Coping with medical mistakes and errors in judgment

Department of Emergency Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA 90033, USA.
Annals of Emergency Medicine (Impact Factor: 4.68). 04/2002; 39(3):287-92. DOI: 10.1067/mem.2002.121995
Source: PubMed


Attention has recently been focused on medical errors as a cause of morbidity and mortality in clinical practice. Although much has been written regarding the cognitive aspects of decision making and the importance of systems management as an approach to medical error reduction, little consideration has been given to the emotional impact of errors on the practitioner. Evidence exists that errors are common in clinical practice and that physicians often deal with them in dysfunctional ways. However, there is no general acknowledgment within the profession of the inevitability of medical errors or of the need for practitioners to be trained in their management. This article focuses on the affective aspects of physician errors and presents a strategy for coping with them.

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    • "Talking to the patient and disclosing the error is likely to have an additional dimension than emotional or informational ones. To describe what happens during error disclosure, some have suggested the religious metaphor of obtaining absolution from the patient [26,27]. "
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    ABSTRACT: Background Doctors, especially doctors-in-training such as residents, make errors. They have to face the consequences even though today’s approach to errors emphasizes systemic factors. Doctors’ individual characteristics play a role in how medical errors are experienced and dealt with. The role of gender has previously been examined in a few quantitative studies that have yielded conflicting results. In the present study, we sought to qualitatively explore the experience of female residents with respect to medical errors. In particular, we explored the coping mechanisms displayed after an error. This study took place in the internal medicine department of a Swiss university hospital. Methods Within a phenomenological framework, semi-structured interviews were conducted with eight female residents in general internal medicine. All interviews were audiotaped, fully transcribed, and thereafter analyzed. Results Seven main themes emerged from the interviews: (1) A perception that there is an insufficient culture of safety and error; (2) The perceived main causes of errors, which included fatigue, work overload, inadequate level of competences in relation to assigned tasks, and dysfunctional communication; (3) Negative feelings in response to errors, which included different forms of psychological distress; (4) Variable attitudes of the hierarchy toward residents involved in an error; (5) Talking about the error, as the core coping mechanism; (6) Defensive and constructive attitudes toward one’s own errors; and (7) Gender-specific experiences in relation to errors. Such experiences consisted in (a) perceptions that male residents were more confident and therefore less affected by errors than their female counterparts and (b) perceptions that sexist attitudes among male supervisors can occur and worsen an already painful experience. Conclusions This study offers an in-depth account of how female residents specifically experience and cope with medical errors. Our interviews with female residents convey the sense that gender possibly influences the experience with errors, including the kind of coping mechanisms displayed. However, we acknowledge that the lack of a direct comparison between female and male participants represents a limitation while aiming to explore the role of gender.
    BMC Medical Education 07/2014; 14(1):140. DOI:10.1186/1472-6920-14-140 · 1.22 Impact Factor
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    • "Furthermore, both physicians and nurses often sought social support, mainly from colleagues. Some examined the event inducing the regret and made changes in their practice, as advised by literature on coping with mistakes [19]. "
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    ABSTRACT: Regret is an unavoidable corollary of clinical practice. Physicians and nurses perform countless clinical decisions and actions, in a context characterised by time pressure, information overload, complexity and uncertainty. To explore feelings associated with regretted clinical decisions or interventions of hospital-based physicians and nurses and to examine how these regrets are coped with. Qualitative study of a volunteer sample of 12 physicians and 13 nurses from Swiss University Hospitals using semi-structured interviews and thematic analysis All interviewees reported at least one intense regret, which sometimes led to sleep problems, or taking sickness leave. Respondents also reported an accumulation effect of small and large regrets, which sometimes led to quitting one's unit or choosing another specialty. Respondents used diverse ways of coping with regrets, including changing their practices and seeking support from peers and family but also suppression of thoughts related to the situation and ruminations on the situation. Another coping strategy was acceptance of one's limits and of medicine's limits. Physicians reported that they avoided sharing with close colleagues because they felt they could lose their credibility. Since regret seems related to both positive and negative consequences, it is important to learn more about regret coping among healthcare providers and to determine whether training in coping strategies could help reduce negative consequences such as sleep problems, absenteeism, or turnover.
    PLoS ONE 08/2011; 6(8):e23138. DOI:10.1371/journal.pone.0023138 · 3.23 Impact Factor
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    • "Prior work has considered the effects of errors on clinicians themselves, both as members of an imperfect and ''dangerous'' profession, and as individuals whose mistakes have harmed patients (Christensen et al., 1992; Engel et al., 2006; Gallagher et al., 2003; Goldberg et al., 2002; Hilfiker, 1984; Levinson & Dunn, 1989; Mizrahi, 1984; Newman, 1996; Wears & Wu, 2002; West et al., 2006; Wu et al., 1991; Wu, Folkman, McPhee, & Lo, 1993). The long-term effects of making mistakes may include symptoms of depression and burnout (Gallagher et al., 2003; Giannetti, 2003; Goldberg et al., 2002; Hilfiker, 1984; Wears & Wu, 2002; West et al., 2006; Yee, 2002). Yet few have discussed the possible utility of blame, although Wu et al. (1991) found that physicians who accepted responsibility for mistakes were more likely to report improvements in their practice. "
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    ABSTRACT: Official policy-making bodies and experts in medical error have called for a shift in perspective to a blame-free culture within medicine, predicated on the basis that errors are largely attributable to systems rather than individuals. However, little is known about how the lived experience of blame in medical care relates to prospects for such a shift. In this essay we explore the benefits and costs of blame in medical culture. Our observations are informed by our clinical experience and supported by interview data from a study in which 163 American physicians were interviewed about caring for a total of 66 dying patients in two institutions. We observe three ways in which blame is invoked: (1) self-blame, (2) blame of impersonal forces or the "system," and (3) blame of others. Physicians articulate several important functions of blame: as a stimulus for learning and improvement; as a way to empathically allow physicians to forgive mistakes when others accept responsibility using self-blame; and as a way to achieve control over clinical outcomes. We argue that, since error is viewed as a personal failing and tends to evoke substantial self-blame, physicians do not tend to think of errors in a systems context. Given that physicians' ideology of self-blame is ingrained, accompanied by benefits, and limits a systems perspective on error, it may subvert attempts to establish a blame-free culture.
    Social Science [?] Medicine 09/2009; 69(9):1287-90. DOI:10.1016/j.socscimed.2009.08.033 · 2.89 Impact Factor
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