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.