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Memo From the Editor's Guest: After you've goofed


Guest Ed Memo, in which Dr. Elliott passes along lessons she's learned about how a doctor must deal with his or her mistakes in patient care.


Memo From The Editor's Guest

After you've goofed

By Patricia Elliott, MD

Here's the scenario: We get a frantic call—a regular patient is suddenly having trouble talking and moving her arm. When she arrives at my office 10 minutes later, her blood pressure is 220/105. She is slurring her speech, and is unable to control the movements in her left arm.

As I glance at her chart, I realize that although I've seen her in the last few months for a couple of other problems—a sinus infection, a bladder infection—I haven't seen her for hypertension since I started her on medication seven months before. Nor have I rechecked her elevated blood sugar. She missed a scheduled appointment for those rechecks.

Usually we phone no-shows to find out why and reschedule, but somehow we'd missed her. Meanwhile, she rationalized that because no refills were authorized and we didn't call, it was okay to stop the medication when it ran out.

I felt terrible, but I had no time to think about how I felt. I had to stabilize her, call the rescue squad, talk to her husband, and call the neurologist who would see her at the hospital. That night and over the next days, I let myself feel the burden of the goof—the guilt, the sadness, the concern.

It doesn't take long to make a mistake; it may take weeks or years to deal with the consequences. I've been down that road, and I'd like to share some insights that have helped me make it along that rocky, painful way.

First, accept that the mistake happened. It doesn't help to pretend you weren't wrong. You know better. You know you didn't order the test, make the diagnosis, act soon enough. Whatever. You feel awful; sleep won't come. The guilt, the shame (even if no one else knows) is still there. You want to fix it, but there is no way. It is done.

Next, apologize. Not long ago, we forgot to call in a prescription for pain, and the patient spent a long, difficult night without it. When she called the next morning asking about it, I said: "Mabel, I am so sorry; I'd have been upset if that happened to me. We'll call that in right away. Please accept my apology." She did, and that simple fact went a long way toward relieving the guilt I felt. It must be said, however, that sometimes, in this era of litigation, apologies can be dangerous. So make them judiciously and word them carefully.

Deal with the problem. Keeping busy won't help; that just puts the grief and guilt on hold. Instead, learn any lessons you can from the accident—an adverse drug reaction, for instance, can teach you to be more careful about monitoring patients on that therapy. Such an adverse reaction also taught me to be more wary, not to trust myself so much, to remember that I have feet of clay, like everyone else—powerful lessons for an MD to learn.

In dealing with your feelings, though, you mustn't try self-punishment—depriving yourself of something, not allowing yourself to feel joy, or even killing yourself. (Doctors have done that.) Such thinking arises when the blunder has been a big one—the heart attack that was missed and led to death, the diagnosis of cancer delayed until it was incurable.

If you can't move on, can't get beyond the anger yourself, seek counseling. Faith-based activity and regular therapy with a mental health professional are both time-honored ways to expiate guilt. We suggest them to our patients, and we should heed our own advice.

In the end, you must take charge of yourself. At a period when I was feeling especially like a failure, I came across a quote in Montaigne: "Make yourself into the kind of person in whose sight you would not want to walk awry. Feel shame for yourself; feel respect for yourself."

That summed it up for me. I must be in charge of myself. I must not let my life be ruled by what someone else—the patient, the family, or my friends—would think. I began to feel at peace again. It happened. I had goofed. I felt ashamed, but I could go on. You can, too.

The author is a general practitioner in Rapidan, VA.


Patricia Elliott. Memo From the Editor's Guest: After you've goofed. Medical Economics 2001;11:4.

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