Making Mistakes

Two weeks ago I started a medical literature elective class and I love it. We read excerpts from different books, do some sort of creative exercise, and then discuss what we thought about the reading. For the first week, we read from a book "House of God" by Samuel Shem, a popular 1970's novel that describes an intern's experience in his first year as a resident. Not many students in our class liked this reading, as there is a lot of crude humor and unprofessionalism by the residents, all in an attempt to cope with the incredible demands of a 100 hour work week. I read the book last summer, and had similar misgivings about the book, but after a mere 6 months into medical school, I reread the passages and found myself laughing out loud. So what has changed in me in these few short months?

The next week we read some passages that described physicians making mistakes, and how they dealt with those mistakes both personally and in terms of their communication with their patients. Our creative exercise was to write a scenario describing how we would handle a medical error that we made, and this is what I wrote:

Prior to starting medical school, I practiced massage therapy for nine years. During this time I had a few chances to challenge myself with how to handle making a mistake during a client’s treatment. Once I went too deep on a woman who already had back issues, and she couldn’t stand up straight when I was finished. Imagine my horror when she had to call her husband for a ride, was taken to her car in her chair, and went to a chiropractor who subsequently sent her home in a back brace.

Another time I was working on one of my weekly regular clients, who had a history of knee problems including two knees surgeries. While stretching his quadriceps muscles, I deeply massaged his hamstrings, and heard a pop, after which it hurt him to move his leg. After he got up off the table, he couldn’t move without pain, and had to contact his orthopedic for an evaluation. Lucky for me nothing was damaged. It seemed like I had broken some scar tissue that had built up after his previous surgeries.
In both of the above cases I felt terrible, and so ashamed, for causing my clients' discomfort and pain. I blamed myself for the lack of being more careful with my clients’ already compromised body areas. In both instances, I apologized, and offered to support their recovery and healing in any way possible. Even though what I did was not intentional, my actions caused pain, and could have caused permanent damage. Luckily both clients recovered, and continued to see me as their therapist. I already had a long-standing relationship, several years long with both clients, and I think that helped smooth over the uncomfortable interaction, in addition to my willingness to take responsibility.

As I move into the quite different realm of becoming a physician, I recognize that any mistakes I make (as I surely will), will not be so easily remedied as above. There will be much more at stake this time, whether it’s due to my scalpel, or my prescription, or my words of medical advice. Here is an example of how I would plan on handling a potential medical mistake:

The recovery room nurse pages me, letting me know my client has woken up from his knee surgery. I amble down the long hall, not looking forward to the conversation that I know must take place.
I approach Mr. Smith, and sit next to the bed.
“How are you feeling Mr. Smith?” and as he nods his head groggily, I add, “How’s your pain?”
“Can’t feel a thing doc,” he responds.
“Good, Good. Listen, I want to talk to you about the surgery, and about some unexpected problems that arose during the surgery.”
The happy morphine look on his face disappears.
“While I was in your joint capsule, cleaning up the right meniscus tear, the posterior cruciate ligament got caught in the line of fire and was nicked.”
I paused to see if he could register this news through his haze.
“And…..,” he waited.
“And, I fortunately was able to repair it while I was in there. What this means for your recovery however, is that it will be longer than I had anticipated, and you may have more problems with range of motion and strength than I previously had indicated.”
Mr. Smith says nothing.
“I am very sorry Mr. Smith for this unintended outcome.”
I wait for Mr. Smith to get mad, yell at me, or to get sad and cry.
Nothing.
“Do you have any questions Mr. Smith?”
“No, No. Thanks for being upfront with me doc, and I know there are risks with surgery. Just get me set up with some strength training so that I can get back to my bike races as soon as possible.”
“Sure thing Mr. Smith, sure thing.”