The hardest thing about being a doctor is that you learn best from your mistakes, mistakes made on living people.”

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ACEP Now: Vol 39 – No 10 – October 2020

—Dr. Karen Delgado¹

What I now find more important is the way in which we address and mitigate our mistakes. Dr. Jerome Groopman poignantly said, “Every doctor makes mistakes in diagnosis and treatment. But the frequency of those mistakes, and their severity, can be reduced by understanding how a doctor thinks.”¹ We gain expertise not only through sustained practice over time but also by receiving feedback that helps us understand technical errors, bias, and misguided diagnosis. Self-aware physicians learn to admit to their mistakes, analyze them, and keep them accessible at all times.¹

I can now look back at this case and understand that my encounter with this patient was fraught with bias. From premature closure to anchoring, there were so many mental shortcuts taken that could have been avoided. As emergency physicians, we are especially susceptible to cognitive errors and bias. The emergency department is full of land mines that can distract us, be it abrupt traumas, nursing orders, code blues, or belligerent patients, to name a few. One study noted that health care professionals in the emergency department were interrupted 30 times on average in a three-hour work period.² Despite our work environment, there are a number of ways to avoid errors like this in the emergency department. Asking simple questions such as:

• Am I feeling fatigued right now?
• Was this patient handed off to me?
• Have I effectively ruled out must-not-miss diagnoses?
• More formal checklists can help prevent diagnostic errors.³

We often learn best from our mistakes, yet in our line of work, the cost of mistakes can be high. This was a practice-changing event for me and one that I will likely never forget. I hope to keep my future mistakes to a minimum but appreciate that through these mistakes, I will become a better physician.

References

1. Groopman JE. How Doctors Think. Boston: Houghton Mifflin, 2007.
2. Graber ML, Kissam S, Payne VL, et al. Cognitive interventions to reduce diagnostic error: a narrative review. BMJ Qual Saf. 2012;21(7):535-557.
3. Graber ML, Sorensen AV, Biswas J, et al. Developing checklists to prevent diagnostic error in emergency room settings. Diagnosis (Berl). 2014;1(3):223-231.