One case that eats me up is the equivalent if an ankle sprain that comes back five days later with osteomyelitis. No risk factors to predict development of this. Leaves me thinking maybe I should have done something different. This isn't exactly the case I had but it parallels it. No m&m out of it but I let misses get to me and then my personal life takes a dump.
You Save As A Team, You Miss As A Team
If so, this is where I am going to grab you by the collar, and violently shake you and say, "
No. No. No. No. No." I'm going to answer this assuming you are a medical student, but this applies to interns and residents, too. You are learning. Cases will and should ring in your head for a while, especially one's you wish you could do over. This serves a purpose by burning them into your brain so you learn from them. We all have such cases, and it's normal to be bothered by them, if you are human. Take comfort in that they will be less frequent as you get along in your training and the years.
But when you say this,
"I let misses get to me and then my personal life takes a dump," it truly is time to channel the defensive inner-redneck recessive gene that is (hopefully) rarely expressed, and fight back. It’s time to stop beating yourself up on this and get angry. Where the hell is your attending on this? None of your supervising doctors are going to tell you this, because they want to foster responsibility in you, and they want you to care and learn from mistakes, as you should. But
whose mistakes?
Their frickin' mistakes. Yes,
their mistakes. ("What the heck do you mean, Dr. Bird, it was my mistake?") Read this now, and never forget it as long as you are a medical student, resident OR attending:
You save as a team, AND YOU
MISS as a team.
("What the heck are you talking about Birdstrike, you are talking in riddles?") Remember, all those times people treated you like as a med student you didn't matter, or as a resident, implying you weren't a "real doctor" yet? You're not a "real doctor," you don't get a "real doctor" paycheck, and don't get "real doctor" respect, yet where there's a miss, you're supposed to jump off a bridge over it?
Nuh-uh.
It's your attending's job to do one of two things: 1-Either
teach you and lead you to make the correct diagnosis and treatment, or 2-Give you appropriate autonomy yet
adequately supervise you so that appropriate care is provided. There's no in between, or third option. Ultimately he (or she) is responsible.
So, that's why every single damn chart you sign, as a medical student, resident or fellow, needs to say, "Case discussed with Dr Blankety Blank," or some other disclaimer of your choice indicating supervision, shared liability and
responsibility. That can be someone, anyone, above you in the chain of command. Every chart. Every chart. Every chart. It's their responsibility to help you make the right call, and ensure the outcomes are as good as if they were working alone. If they weren't around to supervise you, then that's their fault, too. It's their job to do so. Now I'm not telling you not to care, or just throw up your hands and blame a supervisor for any inadequacies you might have. I'm not telling you that you shouldn't take responsibility and view cases and patients as "your own," because you should.
But never forget: the attending makes the big bucks for a reason. You're just a trainee for a reason. And
attendings know this, even though they’re going to make you present the M&M as if you were the only doctor in the hospital when the case unfolded. Rather than being offended every time someone says or implies you're “not a "real doctor yet,” take
comfort in the fact that your attending owns the mistakes FIRST, and you second. They know damn well that if there's a screw up on a patient, and it goes to court, they have zero,
ZERO, leg to stand on by saying, "It's the med student's fault," or "It's the resident's fault." So if you miss something, and your attending saw the patient, and you discussed it. It's his screw up, too. (Sure as heck, don't say that too his face, though.) And if he (or she)
didn't see the patient, that's just as much on them, as inadequate supervision. So, learn from your cases (good and bad.) Take responsibility for them as if they are your own. But also, remind yourself, and take comfort in the fact that as much as they want you to believe otherwise, the buck stops somewhere else (for a while.) Don’t
torture yourself.
You save as a team, you miss as a team.
