If you have been practicing medicine for any length of time, you will have encountered poor outcomes with patient care. Even with the best of intentions and knowledge, mistakes happen. As we all know, there are things we do to prevent mistakes from happening, but it is even more important to know what to do when those mistakes happen.
Most of us remember the tragic mistake of a traveling nurse at Vanderbilt University Hospital, when she mistakenly gave a patient vecuronium bromide instead of Versed. That was a mistake based on this nurse’s bad habit of short-cutting through her medical orders on the electronic dispensaries. Long story short, the patient died and the nurse has now been sentenced to probation as a result.
Closer inspection of this incident may likely reveal that the mistakes made were not solely done by the nurse, but several hospital departments and possibly the administration itself, who may bear some level of culpability in the death of that patient. Of one thing I am sure: poor handling of mistakes guarantees that other mistakes will happen, and whoever makes those mistakes will cover them up to avoid facing severe consequences. Creating an environment of forgiveness when mistakes are made sets the tone for learning from those mistakes and everyone wins, especially the patients.
I am no stranger to mistakes. I have made mistakes I am aware of and I am sure that there are mistakes I have made that I am not aware. I’m not going to say I like it when these events happen, who would? But if you are not using every opportunity that mistakes give you to improve — medically and personally — you are wasting that mistake, and ensuring similar mistakes will happen down the road.
I had once mistaken a breast neoplasm for mastitis. After catching the mistake, a week or two later than I should have, I apologized to the patient that I had not thought of that sooner, and she thanked me for my honesty. I could not have faced this patient again, if I had not admitted to this mistake and made things “square” with her.
Critically assessing your own skills is a vital part of good medical practice. If you persist in the assumption that you can do no wrong, you are short selling your patients and are an accident waiting to happen. When you receive negative comments, are you receptive to them? Do you dismiss them outright or are you attentive to any truth that may be in the comment?
All criticism should at least be considered. Some of it, for literally seconds, but if you are too quick to dismiss criticism, you run the risk of sliding down the slippery slope of self delusion. Criticism that is taken seriously should pass a litmus test: Who is making the criticism? Could there be validity to what they are saying? Is there any reason you may have for not believing the criticism? Are you running away from the truth? Considering criticism through this lens helps to separate constructive criticism from personal insults.
The difference between valid and invalid criticism is in the content, so listening to that content is important. And that’s the hard part. It is hard to listen to your mistakes: it takes humility, and self awareness. Figuring out if there is any validity to it and acting on that will be the difference between you being adequate and you being great as a clinician. Honestly discussing your patient’s poor experiences with them is what engenders trust and loyalty.
Developing trust in patient relationships requires an apology when you have made a mistake. Speaking directly and without defensiveness is disarming and will go far toward healing any bad feelings between the patient and yourself. Showing kindness and generosity in these discussions, not emphasizing your side of the story over the patients is very important. Being kind is never a mistake and does not make you weak or naive — on the contrary, it shows that you know what you are doing and recognize when something has gone wrong, and more importantly, that you are interested in making it right, if possible. On the other hand, rushing to an apology is also a mistake. Apologies should be thoughtful and personal, or they are not worth doing and can blow up in your face. A hasty or disingenuous apology is sometimes worse than nothing at all, because it can appear as if you are apologizing out of your own self interest.
A good clinician always knows what they don’t know. I know that there is a lot of medicine that I don’t know and I am happy to learn from those around me, patients and support staff included. Recognizing and learning from the wisdom around you is always a good habit to cultivate, in and out of the clinic.
One of my mentors told me that it takes a lot of humility to be good at medicine and she was right. I learned so much from her about patient interaction, diagnosis, treatment, and interoffice rapport, and every time I would thank her or commend her on something, she would nod at me to move on. At the end of every day she would share some of the epiphanies of medicine she had as a student and clinician, and as I recall, most of those had started with an error or oversight on her part that she learned a great lesson from.
Once you have determined the cause of the mistake and your part in it, and you have learned what to do the next time it presents itself, let it go. You have learned from the mistake and it will only undermine your confidence to keep beating yourself up about it. We all make them, and you are no exception. You have to make mistakes to make progress. What you do after the mistake is what determines and creates character and wisdom. Do not fear your mistakes, learn from them.
How did you respond after a medical mistake? Share in the comments what you did well or could have done better.
Arlene Dorrough has been a practicing PA for more than 15 years. She is currently working in occupational medicine and urgent care. She is also working as a Medical Examiner for the DOT. Arlene is a 2021–2022 Doximity Op-Med Fellow.
Illustration by Jennifer Bogartz