Doctors make mistakes: A few comments


” Anyone who has never made a mistake has never made anything new” So I am going to start this new post with a quotation by Albert Einstein. Well, I do not think that is a bad way to start, and I always thought that if you want a quote about anything then all you need to do is to look up the Albert Einstein compendium and you will be able to find something perfect to fit your topic.

And today’s topic is “mistakes”

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Everyone makes mistakes. It is part of human nature. When you are at school you make mistakes and you go home terribly abashed to have to tell you mother and father that the exam was terrible, and you made a lot of silly mistakes. Some parents will get angry and punish the child, but the cleverer parent will sit down, chat to the son or daughter and explain that mistakes are normal, nobody is perfect and the key is to learn from those mistakes. The critical thing is, of course, to accept the mistake and then learn from it and try not to make the same mistake again.

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And hopefully not like Samuel Beckett!

Today I wish to talk about a new article published in the Guardian newspaper by Lord Ara Darzi, the English surgeon working in Imperial College London. His article is entitled ” Doctors make mistakes. The best thing medicine is for them to admit it”, and I think that it is interesting because it seems so obvious. Even though in the past doctors were seen to be removed, or in some way “above” the normal man in the street, they are humans. The doctor is not God, the doctor has human foibles, and the doctor makes mistakes.

However, the critical thing is acceptance of the mistake, and then to act on that mistake. In the article Darzi mentions the American surgeon and writer Atul Gawande.

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Gawande is an American surgeon who worked as adviser to Clinton during the Clinton presidency, and who is this year’s Reith lecturer. You can listen to his first Reith Lecture on BBC Radio 4, ” Why doctors fail”, and in this fascinating talk he explains how his young baby son nearly died at the age of 11 days due to a medical mistake. He believes that transparency is the answer to trying to stop or stem the tide of serious medical mistakes. He says –

” How are we going to make it possible for other children like Walker to live a normal life? Only by removing the veil over what happens in the clinic and hospital, only by making what has been invisible visible”. Walker is the name of his son, who having survived the nearly fatal mistake when a baby is a now a healthy teenager with a great and exciting life ahead of him. Darzi then goes on to comment on a new but long fought for initiative in the British NHS to open up the NHS and make it more transparent and more responsible to the people, to the potential patients. Last week the NHS published the individual death rates of 5,000 surgeons in ten different specialities throughout the UK; these data can now be seen on the webpage MY NHS: Data for better services – http://www.nhs.uk/Service-Search/performance/search 

I believe that this is an incredible step in the right direction, obviously one that is extremely difficult to put into practice and also interpret. What data do you use? What criteria? Can you really compare the work of different surgeons? The working circumstances are obviously different, no case is exactly the same.

All these things are true, but this is not the end of this move towards transparency but just the beginning and it is a fascinating and extremely brave decision. The idea was started and launched more than ten years ago by another surgeon, a cardiac surgeon, Bruce Keogh, and not by an administrator with no knowledge of the ins and outs of the operating theatre. Another doctor commented on by Lord Darzi was Professor Peter Pronovost, an anaesthetist working in the field of patient safety at Johns Hospkins Uinversity Hospital in Maryland. I have seen a talk of his given to first year residents about doctors making mistakes and it should be compulsory viewing for all trainee doctors and probably for all consultants. Doctors are humans, they make mistakes, this is normal. Remember this and act on it, and learn from it and remember you are part of a team.

Let’s see how this drive towards transparency continues, let’s see whether it could be possible to implant into different health care settings,and I am particularly thinking of the Spanish National Health Service. I end this short post with the ending of the article by Professor Darzi:

” Looking at our fallibility is uncomfortable, it makes people angry and has led to efforts at providing transparency being blocked. But as Ganawade says, it is the story of our time- and the key to the future of our medicine.”

Thanks, as always for listening, and have a great weekend.

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4 thoughts on “Doctors make mistakes: A few comments

  1. Nearly twenty years ago I read the story of young DeBakey. I can’t remember the exact details, but this story is still stuck in my mind. DeBakey is recognised as one of the greatest all-time cardiovascular surgeons. When he was a trainee, in one of his firsts operations, he accidentally cut the aorta of a patient. Blood started to pump out and death was imminent. The old surgeon that was training him told DeBakey, calmed and quiet: “just put your finger into the hole and keep the pressure. I will repair it.”
    And he did it.
    Big lesson.
    He knew that failure was an unavoidable part of the learning process. He could have smacked down the trust of his trainee, but he wasn’t harsh or humiliating. No punishment. Staying calm and quiet, he saved the patient’s life teaching how to respond to mistakes. Even the biggest ones. And he allowed a young surgeon to become the great surgeon that saved hundred of lives.

    We aren’t encouraged to make mistakes. We punish people who make them. The results? People avoid to risk, avoid to try, avoid to test different things. Children always want to show up when the teacher ask for the right answer in the school. But what happens when they grow up? They hide. Why? Because failure is seen as bad, as something improper. Only wrong people make wrong things.

    As I see, we need to shift from a results-based culture to an effort-based one. Failures, mistakes and errors only mean that someone is trying something. “To err is human” is a very good essay written a few years ago that explains crystal clear why humans are not precision machines. We are creative creatures, not exact calculators. And creativeness implies essay and error to test the solution. Another good insight in this subject is the work of Sir Ken Robinson and how he explains that actual education systems kill creativity just by avoiding exposure to failure.

    Thank you for the post. We need to keep working on this subject.

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