

When it was ‘feeling’ that taught me to see?

How can it not deject me,

When suffering lives on the other side?

 

The change of tide is arriving,

Integration is thriving,

For a new age of understanding,

Is collaboratively re-expanding. 

 

Well there’s my poem for the night – Good night 🙂