Dealing with failure: The aftermath of errors and adverse events

Departments of Health Policy and Management, Epidemiology, and Medicine, Johns Hopkins University, Baltimore, MD
Annals of Emergency Medicine (Impact Factor: 4.68). 04/2002; 39(3):344-6. DOI: 10.1067/mem.2002.121996
Source: PubMed
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    • "Errors will also remain a strain on the doctors themselves, which was confirmed by the level of psychological distress that affected our participants. Doctors are known as the second victims of errors because errors can severely impact on their quality of life and on their emotional well-being in particular [5,9,13,22]. Errors also decrease confidence and may leave psychological scars [9,22]. "
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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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    • "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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    • "In general, it is difficult to admit that one has made a mistake of any kind, particularly in medicine, where the culture shared by patients and providers promotes expectations of flawless performance [16]. Caregiver feelings of guilt, shame, and self-doubt enshroud medical errors [17]. By admitting to a mistake, the physician may lose self-confidence and risk damaging his/ her professional relationships and reputation with colleagues and patients. "
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    ABSTRACT: Physicians and hospitals should be aware of the ethical duty to disclose a medical error that causes harm to a patient. Disclosure should be made to the affected patient or, when appropriate, to a family member of the patient. The manner in which the disclosure process is performed is also important. In emergency medicine, disclosure discussions are problematic because of the limited nature of the patient-physician relationship. The initial disclosure can be conducted in a way that maintains or even improves the relationship with the patient, or in a manner that damages trust. This article discusses the importance of disclosure in emergency medicine; the ethical basis for, and barriers to, disclosure; and the key elements of the disclosure process.
    Emergency Medicine Clinics of North America 09/2006; 24(3):703-14. DOI:10.1016/j.emc.2006.05.015 · 0.78 Impact Factor
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