Why are doctors so quick to criticize one another? What is it about the medical culture that enables us, not only to easily recognize but actively seek out one another’s mistakes? When did we forget that we are all human? Why does it take a colleague losing their life over a mistake before we show some support?
One of the things I struggle most with in the medical field is constantly feeling like every decision I make is going to be judged. Not only judged, but judged harshly, and not by my patients (who are the ones that matter most at the end of the day), but by my colleagues. After a long night shift, I will lie awake worrying about any potential mistakes I may have made during the preceding 24 hours – Who will pick up on those mistakes and what they will say about me?
The thing about doctors is that at school we were all amongst the top academic performers. That is what made us special. We were the ‘top-tenners’ and subject-prize winners and school duxes. And then when we arrived at medical school, we realized that we were not that special at all. In fact, there were now 200 people exactly like us, and the competition had suddenly gotten a little tougher. And that there – the competition, is exactly why we turn on one another come internship and the years that follow.
Some classic examples:
- We get a referral letter that, put politely, is lacking in detail and our first reaction is; “Who wrote this crap? A pre-schooler could have written a better referral?”
- A colleague misses the most subtle-of-subtle MI* (that your consultant actually had to point out to you on the ECG**) and the next morning we all comment; “How could she have missed that!? It’s so obvious!”
- We hear a rumour that someone discharged a patient on the wrong dose of a medication, or forgot to check a crucial blood result, or made one of the hundreds of potential mistakes that a human being (who also happens to be a doctor) could make, and we get some crazy high out of going to search through the notes to figure out who the guilty party is. Not because we have any role in remedying the situation, but because we are just nosy and want to indulge in someone else’s shortcomings.
These are just a few of many real-life scenarios I have witnessed, or actually been guilty of, in my short medical career. We love hearing about and talking about and picking up on each other’s errors. We get some crazy kick out of it and its not okay.
We forget that the person who sent that referral letter was an intern who had ten other letters to write that day and probably had never actually seen the patient in her life. Her seniors just handed her a pile of folders and said: “refer”. We don’t acknowledge that the colleague who missed the MI did so at 3 o’clock on a Saturday morning, in a trauma-laden EC with a patient who didn’t actually complain of chest pain. (And to be honest, you wouldn’t have seen that ST elevation*** if your consultant hadn’t pointed it out to you).
We forget that hindsight is twenty-twenty; that the circumstances surrounding a particular decision have a major influence on the outcome; that we have been there before and that quite frankly we have no idea what was actually going on at the time that any given error was made. We forget that 99.9999 percent of the time no one intentionally wants to do harm. Granted, sometimes people are just lazy but the majority of us are not – we really are trying our best.
But more importantly, we forget that we are all human and that one day we will be the one making the mistake. When that day comes we would expect our colleagues to stand by us, to give us the benefit of the doubt and to offer us support. Not to judge, or criticize or take pleasure in our failure.
The medical field is difficult enough as it is. Let’s not make it harder for each other. If we are kinder, more forgiving and more understanding towards each other we will all practice much better medicine, and ultimately our patients will benefit. For the sake of our mental health, and our patient care, let’s be kind to each other.
*MI = myocardial infarction = heart attack
**ECG = EKG (in ‘Merica) = that piece of paper with all the squiggly lines on it that tests your heart. Also seen many a time (inaccurately depicted) in tattoo form
***ST elevation = big heart attack