Mistakes are an inevitable aspect of any system that involves decision-making; healthcare is no exception. For better or for worse, the mistakes that we make over the course of our careers define, to some extent, who and what we become. In the early days they often influence career decisions. Subsequently, they shape our approach to work, subtly impacting on our communications with patients, our investigative decisions and our willingness to discharge people home. For many nearing retirement, the timeline of a career is a haze of professional satisfaction, punctuated by incidents of avoidable harm recalled with the clarity of yesterday.
Henry Marsh (1) describes the impact of mistakes on his professional demeanour: “At the end of a successful day’s operating, when I was younger, I felt an intense exhilaration. As I walked round the wards after an operating list… I felt like a conquering general after a great battle. There have been too many disasters and unexpected tragedies over the years, and I have made too many mistakes for me to experience such feelings now…”(p.33) Dealing with one’s own failures is, I think, the most challenging aspect of a career in healthcare. How does one balance the inevitable sorrow and guilt with the need to hold one’s head high and continue to make high-stakes decisions?
Medical school lays the foundations for a career in medicine. The thirst for knowledge is unparalleled. As Atul Gawande (2) says, “We paid our medical tuition to learn about the inner process of the body, the intricate mechanisms of its pathologies, and the vast trove of discoveries and technologies that have accumulated to stop them. We didn’t imagine we needed to think about much else.”(p.3) And yet we do. At medical school I was introduced to the abstract concepts of error, unintended harm and, God forbid, mistakes. But I didn’t understand them concretely, like I do now. That I will make mistakes, I will cause harm, inflict distress and compound misery. That one day I would be crouched on the floor beside a patient, with the hateful glare of a relative fixed on the back of my head, uttering “I’m sorry”.
Don’t we, as a profession, have a duty to better prepare our future doctors to deal with their own failings? Shouldn’t we augment the vast knowledge of pathophysiology with self-awareness, emotional resilience and the language of professional but meaningful apology? The challenges are great, but so too are the rewards.
Immersive simulation is a tool that facilitates rehearsal of high-stakes decision-making in emotionally charged situations. Mistakes are more than likely in such contexts. The debrief allows participants to reflect on their actions, off-load emotionally and discuss the possible consequences of alternative choices. That journey of self-discovery and emotional development is, in my mind, what underpins the power of immersive simulation. The challenge now is how that journey can be continued, and supported, in the workplace.
- Henry Marsh. Do No Harm: Stories of Life, Death and Brain Surgery. Published by Weidenfeld & Nicolson, 2014.
- Atul Gawande. Being Mortal: Illness, Medicine and What Matters in the End. Published by Profile Books Ltd, 2014
About the author:
Vicky Tallentire is a consultant in acute medicine at the Western General Hospital in Edinburgh. She has an interest in the training of physicians, and has held a number of roles in the Royal College of Physicians in Edinburgh. Vicky has a particular interest in simulation based research and completed a doctorate at the University of Edinburgh in 2013 using simulation as a tool to explore decision-making and error. She is keen to develop the research profile of the centre and would like to hear from anyone, from any professional background and at any level, who is interested in undertaking research projects in the field of simulation.