“To err is human, to forgive, divine.”
– Alexander Pope, from “An Essay on Criticism”
Probably, the most important lesson I learnt in all of residency can be summed up in these words:
“It’s not the mistake! It’s what you do afterwards that matters”.
These words have accompanied me all these years, I practice by them, taught that to my residents when I was in academics and pass it on any chance I get. It is not only true in medicine but also in the criminal justice system and even at home with our children and spouses. For this discussion though, we’ll stick to medicine.
To elucidate, we have to take a trip back to 1999.
“To Err is Human: Building a Safer Health System” was a report issued in 1999 by the U.S. Institute of Medicine that detailed medical errors in the US healthcare system and the human as well as financial toll it was exacting. The figures were sobering. Between 44,000 to 98,000 people die each year as a result of preventable medical errors. They have been estimated to result in total costs of between $17 billion and $29 billion per year in hospitals nationwide!
It was pointed out in the report that, system failures and less individual provider mistakes were responsible for most medical errors. The push since has been to reduce medical errors and improve patient safety and the results have been encouraging.
However, the fact remains that physicians are only human and like the saying goes, “To err is human…” and that is where my lesson comes into play.
Sooner or later, every physician is going to make a mistake. Show me a physician who hasn’t made a mistake before and I’ll show you a doctor who hasn’t practiced long enough or doesn’t practice at all.
So if we are prone to make mistakes, shouldn’t there be a readiness to face and deal with these errors when they happen? Beyond the checklists and time-outs, beyond the constant threat of loss of accreditation and fines, shouldn’t we as physician on an individual level be ready to deal with that mistake?
That mentality of “It’s not the mistake! It’s what you do afterwards that matters” takes away the fear that dogs one when a mistake is made. It makes one communicate clearly with the patient if possible and explain what happened and what will be done. It allows one to keep a level head and work alone or with a team to reverse or limit any damage. It also reduces the incidence of lawsuits.
This mentality demands something from the physician. It demands a certain honesty and strength of character. One should be able to say, “I screwed up. Now how do I fix it?” It demands empathy with the patient à la “If it was me…”
I know, it is much easier to sweep things under the rug of unintelligible medical speak or blame someone else but that only stokes the fire of trouble down the road and possible harm to the patient.
To help develop this mentality, a mantra that was drummed into me during residency helps. It was, “What is the worst thing that can happen now and what would you do about it?”
With that kind of mind set, one tends to be prepared for whatever but most importantly, one tries to prevent whatever form happening. One tends to see all those checklists on a personal level and that readiness on a personal level ultimately translates to one on the team level too.
Most physicians do as Hippocrates said and try do do no harm. However since the human is plagued by fallibility, maybe accepting that and factoring it into our daily practice may help. So even as you go about your day, remember, “It’s not the mistake; it’s what you do afterwards that matters.”