Mistakes and how we recover: a measure of our success

 

On listening to mock interview responses from our women JMOs at our latest MWS workshop I was struck by their insight, maturity, skill and humility. The junior doctors spoke with passion about their motivations to choose a training pathway and what skills they brought with them.

Yet when we asked a question about an error they were involved in, I was surprised by their replies.  “Describe an error you have made, what you did immediately after the event and what lessons you have learned”. The junior doctors bravely recounted their errors. They could all accurately identify the moment a mistake was made. An incorrect drug dose ordered, a missed diagnosis on ECG, a failure to adequately handover a deteriorating patient. All familiar experiences. Each mistake “could have been me”. The other doctors listening were encouraging and empathetic. When discussing the lessons learned, two common themes emerged. The JMOs readily identified their own errors but struggled to see all the contributing factors – the business of the shift, the pressure from nursing staff to discharge a patient, the lack of senior medical support on the ward, the fatigue. The “swiss-cheese” effect. The second theme was that pervading sense that the error was a defining measure of their competency as a doctor.  That one error invalidated the excellence in the rest of their work. One JMO said “it was completely my fault” another that “I got ahead of myself, I thought I was a senior resident and I ready to take on more. I was wrong.” 

Some wise words from Queen Oprah come to mind “At some point, you are bound to stumble. If you’re constantly pushing yourself higher and higher, the law of averages predicts that you will at some point fall. And when you do, I want you to remember this: There is no such thing as failure. Failure is just life trying to move us in another direction.”

In medicine, a mistake is unnerving, destabilising, distressing. We expect ourselves to protect our patients and not cause them additional pain with our errors. We hope that our conscientiousness will prevent mistakes. And yet, our humanness means we will err. This is a common interview question because making an error is a universal experience at work and we need to know how to recover from that. True reflective practice means unpicking all the factors that contributed to an error (internal and external) and finding the learning points in a kind and forgiving way. It doesn’t mean we don’t make the mistake in the first place.  We are holding our standards at an impossible height. 

I don’t think we teach each other how to fail well in medicine. No one talks about the sickening feeling in the pit of your stomach when you recognise an error– the heart-sink, palpitations, sweaty hands, nauseating feeling. It’s awful. Some of us become immediately defensive, others experience panic, become hypercritical or completely disengage. All common initial responses but they don’t encourage us to embrace the error and make a change. As a medical community, we need to address the unhealthy, toxic “blame-culture” that places fault with the individual and becomes embedded in our own practices. Senior clinicians need to help normalise “failure” and help junior doctors properly reflect on the error without judgement, so that we all learn true reflective practice. This is what helps drive individual growth and system change.  We need to learn how to fail forward.

 

Dr Lisa Potter

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Erika Strazdins