What happens when you make a mistake?

[caladan]

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At various stages of your med education what happens when you make a mistake and the patient is negatively affected or dies?

I'm assuming as a beginning resident they don't let you do much. But what about later on in you residency years when you have more responsibility? Or if you're an attending or afterwards when you're a doctor working at a hospital? Do you get a specified limited number of 'reviews' or 'warnings' and then you're fired?

I'm reading that physicians always have a lot of work and are pressed for time (assumption: they spend as little time as possible working on a case). How do you minimize the chances that a decision you make will be a bad one or that you'll make a mistake? For example, cutting the wrong thing in surgery...

Do you have to be conservative in your decision-making?

I'm obviously not in med-school yet but it is my current goal. The thought of accidentally killing someone is freaking me out. Does it not happen very often?

 

[Pir8DeacDoc]

Decisions are rarely made in a vacuum. Your decisions are often carried about by nurses. Often they have a better clue about what's going on than you do, at least initially. Further, if you aren't sure of a decision that is important, there are always more senior residents to bounce things off of. You should never be ashamed to ask for help. Finally, you have to make the best decisions that you can with the available information that you have and try not to second guess yourself in hindsight. It's helpful to review decisions and analyze if you did the right thing, but brow beating yourself isn't helpful. You must have the confidence to know you did the best you could for the patient at that time and move on.

 

[YayNakedChicks]

How about-what can I do to avoid a mistake? Your fear is good, but use it to help you work harder not to come up with 1,000,000,000 scenarios

 

[mlw03]

How about-what can I do to avoid a mistake? Your fear is good, but use it to help you work harder not to come up with 1,000,000,000 scenarios

i would add that hard work is important, but does not prevent mistakes. sometimes you make a bad choice, whether it's because of bad information, or because it was a coin flip situation and you happened to pick wrong. hard work, in my opinion, lessens the chance of a mistake being made.

 

[docB]

At various stages of your med education what happens when you make a mistake and the patient is negatively affected or dies?

I'm assuming as a beginning resident they don't let you do much. But what about later on in you residency years when you have more responsibility? Or if you're an attending or afterwards when you're a doctor working at a hospital? Do you get a specified limited number of 'reviews' or 'warnings' and then you're fired?

I'm reading that physicians always have a lot of work and are pressed for time (assumption: they spend as little time as possible working on a case). How do you minimize the chances that a decision you make will be a bad one or that you'll make a mistake? For example, cutting the wrong thing in surgery...

Do you have to be conservative in your decision-making?

I'm obviously not in med-school yet but it is my current goal. The thought of accidentally killing someone is freaking me out. Does it not happen very often?

You are asking a lot of different questions. Let me try to break down so of the issues you bring up.

What happens at various stages of training:
As a med student you are on a short leash. If you do something that causes harm it will be primarily your resident and attending who get burned. You will likely not get a good eval or might have to repeat a rotation.

As a resident some of what happens will depend on if your mistake was careless or an honest error. Do not be careless. Careless enough could result in termination of your residency contract, ie. getting fired. Usually you will get a reprimand and/or go before M&M (do a search).

As an attending you may not have anything happen, you might get santioned by the hospital, you can get sued or you can have action taken against your license.

Physicians are pressed for time but we're expected to perform almost perfectly with the omnipresent threat of lawsuit. You tend to be more conservative with the riskier, more invasive things. Experience and knowledge temper that conservativism because the more you know the indications and contraindications for something the more comfortable you are about pulling the trigger.

Damn. code, gotta go.

 

[caladan]

Thanks for the replies. Very informative.

The reasoning behind my question is that I was (perhaps mistakenly) trying to compare my experience in corporate to what would happen in a medical situation. Jumping over the fact that Docs go through years of training.

Since I'm the head of my dept, for every decision I make, I'm the only person ultimately responsible. If I make a mistake of some sort, it's probably something easily fixed. But when human lives are involved, the stakes are greater and you can no longer say 'ooops'.

As you guys/gals suggested: experience, training and hard work diminish the likelihood of making mistakes. Guess I'm just getting ahead of myself.

 

[Annette]

I was just reading (?Sermo) about a study that shows residents who make major mistakes tend to become depressed (DUH!), and end up making more mistakes. The study also mentioned that mistake making and consequences really hasn't been studied in attendings. Given that physicians have high suicide and divorce rates, I wouldn't be surprised to find similar outcomes.

Because the consequences of errors can be devastating, there are multiple systems to help prevent them. Pharmacists review medications before dispensing (except in emergent situations), nurses serve as a slight double check (but new/less experienced RNs may not catch somethings), and there are a number of medications that require 2 nurses to check med and dose before it being given to a patient. My hospital is starting to implement computerized bedside checks of patient identity and ordered medications.

