RP101 – Making Mistakes (Oct 2019)



Session Readings

 

Background  

We have often heard the phrase “everyone makes mistakes.” While this is readily accepted as fact in many fields of work, the field of healthcare has been much more reticent to accept this – the cost and consequences seem too profound, too high to let this be “allowed.”  Mistakes occur at a number of different points in the process of care,  to include diagnosis, treatment, and follow-up. The now famous report from the Institutes of Medicine, To Err is Human, describes error as a leading cause of death and disability in American medicine.   The first of these, diagnostic error, has been demonstrated to be made by providers 10-15% of the time [Elstein 1995].  In fact, a report from 9/2015 by the Institutes of Medicine (IOM) entitled “Improving Diagnosis in Healthcare” concludes that most of us will experience (as patients) diagnostic error at least once in our lives, some of which will have catastrophic effects. Errors in treatment to include medication and surgical errors are equally concerning and an important area of focus in the quest to improve the quality of care we deliver.

While we work to reduce mistakes in healthcare, the fact remains that each of us will make mistakes in the course of our practice. In this session, we are not focused on how we will avoid mistakes, but how we have reacted when we have made mistakes or failures in the past and whether these reactions have impacted our actions in ways that compound or mitigate these mistakes. Our reactions to mistakes – or near mistakes –  can be quite powerful and long-lasting, whether or not the mistake results in a bad outcome. Feelings of guilt and shame often pervade the experience,  influencing us in myriad ways that can impact the way we treat our patients. We also know that poorly resolved mistakes in healthcare contribute to decreased provider satisfaction with their chosen profession, an increased rate of attrition from the profession, and increased rates of suicide.

I want you to consider whether or not your experience making mistakes (of any sort) can help to prevent subsequent mistakes, or at least give you a framework for how to manage your feeling about mistakes and failure. How do our tendencies towards perfectionism as health care providers play into this narrative? How do concerns about our jobs, our reputations, and our peers play into our actions? How do these situations create ethical dilemmas? How do institutional policies or leadership responses affect how we think about mistakes?

Assignment

Bring to the small group a story of a mistake you’ve made. What was the story? How did you react when you realized it was a mistake? How did others respond? How did it shape you for the future?

Please listen to this podcast (15 min) in preparation for our small group discussion: https://www.npr.org/2017/12/01/567529121/leilani-schweitzer-how-can-hospitals-be-more-transparent-about-medical-errors


Objectives

By the end of this session of Reflective Practice, students will demonstrate the ability to:

  • Reflect on mistakes they have made during their lives and potentially early medical careers
  • Listen to narratives about others’ mistakes and reflect on how they think about others’ mistakes vs their own
  • Identify their reactions to making their own mistakes and the sources of those reactions
  • Explore how those reactions impacted the care they delivered or could impact the care they deliver
  • Analyze strategies for coping with mistakes in the future.
  • Discuss guilt, shame, perfectionism, and self-compassion as themes in error and in resilience after error.
  • Illustrate both effective and non-effective ways of communicating mistakes

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Panelists:

Dr. Mike Cole, COL (ret), is an intensivist practicing at Suburban Hospital in Bethesda, MD and ___ Hospital in Frederick, MD. He is double boarded in medicine and psychiatry and is a 1997 USUHS graduate.

Dr. Candy Wilson, Col, is deputy director of the PhD Nursing Science Program, and is both an APRN in Women’s Health and has a PhD herself in Nursing Science. She is an Assistant Professor in the Daniel K. Inouye Graduate School of Nursing at USU.

Stephanie Raps, Maj, is an active duty AF nurse and is a candidate in the PhD Nursing Science Program.
tedmed_wh_rgbConfront harm and prevent medical casualties (~10min) - LtGen Horoho Patricia Horoho, retired Lieutenant General in the U.S. Army and the first woman and first nurse to serve as the Army’s Surgeon General, reveals how healthcare can cause harm by sins of commission and omission.
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The New YorkerFailure and Rescue by Atul Gawande The difference between good and great healthcare is not fewer mistakes, it is more rescues.
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New York TimesMy Human Doctor Medical school teaches us to examine, to research, to treat. We don’t learn to err and recover.
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New York TimesMy near miss A doctor relays a close call with a patient's diagnosis...the "near miss" - a mistake that could have cost the patient serious harm, but didn't.
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TEDxBrian Goldman: Doctors make mistakes. Can we talk about that? What’s an acceptable “batting average” for a physician? Brian Goldman examines the paradox of perfection in medicine, starting with three little words all physicians dread.
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New York TimesThe Many Errors in Thinking About Mistakes by Alina Tugend Children learn that ‘everyone makes mistakes’ as a crucial part of the learning process, but are rewarded for getting the right answer. A NY Times columnist explores society’s paradoxical approach to making mistakes.
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TEDxTransparency, Compassion, and Truth in Medical Errors Leilani Schweitzer's son died by fault of medical error - she talks of the importance of transparency, truth, and compassion in medicine.
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Session originally created by: Adam Saperstein | Uniformed Services University | Admissions Medical Officer, USNA | Assoc Prof. Family Medicine