Do you remember…….
Three little words, but three words that can strike fear into even the most experienced of clinicians. Do remember that patient you sent home? Do you remember that patient you referred to me? Do you remember that patient you operated on?
Can you recall the last time these words were directed towards you? How did they make you feel? How did you react? Did you feel defensive? Did you break out in a cold sweat and feel the pounding of your heart in your chest? Did you immediately know which patient you were about to be informed about; some inner gestalt that had been surreptitiously eating away at you suddenly realised? Was the conversation that ensued helpful, productive, educational? Or was it not really heard, whilst you tried to make sense of what was being said, how you were feeling and what was going to happen next?
Over the last year I’ve introduced something new into the induction programme we run as a department for each new cohort of junior doctors. Inspired by conversations on Twitter, at the end of the first day we show the TED Talk by Brian Goldman “Doctors make mistakes. Can we talk about that?” We ask trainees not to discuss the content, or any thoughts and feelings evoked by the talk, but instead to go home and just think about what they have heard.
The next morning the first session of the day involves a number of the consultants and senior trainees sharing stories of mistakes they personally have made. Stories of missed diagnoses, adverse outcomes, poor communication, possibly avoidable deaths. Many of the stories shared happened years ago, but the detail and depth of feeling with which they are relayed makes them seem like they occurred within the last few days.
Clinicians often remember the names and faces of the patients and families involved. Memories of these events will likely stay with them for their entire career, will have shaped the clinician they have become, will have influenced how they educate and mentor trainees. These events may well have led to periods of self doubt, anxiety, low mood and maybe even time off work. Often in years gone by these events wouldn’t even have been discussed, hidden away like an indolent cancer ready to raise its ugly head, uninvited, unwelcome and when least expected.
The last time we ran this session you could have heard a pin drop in the room. You could almost feel the sense of relief; hear the relaxing of held breath. And then the conversation started, and continued for well over the allotted one hour time slot. Trainees who have only just met a new team happy to share their own stories of times when things didn’t quite go according to plan, when maybe patients came to harm. Stories of self doubt. Feelings of shame, distress, regret.
In the days after the session I had a conversation with one of the trainees I would personally be supervising, and was delighted to hear how well the session had been received. Previously anxious about starting work in the ED, he relayed how he felt more relaxed, comforted that mistakes do happen and will continue to happen, but that the ethos of the department is one of openness and learning rather than blame and recrimination.
We need to discuss our mistakes. We need to talk about why they happened, how they happened, what could have prevented them from happening. We need to learn, not just from our own mistakes, but from those made by others. We need to develop and promote a culture where those three little words no longer strike fear, but are part of everyday conversation. The safety of our patients depends on it, but also, maybe more importantly, our own sanity and wellbeing depends on it.