Since moving into research, the patients who visit my thoughts have been distilled. I’m only visited by “the lovelies” and those I wish I could have treated differently – “the uglies.”
If I look critically at it, I don’t even really mean mistakes. Sure, mistakes are part of it, but often it is just something that niggles. Maybe it was a system problem that I could have prevented. Maybe there was a complication of a procedure, reasonable, but one I felt I could have avoided. Maybe I irritated another staff member without understanding why.
There is no outlet to discuss medical mistakes. Everybody has things in their lives that they wish they could do over, but in medicine, it takes on a whole new dimension. It is confronting to admit to a friend that you were mean to your significant other. It is terrifying to admit to anyone that you were mean to a patient.
One of my first jobs with higher responsibilities was in orthopaedic surgery (bones and joints). I was a 2nd year resident, doing a job reserved for third years. I had hit the big time – resident during the day, but the chance to do first on call, and first assists on my after hours calls.
One weekend we had a killer list of emergencies. We had a young guy with a fractured pelvis and acetabulum that took hours to repair. I’m sure there were multiple hip fractures to deal with. There was also a guy who rolled his ute and fractured his spine, and needed a HALO. A smattering of fractures came through, requiring closed reduction. And I assisted in my first tibial plateau ORIF. The rest of the cases have faded now, but I remember spending most of both weekend days in the OR, racing back and forth to ED to see new patients. Patient notes would get restricted to a few lines, with the consent often giving more information than the admission notes. And lines of chinese whispers (registrar to consultant to registrar to patient to family to ward staff) s l o w e d. We were swamped.
I got a real rush from that weekend. The surgeon and I worked really hard and participated in some fascinating cases.
About six weeks later, I got to the end of my rotation and got quite reserved feedback. The consultant said the medical team were really happy with me, and thought I had progressed really well.
Then he said “But it all fell apart a bit in the middle there, didn’t it? You ha all those issues with the ward.”
“Hunnn uh.” (Thinking “What? No way! I was the queen!”)
Consultant continues: “But you got it together again and returned to your high standard. So we are going to give you great feedback.”
I walked out shell-shocked. I wish I had of said that I had no idea what he was talking about (I didn’t). I had no idea I fell apart (a sign that I was out of touch). But I was so nervous about admitting anything, even in a closed room at feedback, that I missed the opportunity to understand. All I can figure out is that killer weekend cut me off from the ward staff – I just didn’t have time to talk to them. I remember telling them about a NFR order an hour after talking to the family. Maybe they didn’t get what was going on that weekend. Maybe their weekend was as busy as mine, and I was really bad at making it easy for them. I don’t know. I can’t really ever find out now.
But that review, and that question stays with me now. I turn it around in my head often. If I could admit that I am not medically perfect, then maybe I would sleep better.
Image courtesy of Arkworld on Flickr.
Cris one of the hardest things for each one of us to admit to ourselves is that we are not perfect. What we often fail to understand is that nobody, I mean NOBODY is medically perfect.
Thanks, Vijay. I feel pretty strongly that external expectations makes us clam up about mistakes, and not learn what we can from them.
I know how much I suffer from it. You’ll notice this post is not about a patient care mistake, but a staff management mistake. I have trouble airing all of them, and I’d be a better doctor if I could discuss them.
Vijay said so well what I want to say. Still I know what you mean.