You made a mistake. I know you're busy beating yourself up about it. I know that after years and years of training in life-saving medicine, you've also trained yourself to accept the blame for all sorts of things beyond your control.
You're asking, “How could I have missed that?” or “Why didn't I think about that?” You're wondering why you didn't give a different drug, order another test, or perform a different procedure. You may be replaying the whole scene in your mind—the nightmare intubation, the pediatric trauma, the young family, the old couple. You're imagining the death notification or simply the way you had to admit that you had done something wrong.
You may not be sleeping well. You may have had a little too much wine to cope. It's possible that your family sees it in your eyes. You might be looking forward with dread to that upcoming peer review. You fear, after talking with risk management, that you'll be facing a lawsuit. You might even be wondering if any of it was worth it or if you can keep going after what had happened.
Can you put all that on pause for just a minute? I have a few things to tell you. I'm not a psychiatrist or counselor. I'm not a lawyer. I am, however, a colleague who has been working in this crazy world of emergency medicine for 24 years (27 if you count residency, which we should). I have also made mistakes. Like you, I have caused harm. So I have some insight into this whole error issue.
First of all, it's a miracle that we don't make more mistakes. Our emergency departments are constantly flooded with a bizarre mixture of everything from infected hangnails to aortic disasters. None of them comes with signs that say, “Tomorrow I'll be septic,” or “I'm secretly having an MI!” Last time I checked, we don't have crystal balls in the nurses' station. We spend our days at breakneck speed sorting through a thick cloud of unknown factors, attempting to satisfy the patient, please the consultant, finish the chart, provide the bill, do it all faster, cheaper, and better, whether we're sick, hurt, sad, or exhausted. All the while, we incidentally save lives and ease suffering.
Secondly, none of this is the same as engineering or hard science in terms of mathematical predictability. Medicine is a hot mess of human anatomy, physiology, sociology, psychopathology, weather, culture, alcohol, drugs, lies, sex, misery, hope, and compassion. And humans are constantly in the process of dying. You can't change that fundamental reality.
Take the Bullseye Off
That you do good at all is a testament to your great intellect, physical endurance, and endless love for your fellow humans. Look here, this is one of the hardest jobs on the planet! Accept that, and accept your fallibility.
Yes, you may be sued, and you may lose! Physicians may kick you around for a while. (They do it as a kind of ritual, a talisman; it helps them believe the lie that it won't happen to them.) Lawsuits are part of the financial ecosystem. Lawsuits and criticism come with the territory. It feels personal, but it isn't.
In light of all of these things, you must remember this: Medicine is your job, your profession, and maybe your calling. It is not your identity. You are far more complex and nuanced. You are a daughter or son, husband or wife, girlfriend or boyfriend. You are a sibling, cousin, friend, pet owner, artist, athlete, craftsman, soldier. You can apply whatever identity you like, and change it as you see fit. But you are not just a doctor.
If the whole locus of your identity lies in being a physician, then errors, losses, failed resuscitations, and all the rest will strike at your center. You must move the center. Take the bullseye off your being.
That way, even if you could never practice again (through accident, illness, or litigation), you would still be a valued, treasured person who had a great experience being a physician. That's unlikely to happen. There are bumps and pitfalls in medicine, but you will still keep doing great work.
This is what you must take from me today. This is what you must share with others. In the course of your career, even a short career, you will save, help, and comfort astronomically more people than you will ever harm. And you will show more kindness than most people ever imagined possible.
And at the end of your days, when you lie down to that final sleep, you will be able to do it with the knowledge that you did all that good. Troubles aside, that's a great blessing. Keep the faith, my people! Emergistan treasures you. And you are good.
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