I hate that question. The one people ask you that means ‘oh, he died a terrible death after you discharged him!’ We all have it. In fact, it haunts me when I’m away on vacation. I’m afraid I’ll come to work and see that letter from an attorney, the note from my partners, or or the post-it from the secretary: ‘Please call coroner’s office; they have a question about a patient you recently saw.’

It has happened to me. It makes your heart race, your palms sweaty, your mouth dry. It makes you go to the chart and frantically go through it to see if you made any glaring mistakes, or even any subtle ones. It makes you scrutinize every word in every paragraph. It makes you feel guilty and sad. The thing is, most of us don’t do this urgent retrospective because we’re purely self-interested and worried about lawsuits. We do it because we care about our patients, and are devastated when we make serious mistakes. But we’re also concerned about our skills, and because we attach our worth (wrongly) to our abilities, our real (or imagined) misses are very personal.

I’ve seen it happen many times. And the one advice I can give to everyone is ‘be kind and careful when you deliver the news.’ If you can tell someone before they come back to work, do it. If you can look over the chart and offer encouragement, do it. If you need to tell them and then offer them a day off to process it all, do it. Because the knowledge that someone we saw died or had a seriously bad outcome is physically and psychologically rattling. It leaves us doubting, hesitant and sometimes quite frankly unable to practice for a day or two.  And especially in emergency care, the hesitation that self-doubt brings can be dangerous.  Like a big-game guide who can’t pull the trigger when the Cape Buffalo charges.  Like the F-16 pilot who is afraid to pull the aerobatic maneuver that will save his life in combat.
Guys and gals, we’ll all make mistakes, no matter what the experts tell us. And people will die. It’s written into the system; part of the program. We can’t stop it all. We can do our best to prevent it, or to interrupt it, and usually we do a jam-up job. But sometimes, even the best of us are blind-sided.

If it happens to you, take a breath, clear your head and remember that no matter what, God loves you and your family and friends love you. And if it happens to your partner or friend (or enemy), don’t jump on the dog-pile of blame, guilt, or any of the other dysfunctional things doctors do.

Just be there for them and offer them a hand; listen to them go over it as many times as they need; and remember that one day it will be you.

‘Remember that doctor whose patient died? He didn’t do anything wrong. And he’s fine now.’

Edwin

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