Making Mistakes

Nobody is perfect. Mistakes happen all the time and there is always the potential to learn from them. This is obvious from attending the average morbidity and mortality conference. The important thing is to admit the mistake and learn from it so that under similar circumstances it won’t happen again.

It is important to distinguish between making mistakes and experiencing complications. Any physician treating patients will know about complications…they happen to the best of us all the time. Sometimes they are explainable and sometimes they are not. If you treat high risk patients, complications of the disease and of care will be your constant companions. Be assured that the patients will understand and will be grateful that you accepted the challenge of caring for them. The art of medicine is in anticipating complications, dealing with them, , mitigating their effects, and bringing the patients safely through.

It has been estimated that in 2016, more than 250,000 deaths occurred in the United States due to medical mistakes. To say that this is a serious situation is an understatement. In addition to death, the non-lethal effects of medical errors on quality of life, loss of employment, loss of income, loss of family time, and mental health are significant. The true impact of medical mistakes is hard to measure, but the whole subject represents largely preventable tragedy. All healthcare workers should all try to practice with an error rate as low as humanly possible. Facing up to mistakes requires humility in admitting fault and accepting blame. It also takes courage to continue to practice medicine with confidence and skill, despite having just been reminded that you are fallible.

As surgeons we are prone to errors of process, judgement, and technique.

With errors of process, we might operate on the wrong patient, the wrong limb on the right patient, and leave sponges or other foreign material within the wound. We might prescribe a medication to which the patient is known to be allergic, or that might predictably cause adverse effects. We might be careless in not giving an appointment to a patient is significant distress. In many large medical centers, processes are in place to prevent mistakes. Standard operating procedures include a “time out” or a “huddle” to guard against doing the wrong procedure on the wrong patient. Surgical counts minimize foreign bodies. But rules and processes only go so far. There is always the thought that “I could never do that: or “it won’t happen to me”, but it can, and it probably will.

Errors of judgement usually stem from a faulty thought process concerning a clinical situation. Diagnoses may not be completely accurate and relevant risk factors may not be appreciated. The pressure of work may lead to expedient decisions that are not in the patient’s best interest. For example, delaying a test or a process to “see how the patients does overnight” may miss a critical window for effective care. Conflicts with family or recreational affairs should not be allowed to delay clinical care. Handovers to on call staff or covering staff must be smooth and critical information cannot be omitted. Errors of judgement due to inadequate information are preventable.

Technical errors imply inadequate training or lack of talent. The surgical apprenticeship of residency is designed to produce safe surgeons, but the quality of programs varies along with the technical talent of the trainees. Here is where the assessment of mentors and teachers in important. Fellows who have deficiencies in technique must be re-trained. New surgeons must recognize their technical deficiencies and operate within their own skill set.

Here are some other ways to minimize mistakes.

1. A good surgeon has a touch of obsessive-compulsive disorder, developing routines that safeguard against errors and sticking to them.

2. Follow the standard operating practices in your institution.

3. Make sure you are a good communicator, with colleagues, with residents, nurses and patients.

4. Know about your patient; read the records, review recent tests and images. Adapt your care to patient risks and comorbidities.

5. Get advice when you need it

6. Guard against lack of sleep and burnout

*Rodziewicz TL, Houseman B, Hipskind JE. Medical Error Reduction and Prevention. 2022 Dec 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29763131.