To Err is Human

Transparency about medical errors benefits both patients and hospitals. Dr. Allen Kuchalia recently joined our GI grand rounds to discuss the measures he’s implementing at the system level to support physicians in medical disclosure. He described how being upfront with patients and families about mistakes can help ease their pain and preserve the patient-clini​cian relationship. His research showed that institutional commitment to disclosure can lead to reduced medical malpractice claims.

Significant progress is being made to increase transparency with our patients. But a lot more work is needed to bring transparency to the emotions healthcare professionals experience when they’ve had an unanticipated outcome. In a March perspective piece in “The Lancet,” entitled, “Errors, injustice, and physician well-being,” the authors describe how openly sharing the emotional experience of physicians is nearly taboo in our medical culture. The fundamental paradox is that our medical culture is built on the “fantasies of medical omniscience and infallibility,” even though uncertainty often plagues a lot of our medical decision-making. Our medical training leaves us ill-equipped to manage feelings associated with this uncertainty, especially the shame that often accompanies a medical error. Because there’s no easy space to share the personal experience of error without feeling stigmatized or judged by peers, we’re silenced from describing that experience. This forced silence then threatens clinician well-being, contributing to burnout.

I found that much of what the authors write rings true. Thanks to my institution’s patient safety and quality organization, we’re well-versed in structured processes that facilitate factual discussion about medical error, so that we may learn how to prevent future patients from being harmed. Morbidity and mortality conferences and RCAs (Root Cause Analyses) are two such vehicles that enable discussion with the intent of promoting change. We also have a well-established second-victims program to help support healthcare professionals through traumatic loss or experience. However, it feels like we’re individually less prepared to show compassion for our colleagues who’ve experienced complications. We might feel sympathy because such incidents remind us of our own fallibilities, but how often do we actively reach out without our colleague having to approach us first?

Unless we acknowledge we’re fallible, we risk transferring this attitude to those who look to us for guidance. While I was working for Hopkins at its affiliate hospital in Saudi Arabia, it was a Baltimore colleague from another department who vociferously advocated suspending or terminating experienced clinicians who’d been involved in a sentinel event in which they’d no intention to cause harm. The message was clear—they should’ve known better. In each of these cases, it wasn’t the absence of knowing, so much as the failure to accurately assess a critical situation leading to a wrong diagnosis and treatment path. The pursuit of excellence and the “fantasies of omniscience and infallibility” allows us to judge others harshly. But it’s the lack of empathy that’s most cruel, taking a significant toll on physician well-being by letting the shame fester. Regrettably, those involved felt like they needed to leave the practice of medicine all together.

I’m fortunate at my workplace to have a tremendous resource called the Resilience in Stressful Events (RISE) team. An initiative championed by Dr. Albert Wu, the RISE team consists of trained emplo​yees who are ready to help support healthcare professionals during times of stress. But when it comes to changing culture, we can’t simply rely on the institution. As individuals we must work intentionally to change the culture ​within our own departments and divisions if we truly value physician well-being. We must each make an effort to show kindness to our colleagues, stop gossiping, and instead, be the first one to offer a listening ear. If we role model empathy for others and create opportunities to openly share our emotional experiences, we transform our environment where we care not only for patients, but for each other.

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.