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 🙂