Why physicians need to celebrate their fallibility.

Walker Gawunde was just 11 days old when a simple medical mistake nearly killed him.

After being rushed to the hospital with a suspected heart defect, medical staff followed standard protocol and attached a pulse oximeter to his finger to monitor his blood oxygen levels. Happy with the 98% saturation reading that popped up on the screen, they carried on without giving it a second thought.

Things quickly deteriorated when Walker’s kidneys began to fail. A paediatrician was called in and he swiftly ordered the staff to switch the oximeter to the other hand. The saturation rate was so low it was unreadable.

Unbeknown to staff, Walker had a major problem with his aorta–it was supplying blood to only one side of his body. An emergency injection was immediately administered and surgery duly scheduled. A short stint inside the ICU and Walker very luckily managed to emerge from the incident unscathed.

Thanks to the quick thinking of this paediatrician, Walker is now a healthy, young man completing a college degree. But the baby in the cot next to his was not so lucky. He also faced a life-threatening condition but help had come too late. He went into organ failure and is still awaiting a transplant. Unfortunately, stories like these are all too common.

Walker’s father happens to be American surgeon and celebrated author, Atul Gawande. In a lecture delivered at the John F Kennedy Presidential Library in Boston called “Why doctors fail”, Atul argues that cases like these are regularly swept under the carpet for the sake of maintaining an illusion of infallibility within the corridors of medicine. He believes strongly that the only way medicine can truly progress is for a culture of transparency to become entrenched within the profession. Atul insists that we can only create this culture by “removing the veil over what happens in the clinic and hospital; only by making what has been invisible visible”.

But how do you cultivate a culture of transparency when clinicians are so used to putting on a facade of unfailing authority? It starts with one person. One domino to kick off a chain reaction that makes it ok to speak up.

In a recent opinion piece in the New York Times, Dr Abigail Zuger recalls a case where she sent a patient with a swollen ankle to the radiology department for a scan. When the patient got there, he was livid. Why? Because Dr Zuger had ordered the scan on the wrong foot. As it turns out, Dr Zuger happens to be amongst the 15% of the population who suffer from left-right confusion and she openly admits it. Far from hiding her condition, she acknowledges that she has to make a concerted effort to distinguish between her right and her left and that sometimes–just sometimes–this affects her ability to care for her patients.

We are fallible and we must remember that fact at all times. The illusion of expertise is that it provides the expert with a false sense of security and as time goes on, can mask the very real possibility that he/she can still make a grave mistake. Being an “expert” feels good. It strokes the ego and represents hierarchy within the medical world. So how do we overcome the ego and develop a state of continual growth?

The ever-wise William Osler once stated, “One special advantage of the skeptical attitude of mind is that a man is never vexed to find that after all he has been in the wrong.” (Osler, 1909)

The culture within medical ecosystems around the world may differ widely but one pattern tends to remain consistent- it’s difficult for a medical practitioner to openly admit to making a mistake and seeking advice. Regardless of your level of expertise, there is always room to grow. Whether you’ve just started medical school or you’re about to retire from a luminous medical career, you will always find something new to learn in the wild and wonderful world of medicine.

So next time you don’t know the diagnosis or right treatment approach, think before speaking up. It’s totally ok to say “I don’t know but I will do everything I can to find out.” Patients appreciate vulnerability and honesty and so should we.

Growth is a mindset. It starts with the acknowledgement that you are fallible. That you are capable of making mistakes, no matter your level of expertise. With that acknowledgement comes a level of self-awareness that is necessary for personal improvement. Without self-awareness, there can be no personal growth and without personal growth, your growth as a doctor stagnates too.

Finally, as British actor Damian Lewis said, fallible characters are more interesting than superheroes in the end. As a clinician who may one day be responsible for shaping the minds and professional development of the clinicians who look up to you, letting them know that it’s ok to make mistakes and learn from them might one day save someone’s life.

References:

Osler, W. (1909). The treatment of disease. Canada Lancet; 42, 899–912.