(My dog Kai can't catch a treat to save his life. But he's undeterred by his mistakes.)
One of my main roles as a resident physician is to practice in a supported and supervised environment so that I can grow as a doctor. Part of this means making mistakes.
I saw a lovely 91-year-old woman on my last shift in the emergency department. She was brought in by ambulance after having lost consciousness for two minutes.
By the time I saw her, she was feeling surprisingly well. She said that if it weren’t for the million monitors we had attached to her, she would walk out the door. The only thing that was objectively awry was her blood pressure.
She had a blood pressure of 220/100. Normal is less than 120/80.
Uh oh.
I won’t dwell on the specifics of the case itself, because this post is about mistakes – I didn’t treat her blood pressure.
Even after a few hours. And reassessing her twice. And getting the results of her bloodwork and imaging tests.
Now, there is a scenario where we wouldn’t treat severely high blood pressure, but this wasn’t it.
In this post, I’m going to go through what I did at the time and afterwards in order to deal with my mistake.
Step 1: Own it
My preceptor was generous when she realized my error. Instead of berating me, she simply asked me what I was planning on doing about my patient’s blood pressure.
I owned my mistake – called it by its name – and spoke with my preceptor about what would be an appropriate treatment option. I made sure not to brush it off, or make excuses.
I then apologized to my patient for not fixing her blood pressure sooner, to which she replied, “I though it was a little high! No problem dear.”
Speaking up about my mistake allowed it to be rectified ASAP.
Step 2: Open up about it
Brené Brown talks about how shame fuels the flight or flight response, which stops the learning brain in its tracks.
I immediately heard many a story in my head when I forgot to address my patient’s high blood pressure:
“I can’t believe you did that.”
“You can’t even get the basics right.”
“You just read about this topic last week! You literally know better.”
“How did you get to be a doctor?”
And on and on.
In my last post, I talked about how brains need safety to learn best. Constantly berating yourself creates a hostile internal environment, which hinders learning.
For me, the antidote to shame is opening up about it. I told my husband about the case, and asked what he would have done in this scenario. I talked to my friend about making mistakes in medicine. And, as you can tell, I wrote about it.
Step 3: Learn from it
In this case, I swallowed my pride, and reminded myself that I’m still learning. Most residency programs are 2-5 years for a reason.
Once I was in my learning brain mode, I thought about how I could prevent this mistake in the future. I decided that I’m going to list all of my patient’s acute issues and then writing a provisional management plan for each. That way I’m less likely to forget about an issue.
Further, I read up on hypertensive urgencies and emergencies (again). Since I had a specific patient in mind, I think what I read will be more likely to stick.
Step 4: Move on
Once I’m done writing this post, I’m moving on from this mistake. I’ve accepted that I’m human, and that this won’t be the last mistake I make. Not by a long shot. But by making mistakes now, I can figure out my weaknesses, cognitive biases, and unhelpful tendencies. All under direct supervision of an experienced physician.
I hope this helps anyone who feels like, “it’s ok for others to make mistakes, just not me.”
Stay well friends,
Dr. Kuhnow
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