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When I was still a core trainee, I looked at a chest x-ray for less than ten seconds, closed it and I wrote: ‘CXR – no evidence of pneumonia’.
I was on-call and reviewing an elderly lady with multiple co-morbidities who the FY1 was worried about. Her septic screen had returned a mixed growth in her urine, but despite five days of antibiotics, she remained pyrexial and her inflammatory markers climbed.
This is not the first time I have poured this event out onto a page. The initial version championed the details, to prove I wasn’t negligent and the clinical picture, to prove that you too could have made this mistake.
I have taken that version back.
Now, I will only tell you this; that three days later this patient developed shock and we discovered a diverticular perforation. My heart raced when I pulled up that chest x-ray, knowing I was about to be confronted with what I did not want to see.
Air under the diaphragm. It glared back at me; because of course now you can see it and everyone can see it and how could anyone have missed it?
But I missed it. Common and clichéd; my mistake of inattentional blindness.
I told the consultant my truth and he looked at me earnestly and said: ‘This is not your fault, you looked at it and you missed it; I didn’t look at it and I would not have missed it.’
Progressing in medicine is in general a bit like growing up; there creeps a realisation that you are important and if you’re lucky, what you do matters to more than just you.
The thing about responsibility is that if you take it seriously, somebody telling you ‘it wasn’t your fault’ doesn’t help you deal with it. You struggle to take the ‘get out of jail free card’ because it is just harder to tell yourself those sorts of stories.
I carried my mistake around alone; heavy on my chest and close around my throat. There were days when I didn’t even think about it, but it was always there; still and looming as the reason I was afraid to think at all.
After a week, I knocked on the same consultant’s door and said nothing except ‘I just can’t stop thinking about it’.
He sat me down and talked about how the burden of responsibility requires accepting that you will sometimes do your best and make mistakes.
He told me that I must always be brave and responsible enough to look at and examine my mistakes honestly, but that this is not the same as just punishing yourself. Then he told me about his mistakes and I was no longer alone.
People don’t want their doctor to make a mistake.
Hospitals need you to keep going.
The media are always poised to point out the ‘bungling’ doctor.
So the system will come up with an answer that takes responsibility, without anyone taking responsibility at all.
But that doesn’t help you, you whose feelings also matter.
So I think this; tell yourself, tell your friends, tell your colleagues. Even the ones who you don’t like, the ones who you think will judge you like you fear you will judge yourself.
Tell them you made a mistake; we owe each other that.
By the Secret Doctor
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We have support and advice on the emotional toll of being a doctor
Fantastic article. We're all human after all. I had been waiting longer than usual for your next article and this one was written honestly and beautifully. From an aspiring doctor
Thank you for being brave. Please put your name on it. I did that, and I don't regret it.
Thank you for the article.
As my general surgeon consultant used to say, "if someone says they've never made a mistake, they are either lying or they've hardly done any work."
We are humans. A very small percentage of our work will be mistakes. Just take each mistake as a lesson.
Your F1 missed it and you missed it. It's rare 2 people make the same mistake but it happens. Maybe if you'd met the patient yourself you would have had a different perspective. Sometimes it's part of the system that there are so many pressures put on F1s and all junior doctors.
I did meet the patient! I reviewed them...Thoroughly; but as I said I took all that stuff of out of the article because it wasn't the focus of what I wanted to say. Thanks for reading.
- The secret Dr
It takes a lot to admit to one's mistakes . However, in the current climate where junior doctors are hounded, humiliated and not treated very well generally, it was nice to know that you received a lot of support from your senior colleagues and you deeply reflected on it. I am always teaching my junior colleagues especially when they work with me in Geriatric Medicine to look at any investigation in the context of the patient and perhaps go back to the patient, go through the history and perform a targeted examination.
I firmly believe this is why we shouldn't forget we are a team. The Radiographer also either didn't see it or didn't mention they had seen it. As in all walks of life you come across Docs that welcome a pointer and ones that don't. I ask, as a radiographer that has had their fair share of unpleasant replies (also alot of thanks and genuine gratitude) when pointing out something that is subtle or urgent, please be nice. We are all there in the patient's best interests and we are all busy but if a Rad has taken the time to contact you they must be pretty concerned for that patient.
From a Radiographer and regular patient Keep up the good work. All Docs are awesome!
Thank you for posting this; it reminds us that we are human, we make mistakes and that's ok. I have made a couple of mistakes, none resulting in serious harm but that feeling never goes away. It gets easier to deal with in time. But it still remains. We need to share more because more often than not, we realise that we're not alone. Others before us have been in our position have done similar things and come out the other side. Schwartz Rounds are the epitome of this. I wish they were standard practice throughout the NHS.
Honest and valuable reflection. This type of error is often due to premature termination of search - looking at the lungs and not picking up on an abnormality that isn't pulmonary. In systematic studies of radio graphic errors these constitute quite a proportion.
Agreed most of time we physician unintentionaly makes mistakes which changes the outcome of patient. But we cant control them
Its about learning from errors and oversignts and shari g with others.
We are all human and not robots its just that in health care the ommissions may have life changing concequences.
I find myself repeatedly coming back to read and re-read this article. I appreciate it's stark honesty which in my opinion reflects something that we as doctors are often reluctant to admit; our own falliblity.
I think the same philosophy could be applied to all professions and personally. Making a mistake is only human. Learning from it is the best thing. Beating yourself up is a mistake. Give yourself a break. Love yourself. Be kind to others and to yourself. Wish I'd taken this on board 40 years ago.
This was not your fault. You were a junior doctor and this was a systems problem. If a patient is sick enough to be in hospital and have any sort of imaging, those images should have been reviewed by a radiologist within 24 hours.
It's when people start thinking that they are infallible it becomes scary....I know a few and one made a mistake but blamed others. You owned up and you are the one I would want to treat me and my family.
www.ncbi.nlm.nih.gov/.../ Hope this article helps this doctor come to terms with their. We are human, we are not machines and we are subject to bias when looking at these things.