For decades and generations Physicians have often been thought of as knowledge-bearers for the ill with the ability to cure it; or, at least that’s how I’ve often seen it as a kid and attempted to understand it through the eyes of my patients. When we don’t know the answer to the most important questions of our health and the things that scare us the most, we lay the questions at the feet of Physicians hoping they will give us the answer – or maybe these days we turn to google, but that’s a whole other conversation… Yet, medicine is not always black and white, and among the grey, doctors aren’t always perfect. Like some previous posts, I will reiterate this until the day I die, as will happen to me as any other mortal: Doctors are only Human.

Unlike many professions and callings, Medicine has the added responsibilities of affecting life and death and understandably holds a higher level of risk and stress than many other jobs. However, an inevitable but sometimes not often discussed truth is that frankly: Doctors make mistakes too. So what happens when a human makes a mistake, but it is one that can affect the trajectory of another life?

Outside of the questions of intentional harm runs the honest line of medical negligence. Often times this means that in practice a provider acts in a way that is not in line with “standard of care” or “best practice.” Basically, are my doing what any other practitioner with the same background and credentials would do in this exact situation? For example, if a child has an ear infection are my treating it with a similar antibiotic choice that a colleague of mine would do? That maybe a medical academy or group of other Pediatricians would do? Sometimes these questions are just as straightforward as that, but sometimes they deviate by nature or by institution. The science of medicine is neither inferior nor superior to the art of medicine. Sometimes, the grey zone has no “standard” and nothing can really fit a definition of “normal.”

But this isn’t a post on law, repercussions or any of that… That’s for another day…

So, all of the nitty gritty aside, I had a conversation regarding mistakes with one of my mentors and directors months ago at one of my locum jobs. Ten years my senior in practice, but decades my senior in experience and introspection, we had a talk about the concept of being Gun-Shy. Recently to that point in time, a consultant had made a recommendation that had resulted in a death or at the least had not succeeded in avoiding the death. Based on a decision that fit in line with “standard of practice” and “guidelines” a recommendation was made; but still, this instance fit no “normal” and to the shock of an entire unit, someone died. While the details which will remain private are ultimately multitudes sadder, a similar situation had come up afterwards where the primary provider had requested likely from the same specialist, the same consultation question. To the chagrin of the family and the unit, the subspecialist in this nearly identical case refused to provide recommendations without seeing the patient first… Something, they hadn’t required previously.

We sat in silence for a second as I remembered the bleak sunrise through the empty unit when I had been present at the time of the death… Who could blame [the consultant] for not wanting to make a recommendation THIS time… It brought me through cycles of reflecting on times at which I have made small or nuanced mistakes, the times with close calls or almost misses. Luckily within the 5 years I have been a Physician and the 3 years of which I’ve been an Attending Physician, these incidents have been fairly few and far between, but they definitely have happened.

After a bad outcome, in many hospitals, conferences are held called Morbidity and Mortality during which the happenings of a bad or suboptimal outcome are discussed. Many times they result in gradations of affects on patients and, luckily, not always on death. As Physicians we spend our entire lives learning how to not harm and dedicating all of our sanity to doing what we believe is in the best interest of a patient. So when something bad DOES happen, it is only human to retreat and readjust, to reflect and recapitulate. It is impossible to forget and we beat ourselves up about it. All. The. Time.

We are more cautious – I missed a pneumothorax (collapsed lung), so I will get more xrays…
We are more afraid – I had a rare procedural complication, so I don’t want to do that procedure again…
We are more apt to second-guessing – Do I know what I’m doing? Is this the right thing to do?

It becomes an obsession to avoid the pitfalls we had before and we are often caught in a period of PTSD that we know we can’t lull in for too long. So, we dust ourselves off, we hop back on the proverbial wagon and walk the line carefully again, and hopefully over time we are able to grow from our errors and return to who we were before. I don’t think we ever fully move on, nobody loves making mistakes; but, doctors are human, and humans make mistakes.

Image Credit: http://www.theycallmedaktari.com/depressed-doctor/