I recently read a book that brushed off failing in the workplace because “no one really dies when you make a mistake”. This made it blindingly clear to me why doctors take failure so hard — the stakes can be high.
And it made me wonder if we are adequately teaching our students and helping our colleagues to cope with failure.
I’ll hold my hand up — I have failed, more than once. These failures were sometimes magnified by healthcare system issues, but there was still a little bit of me in all of them.
It’s the unexpected failures that really get you in the guts. The feeling you get after you realise you have made a mistake or something’s not gone to plan — that gut-wrenching, palpitating, nauseating, tense and knotted feeling.
And then the internal chatter starts: “I’m useless”, “I’m an ungenerous doctor”, “I’m stupid”, “I can’t believe I missed that”, “I never work hard enough”, “I’m really just no good at this”.
The reality is that in spite of trying, studying, listening carefully to patients and examining them thoroughly, you will make more mistakes.
I’m not talking about the ‘negligent’ or ‘careless’ mistakes — I really don’t think I make those. I’m talking about the mistakes I will make because I am human.
Once a GP registrar at my practice made an error because of an “unknown unknown”. I was reflecting with them and told them about a diagnostic error that I’d made — I once missed a metastatic cancer.
The registrar looked at me with shock and horror. “You made a mistake? Even after your fellowship?”
The registrar was under the impression that once qualified, GPs do not make mistakes. This is also the myth I bought into at medical school — fix the systems and all of the errors will go.
Of course, I would tell myself, there are those doctors who are lazy, incompetent and rude, they are the ones who fail. But ‘good’ doctors — those who work hard, study hard and are conscientious and who work in the ‘right system’ —will never make mistakes. I have a sneaking suspicion that this is how most doctors think.
Undeniably, system issues are one of the biggest contributors to medical errors. But it is a disservice to our students to lead them to believe that failure will never come their way.
I recently read an approach to dealing with failure in a book called How To Be A Happy Academic. Don’t be put off by the title as it holds many gems for those outside the ivory towers. The authors advocate for “learning to fail well” and have six steps for dealing with failure:
Be open and honest with yourself about what happened, and allow yourself to feel rubbish about it.
Be grateful for the failure — this sounds crazy but this means acceptance, gratitude it wasn’t worse, and openness to learning from the situation.
Crystalise your contribution — this is probably best done with the guidance of a colleague by going over notes, and not over- or understating your role in what happened.
Share and support others — the medical culture does not encourage the open sharing of failures, which is unfortunate as we can learn from where others have tripped in the past. Teachers sharing personal examples is more powerful than general stories about the mistakes of others.
Learn from it — there is always more we can learn about being better GPs (‘The Good GP never stops learning’, right?)
Moving on — ruminating and holding onto mistakes is not helpful for anyone.
The medical culture surrounding mistakes and the shame of failing is learnt during medical school and hospital training. Thankfully, the culture in general practice is different to this broader medical culture. I will never forget my first training workshop as a GP registrar. I still remember how the teacher made me feel — welcome, open, right at home.
She told me “there are no stupid questions here”, and she really meant it. It was a complete culture shock after coming from the hospital system and the way I had been taught.
I hope general practice remains a sanctuary for learning in a safe environment where we can share our failures, learn from our mistakes and move on together.
First published at Medical Observer, on 5 June 2018 (editor, Jo Hartley)