Physicians discuss medical errors

AMA Wire
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What helps physicians after committing a serious medical error? Researchers recently asked 61 physicians the same question and distilled their words of wisdom into a must-have list of recommendations for physician training programs to consider. Here’s how experienced physicians have learned to cope with medical errors and to grow professionally despite challenging experiences in practice.

Authors of a recent study published in Academic Medicine found that although “health care institutions are increasingly recognizing the physician as the ‘second victim’ of medical error, more attention needs to be placed on reframing the error into a positive post-learning event, rather than a ‘coping’ or ‘surviving’ framework.”

This propelled professors at University of Virginia School of Medicine, University of Florida and Harvard Medical School to investigate factors that may help physicians gain wisdom and inform educational programs to support physicians after harmful errors occur.

Authors of the study spent three years conducting interviews with physicians who volunteered to discuss their most serious self-reported medical errors. Using their interview responses, study authors identified key themes that reflect what helped physicians cope with medical errors and advance in their careers. Among the themes they identified as beneficial to physicians learning and healing after committing medical errors were these seven steps:

Talking about the medical error

“One of the most common responses to the question ‘What helped?’ was ‘being able to talk about it,’” study authors wrote. “[M]ost felt that having someone who could understand the experience from a clinical context was helpful.”

Physicians also emphasized the importance of speaking with colleagues who didn’t attempt to minimize the seriousness of the error, dismiss its associated emotions or “solve the error” by offering well-intentioned advice.

Instead, “physician participants said they responded best to someone who simply ‘held’ the feelings that they were expressing—that is, someone who really listened, acknowledged the seriousness of the situation and helped them to put it in perspective,” according to the study.

Forgiveness

Some physicians took time to forgive themselves after committing an error, a process that requires self-acceptance and awareness.

“Okay—the only forgiveness that I decided to give myself is partial to this day, and it always will be, but that’s okay. I figure that I keep that other unforgiven part as the pressure to keep doing better,” a physician in the study said.

Having a moral context to help them “do the right thing”

Physicians said having moral standards—such as professional codes of conduct, spiritual teachings or a strong sense of humanism—helped them know how to “do the right thing” after committing a medical error, according to the study. Some physicians said their mentors helped them recall important values. 

Learning how to deal with imperfection

How can physicians escape unrealistic quests for perfection without lowering their professional standards? Physicians frequently grappled with this question during interviews, according to authors of the study, making “the imperfect but good physician” a common theme that emerged in conversation.

For many physicians, admitting vulnerability among their peers helped. “By talking with colleagues, they began to realize that other very good doctors had made mistakes too, which gave them permission to change their perfectionist understanding of themselves,” according to the study.

“One of the processes of growing older, more experienced, more mature, is [that] reality replaces icons,” one physician in the study said. “People think of me as perfect. I happen to know it is not true. I don’t need or want anyone to have that concept of me anymore.”

Other physicians said actively remembering their mistakes—by keeping a mental inventory of patients that may have died or those they wished they had treated differently—has taught them how to live with their imperfections while honoring their memories of patients.  

Becoming an expert on their mistakes

For many physicians, making a mistake prompted them to “become an expert in whatever they felt was the knowledge or technical deficiency that caused the error,” according to the study.

This required some physicians to shift careers, while others mastered new topics or techniques related to their previous medical error. Study authors said this process of mastering new subjects helped physicians accept and heal from their mistakes.

Preventing recurring mistakes and improving teamwork

Several physicians in the study decided to investigate their errors and identify how to avoid them in future practice, noting the importance of working across care teams to address errors and prevent them from recurring.

According to the study, “[t]hey found meaning in developing system changes so that what they and their patients had gone through could at least protect against future mistakes.”

Helping others and teaching about it

An average of eight years had elapsed since most physicians in the study committed their medical errors, which underscores that the process of “recovery and growth in the wake of a medical error” requires years. During the process, many physicians said discussing medical errors helped them transition from simply talking about their mistakes to actually teaching others how to prevent them.

This creates educational opportunities for physicians to discuss their mistakes in an educational and therapeutic setting, according to the study.

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Medical school
Oct 27, 2016
Medical education is hugely expensive. Are students getting good value for their investment? One school looks at evaluating what they spend on education and what actually has the highest impact.