I often log on to my EMR remotely to check results on days I’m not in the office. At one point, I saw a patient in the office and diagnosed him with a minor illness requiring no treatment. Later, I checked my EMR and there in front of me was the sickening truth that I had made a mistake. He had presented to emergency the night before with a life-threatening illness. Much to my relief the patient didn’t die, but he could have. I immediately felt guilt, remorse, shame, and self-doubt accompanied by a chest pain and a sinking feeling in my abdomen. I was flooded with negativity. How could I have been so careless? I’m a terrible physician! Why didn’t I take the time to listen and make the correct diagnosis? Maybe I should tell all of my patients to find a physician worthy of them? The visceral malaise and cognitive despair was overwhelming. There was no escape from it in the days that followed—it was there when I closed my eyes at night, in the morning when I woke, and all the time in between. It is a struggle to deal with all the emotions associated with such a blunder while carrying on seeing patients.
The experience got me thinking about how physicians deal with mistakes. Doctors are human and, therefore, fated to make errors during their careers. Fortunately, my mistake didn’t lead to mortality or significant morbidity, but it could have. My heart goes out to physicians whose misdiagnoses led to significant adverse patient outcomes. I can’t imagine the mental and physical stress involved (there by the grace of God go I). I confess that this isn’t the first mistake I’ve made, and I’m sure it won’t be my last. However, enough time has passed that I’ve now reflected on the process I went through and thought I would share it in case it might help someone else.
First, I talked to my wife and colleagues, discussing my error and sharing my feelings. My wife, as always, supported me and reminded me of the many patients who would vouch for my care as a physician. My colleagues listened and shared their stories of medical woe, making me feel less alone. I carefully looked back at my encounter with the patient and thought about where things went wrong and what I could have done differently. What factors were involved, including mine, the patient’s, and those of our therapeutic relationship? I was able to identify and take ownership of my part of the interaction, which led to my misdiagnosis. I then took the difficult step of phoning the patient and apologizing for letting him down. This was not a pleasant process. He was justifiably angry, but I believe this step was necessary for me to move on and continue to be an effective physician. As a result, with the passage of time, I have been able to put this experience in its proper place as an unpleasant memory, but one I have learned from.
The patient has come back to see me in the office, which I’m sure was a big step for him. He related that much of his disappointment and anger was tied up in the thought that he might not be around for his daughters. This was a sobering reminder to me of the lives that can be affected when we make errors in our profession. The challenge is to accept this reality without letting it paralyze us while we do our jobs and hopefully learn from our infrequent mistakes.
David R. Richardson, MD. Mistaken. BCMJ, Vol. 61, No. 4, May, 2019, Page(s) 154 - Editorials.
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