It Hurts Whether You Fail or Not

As a surgeon, I don’t often sit in my office, but on this afternoon I did. After a knock on the door, one of my first-year surgical residents entered and asked if we might have a private conversation. He seemed ill-at-ease and miserable as he sat down. He was reluctant to talk at first, but he finally described how he had recently transferred a patient to the internal medicine unit. Two days later, he learned the patient had passed away. Immediately before the transfer, he had adjusted the patient’s medication and implemented a new drug, and I began to understand what was causing his pain when he whispered with tears in his eyes, “I think this patient died because of me.” The power of that moment remains with me to this day. Failure is an intense experience for health care professionals. Even in most cases when the patient experiences no lasting harm, the professional who failed will suffer. There is no getting used to this pain. We cannot prepare for it, and often we feel alone in working through it. I wondered how I should react to my resident’s admission. This experience might damage him both professionally and personally. In the end, I responded the only way I knew how—with empathy. I took him and what he had confided to me seriously. No other course of action would have been appropriate in this delicate situation. We studied the case from the beginning and discussed every detail. To support his understanding of the case, we drew a mind map of the patient’s history, including all his symptoms, the list of diagnoses, and the many different medications he had been taking. We examined package inserts for rarely encountered side effects or interactions with other medications. We checked all his parameters and blood results twice. We found no evidence that my resident was in any way responsible for the patient’s death. The elderly man had died of multiple organ dysfunction, and there was no hint that anyone had done anything wrong. My resident seemed relieved but still miserable. Why? Because he had realized something invaluable in the minutes spent in my office—that as a doctor, he will inevitably fail, and thus he’ll experience this kind of situation and these emotions over and over again. Sometimes we as physicians will discover that we failed and learn from it, which may help us cope. At other times, however, there won’t be an explanation. Those moments will hurt, even in the absence of failure, because we lost a patient. Dealing with painful, sometimes paralyzing emotions like shame, guilt, and grief is an inherent part of our work. Although we did our best to help this patient, it doesn’t erase the feelings of embarrassment and insecurity that can languish for weeks, or even months, after. These experiences influence our identity formation as medical professionals. In sharing these stories, we help ourselves and others to recover. As clinical supervisors, we must not forget that failure is a part of teaching and learning; we must remain sensitive to this aspect of our trainees’ experiences. We need to teach trainees to show themselves the same empathy they would show others. Acknowledging that failure is inevitable means pushing past our discomfort and accepting our own vulnerability. I reveal my fallibility by taking responsibility for my actions, acting as a role model by sharing my struggle with trainees, reflecting with colleagues to learn and cope, and having honest conversations with patients. There is value in accepting failure and being vulnerable. We need to look at failure as a lesson and an opportunity for introspection and growth. Allowing ourselves to show vulnerability is an indicator of strength. It is not easy, and it takes practice, but it opens the door to more authentic connections with our trainees, colleagues, and ultimately, our patients. If someone knocks on your door, open it, and be human—tell, ask, and listen. The next time it could be you who knocks. She would also like to thank Lorelei Lingard, who inspired her to tell this story, and Sarah Burm, who gave her feedback on an earlier draft

Conversation · Empathy · Harm · Health care · Child and Adolescent Health · Law · Medicine · Nursing · Pharmaceutical Practices and Patient Outcomes · Pharmaceutical studies and practices · Psychology · Social Psychology