Sharing stories of medical error
We asked physicians to tell us two stories of their own medical error,
one which they chose to share with others and one which they chose to
keep private. They told stories that took place in the very distant to
the quite recent past. The stories included many types of error:
diagnostic errors (e.g., missing low-flow ischemia, failing to diagnose
an embolic clot, failing to recognize tamponade physiology, missing an
aortic dissection on a Pulmonary Embolism scan); management errors
(e.g., failure to note medication interactions, failing to order a test,
reassess the patient, read a test in its entirety, or to redo gasses;
inability to secure the airway; and discharging a patient too soon).
Across a variety of clinical environments, dialogue around medical
errors happens in an unstructured, informal way. The decisions to share
with supervisors, colleagues, or trainees are determined by varying
motivations. Stories of errors are shared with supervisors or colleagues
for emotional support, reassurance, and/or for guidance on a course of
action; they are shared with colleagues for affirmation and with
trainees for teaching purposes. Some physicians chose to anonymize their
personal involvement when sharing the story one-on-one with trainees or
shared a stylized, anonymized version of their experience with the
intent to teach general principles with trainees. For example, one
physician said he took it upon themselves to prepare a lecture on the
topic of his medical error as he wanted his trainees to have the
opportunity to learn from it before they themselves faced a similar
situation: “the mistake I made was a mistake anyone can make, but the
fact that I made it wasn’t as important as making sure nobody makes it
again” (Participant 012).
The typology of stories that are shared willingly compared to those that
were kept hidden hinged on the following key factors (i.e., reasons for
sharing): 1) whether trainees are able to learn a valuable lesson from
hearing the stories (regardless of whether they are general or specific
cases); 2) the level of torment it causes the individual who is sharing
the story; 3) whether they have an open relationship with their
supervisors and/or work in an environment that is open to dialogue
around error. These three factors work together to incentivize or
disincentivize the sharing experience and are valued in varying weights
by the individual. Those themes were rarely present when the stories
were kept private. For example, one participant said the following about
an error that he chose not to share with colleagues or trainees, “Well,
I mean at the time it was very difficult. I had to stop work for a few
days. I think it actually triggered a depression. It was also around the
time that my son was born and he’s now 21 and clearly, I could not
connect as a father for the first few months of his life because of what
happened. I think I had some counselling at the time but I don’t talk
about it much since then (Participant 002).”
Many participants approached the topic of preventable errors with an
understanding that errors, which can happen to anyone, are indeed vital
to the learning, growth, and development of practitioners. From the
perspective of the physician, the efforts of supervisors who
co-developed good communication standards and processes for initiating
dialogue around errors while emphasizing ethics and professional values
amid the affirmation of good clinical decision-making skills are highly
valued and appreciated. Essentially, this includes an effort between the
supervisor and learner to pre-establish how errors should be discussed
and a course of action for how different types of errors should be
handled (e.g., growth points are discussed and feedback around what was
done well is highlighted). Similarly, after an error is made, colleagues
who made an effort to empathize and re-affirm the good decision-making
of the physician are valued. By sharing related stories of past errors,
both colleagues and supervisors are important in helping physicians who
had recently made an error by helping them understand the big picture
around the error, offering action-oriented growth points, and
communicating hope and optimism in a non-judgmental way.