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Mindful EM

Mindful EM

Dealing with Mistakes and Preventing Regrets

Hazan, Alberto MD; Haber, Jordana MD

Author Information
Emergency Medicine News: May 2017 - Volume 39 - Issue 5 - p 24
doi: 10.1097/
    medical errors
    medical errors:
    medical errors

    We all make mistakes. That's an inherent part of being human. We make them, learn from them, and move on.

    That's fine if the mistake means leaving your car keys in the refrigerator or nicking your finger while chopping a salad. But what about when you make a mistake as a physician? How can you move on after a medical error that hurts or kills a patient? We know mistakes are part of the learning process, but it's difficult to be blasé when your actions could result in a poor outcome for someone you treated.

    We all learn — and struggle with — the dictum we learn in medical school that we will kill at least one patient in our career. We become physicians to heal, and the idea of killing someone is foreign to us, something we can't imagine. We assume that medical school and residency will teach us how to respond if this happens, but most of us still don't know how to recover when our actions lead to patient harm.

    Dealing with a mistake can be incredibly overwhelming and emotionally taxing, and it can hinder our ability to care for future patients. It's imperative that we first acknowledge that we are going to make mistakes in our career. We hope they will not be devastating errors, but we must be willing to practice medicine with the hope to do the best we can and an understanding of our vulnerability to error, and we must be willing to grieve when we make a mistake. Like many things in life, dealing with mistakes can be broken down into steps.

    Acknowledge. We must first identify and acknowledge our mistakes. As trivial as this may seem, we sometimes lack the insight to identify when our actions have led to patient harm. We could practice the wrong kind of medicine for a particular disease entity and not know it, or we could interact with a patient population in a less than ideal way. We also may want to protect ourselves from being scrutinized by not admitting fault. Acknowledging our mistakes allows us to take the next proper step.

    Make Amends. This is where we should spend the bulk of our mental energy. Often we dwell too long on the mistake after acknowledging it, without really doing anything to rectify the situation. We need to grieve, but instead of becoming depressed or hiding from the mistake, we should work to channel our energy into righting any wrongs. Is there anything we can do to rectify the mistake? What is in the best interest of our patient? What can we learn to prevent future mistakes? Sometimes this process will require writing a letter, making phone calls, or calling a consultant.

    Move On. Once you've identified that your actions led to harm and you have attempted to right the wrong, it's critical to move on. Most of us have a hard time with this because we're perfectionists — and our own harshest critics. Dwelling on the past, instead of moving on, puts us at risk for making more mistakes. Our job requires mental clarity. It's difficult enough to run a busy emergency department without our past mistakes constantly running through our minds.

    It's also critical for us to move on because not doing so put us at risk for repeating mistakes. This approach allows us to avoid regret, which often results from not dealing with our mistakes in a productive way in the first place. If you are mindful about the way you deal with your medical errors and follow these steps, you shouldn't experience regret. In a way, it's the failure to move on that raises the possibility for regret later in life.

    It may not be fair for someone to judge you by the mistakes you've made, but it would be fair to be judged by the way you deal with your mistakes. Did you acknowledge wrongdoing? What steps did you take to rectify the mistake? Did you make amends? Are your efforts genuine?

    Ultimately, the way you deal with your mistakes defines who you are. The medical culture is notorious for punishing those who make errors rather than fostering a safe and supportive environment to acknowledge them. This is not only dangerous for our patients, but also hinders our ability to better ourselves as a profession. We must all work toward creating a safe and supportive environment to share our errors, learn from them, and help each other move on for our patients, for ourselves, and for the future of medicine.

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