Unfortunately, there are still many preventable and unpreventable errors that can and do happen. DocB is correct in that our society, physicians and the health care system are not allowed mistakes. In the end, I try to take into account the big picture- for example, I may have hit an artery when trying to put in a central line, caused the patient more pain than necessary, but he is alive because I could get the antibiotics into him. I also try putting someone else in my shoes and ask myself how I would judge that person. I think most of the time people are hardest on themselves.

 

[Bertelman]

Thanks for the replies. Very informative.

The reasoning behind my question is that I was (perhaps mistakenly) trying to compare my experience in corporate to what would happen in a medical situation. Jumping over the fact that Docs go through years of training.

Since I'm the head of my dept, for every decision I make, I'm the only person ultimately responsible. If I make a mistake of some sort, it's probably something easily fixed. But when human lives are involved, the stakes are greater and you can no longer say 'ooops'.

As you guys/gals suggested: experience, training and hard work diminish the likelihood of making mistakes. Guess I'm just getting ahead of myself.

I'm very early on in my residency, and I can tell you I have already made a mistake that jeopardized my patient's life. It will happen. I was confronted with my error, and my practices have changed. Any resident that tells you they have never made an error that potentially had grave consequences for their patient is either
a) lying
or
b) arriving for their first day of residency.

 

[Pir8DeacDoc]

Any resident that tells you they have never made an error that potentially had grave consequences for their patient is either
a) lying
or
b) arriving for their first day of residency.

Don't be so sure about that. It might make you feel better but I'm not sure I'd agree. I have certainly made mistakes but I don't think any of them were of the "grave consequence" variety (yet)..... Maybe I am just completely oblivious to my mistakes.

 

[Bertelman]

Don't be so sure about that. It might make you feel better but I'm not sure I'd agree. I have certainly made mistakes but I don't think any of them were of the "grave consequence" variety (yet)..... Maybe I am just completely oblivious to my mistakes.

It doesn't make me feel better. Of course my post was somewhat facetious, but I really believe that most residents who care for critically ill patients are capable of making a mistake that could cause harm to their patient. Luckily it usually doesn't run out that way.

I'm really not sure what specialty you are studying, or where you are in your training, but left to your own overnight covering 30+ patients, all with significant cardiac/renal disease, some in the ICU, 2 months into residency, the likelihood of making a mistake is rather significant. I'm not making excuses for myself, and I'm not dreaming that everyone else makes a mistake to feel better about my own. I would say that most of us have made significant mistakes that were either corrected before they happened, or resulted in no adverse outcome. Whether you were aware of the mistake is another story. I was made aware of mine only because it was caught by a graduate of the program at another hospital who felt I should be informed.

 

[Blade28]

Since I'm the head of my dept, for every decision I make, I'm the only person ultimately responsible. If I make a mistake of some sort, it's probably something easily fixed. But when human lives are involved, the stakes are greater and you can no longer say 'ooops'.

I guess you could liken that position to an attending - the one who's ultimately responsible. He/she does have fellows, residents and medical students working beneath him/her.

 

[McDoctor]

At various stages of your med education what happens when you make a mistake and the patient is negatively affected or dies?

I'm assuming as a beginning resident they don't let you do much. But what about later on in you residency years when you have more responsibility? Or if you're an attending or afterwards when you're a doctor working at a hospital? Do you get a specified limited number of 'reviews' or 'warnings' and then you're fired?

I'm reading that physicians always have a lot of work and are pressed for time (assumption: they spend as little time as possible working on a case). How do you minimize the chances that a decision you make will be a bad one or that you'll make a mistake? For example, cutting the wrong thing in surgery...

Do you have to be conservative in your decision-making?

I'm obviously not in med-school yet but it is my current goal. The thought of accidentally killing someone is freaking me out. Does it not happen very often?

I think it's useful to draw a distinction between making an error, be it technical (inadvertantly snipping a vessel in surgery) or in judgement (an incorrect diagnosis), and being negligent or overly superficial in assessing patients. There is a legal distinction, I'm sure, but I'm speaking in laymans terms.

You will make errors throughout your career as a doctor. In primary care, incorrect diagnosis is probably fairly common. If you are thorough in your history taking and objective assessment, yet you come to the wrong conclusion, then you probably shouldn't be too hard on yourself except to learn from the experience.

Blowing patients off because they are "complainers", seeing a reckless number of patients in one day (I've heard of FP's who schedule in 5 minute blocks), not taking a thorough history, not doing an adequate exam, not staying current with the standard of care...these are pitfalls you can avoid to limit your chance of a sentinel error.

I'm just parroting DocB's point...don't be careless and you should be alright.