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My October EM News column.

So you made a mistake. I know you’re busy beating yourself up about it. I know that after years and years of training in life-saving medicine you’ve also trained yourself to accept the blame for all sorts of things beyond your control.
You’re asking, ‘how could I have missed that,’ or ‘why didn’t I think about that?’ You’re wondering why you didn’t give a different drug, order another test or do a different procedure. You may be replaying the whole scene in your mind; the nightmare intubation, the pediatric trauma, the young family, the old couple. You’re imagining the death notification, or simply the way you had to admit that you did something wrong.

You may not be sleeping well. You may have had a little too much wine to cope. It’s possible that your family sees it in your eyes. You might be looking forward with dread to that upcoming peer-review. You fear, after talking with risk-management, that you’ll be facing a lawsuit. You might even be wondering if any of it was worth it, or if you can keep going on after what happened.
Can you put all that on pause for just a minute? I have a few things to tell you. I’m not a psychiatrist or counselor. I’m not a lawyer. I am, however, a colleague who has been working in this crazy world of emergency medicine for 24 years. (27 if you count residency…which we should.) I have also made mistakes. And like you, I have caused harm. So I have some insight into this whole error issue.

First of all, it’s a miracle that we don’t make more mistakes. Our emergency departments are constantly flooded with a bizarre mixture of everything from infected hangnails to aortic disasters. And none of them come with signs on them that say, ‘tomorrow I’ll be septic,’ or ‘I’m secretly having an MI!’ And last time I checked we had no crystal balls in the nurses’ station. So we spend our days at breakneck speed sorting through the a thick cloud of unknown factors, attempting to satisfy the patient, please the consultant, finish the chart, provide the bill, do it all faster, cheaper and better, whether we’re sick, hurt, sad or exhausted. And all the while, we incidentally save lives and ease suffering.

Second, none of this is the same as engineering or hard science in terms of mathematical predictability. Medicine is a hot mess of human anatomy, physiology, sociology, psychopathology, weather, culture, alcohol, drugs, lies, sex, misery, hope and compassion. Furthermore, humans are constantly in the process of dying. You can’t change hat fundamental reality.
That you do good at all is a testament to your great intellect, physical endurance and endless love of your fellow humans. Look here, this is one of the hardest jobs on the planet! Accept that, and accept your fallibility.

Third, you may be sued. You may lose! Physicians may kick you around for a while. (They do it as a kind of ritual, a talisman; it helps them believe the lie that it won’t happen to them.) Lawsuits are part of the financial ecosystem. Lawsuits and criticism come with the territory. It feels personal. It isn’t.

In light of all of these things, you must remember this: medicine is your job, your profession, maybe your calling. It is not your identity. You are far more complex and nuanced. You are daughter or son, husband or wife, girlfriend or boyfriend. You are sibling, cousin, friend, pet-owner, artist, athlete, craftsman, soldier, sailor, airman, veteran. You can apply whatever identity you like, and change it as you see fit. But you are not only ‘doctor.’

If the whole locus of your identity lies in being a physician, then errors, losses, failed resuscitations and all the rest will strike at your center. You must move the center. Take the bullseye off of your being.

That way, even if you could never practice again (through accident, illness or litigation), you would still be a valued, treasured person who had a great experience as a physician. However, that’s unlikely to happen. There are bumps and pitfalls in medicine, but you will still keep doing great work.

This is what you must take from me today. This is what you must share with others. In the course of your career, even a short career, you will save, help and comfort vastly, astronomically, more people than you will ever harm. And you will show more kindness than most people ever imagined possible.

And at the end of your days, when you lie down to that final sleep, you will be able to do it with the knowledge of all that good.

Troubles aside, that’s a great blessing.

Keep the faith my people!
Emergistan treasures you. And you are so good.

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