Peer Review: Judgment, Bias and Teamwork

I think about every single decision I’ve ever made or make as a doctor, good and bad, and the way it has affected my patients, my colleagues and myself. As many likely do, I spend a large amount of my time reflecting on how things could have gone a different direction or if I could have possibly made a different choice at a different time. Not quite to ask myself, “What If?” but more so to change future decisions. Sometimes it eats away at me at night; although, with time I am learning to separate the other compartments of life from things I can no longer control. I have become well aware after working all over the country that there is not necessarily always a right answer and, as I once said to an interviewer: The way people interpret the evidence can vary.

Inevitably, as we are human and have various methods of practice, practice experiences and the fact that no singular answer is ever necessarily 100% accurate or superior to others, we face the questions of retrospective judgment from those we work with after a tough call has been made – especially as doctors. There is not a day that goes by that I wonder if my peers are judging me – Why didn’t you turn the fluids up? Why didn’t you get the CT scan on that patient? Why did you start antibiotics? Are you sure the guideline says to do that, what’s the reason? Sometimes, the questions are out loud.

Through the fact that much of medical education, despite the attempts made towards progressive new pedagogies, is still conducted through a possibly unintentional Socratic Method, I am used to defending or rationalizing my decision-making in the eyes of those around me. With good reason, I have a serious job, and although i’m a light-hearted person, I take serious situations seriously still. Yet, it is always difficult to look into the eyes of another provider or make a phone call to a consultant or specialist and feel those awful feelings of being wrong, of making a mistake, of not being a Good Doctor.

Even though I have early on tried to adopt a mentality of leaving ego outside of the room and continually am reminded of how much I have to learn, and that truly I can learn something from every single person in the room, it is embarrassing to make a mistake or get questioned on my decisions or situations. It is always difficult to receive criticism and feedback, especially by your peers.

I will never forget when I was performing a procedure I’d done dozens of times when I had a moment of bleeding and a blinding feeling of immediate stress and dismay. I called one of the surgeons I worked with in a daze, scared that I had caused a huge problem, and luckily he showed up right away to offer his decades of experience. I was so nervous to ask for his help just wondering what he’d think about me and my incompetence. It was one of our first long conversations and he said to me, “Don’t worry, this has happened to me too.” My heart sank, and I called him by his first name after that.

I will never forget the millions of times that I have called specialist transport teams for backup working in small hospitals with limited resources. I used to be on the other side of that phone call at the big hospital and I would always question why something that seemed simple, needed our help. I remember unintentionally having my own bias and judgement towards those asking for transport and am aware now that I have been on the other end of the line, that I might be received with the same eyes. It is nervewrecking.

I have watched doctors around me struggle with the same inevitable cycles of consequence that we face by things we do and reviewing with each other various methods we would have handled it. I want my patients and my friends to applaud my choices, but always just hope that my peers will at the least not condone them. I have been lucky to work with some of the smartest humans one could ever meet, and the most brilliant ones have listened to my questions and errors with kind ears and given constructive yet respectful response. For teamwork to succeed, feedback is necessary. I am always nervous when I sign out to another doctor that I am not neurotic enough or am maybe too much, that I might have misguided focus or not focused enough and although it gets better with experience, it is always a humbling time. So I try to remind myself, especially when I am the teammate taking the baton, that the person behind me ran the best race they could.

It is hard not to worry about how we will be perceived by our peers and in time we will all inevitably be dealt the same hand for review; but, hopefully we can remember this when we are faced being the reviewer.

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