Dr. Karen Tran-Harding joins us on the blog to discuss how we often "fail" in medicine when we are striving for perfection, but how those "failures" are actually opportunities for growth and do NOT make us a FAILURE as a physician. In fact, if we approach them correctly, they will make us stronger physicians in the long run.
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On the first week of my OB/GYN rotation as a medical student, I was becoming very enamored with the specialty and was considering switching into it from my lifelong goal of pediatrics. So, when one of the junior residents asked me if I would remove skin staples from a patient’s C-section incision, I immediately volunteered in an attempt to be impressive. She showed me exactly how to remove the staples but had to step out halfway to answer a page. I finished up myself, gave my resident a big thumbs up afterwards and the very nice patient was discharged home.
That evening, I watched as another resident removed skin staples from a different patient. Except this time, she performed one major last step – she placed steri-strips (tiny bandages) over the patient’s skin for reinforcement. I immediately ran outside to alert the junior resident. A senior resident overheard and joked that hopefully the patient wasn’t bleeding out somewhere.
Years later, when I was an OB/GYN resident on my Gynecologic Oncology rotation, I had a lovely patient that was getting a bit wheezy the day of her discharge. My fellow asked me to order a chest radiograph before we let her go home just to be on the safe side.
After finishing up a new admit to our service, I signed into the electronic medical record to check for my patient’s chest X-ray results. The report for her imaging wasn’t posted yet so I looked at her orders to see if it had even been performed. My blood pressure rose immediately as I realized she had no chest radiograph orders. However, my other patient that was next on our patient list who didn’t need one did receive a chest X-ray. I had placed the order on the incorrect patient. I was mortified and immediately paged my fellow and attending to ask for forgiveness.
A few months later, when I was finishing up a C-section with one of my favorite attendings, we closed the patient’s fascia and my attending stepped out to check in on a laboring patient. The patient had a larger body habitus so I took a look at her subcutaneous layer and made a quick decision to not reinforce that layer. So just like a hundred times before, I carefully closed her skin and placed a bandage over it.
Later that evening, when I was checking out the list to the huge team of evening attendings, residents, and medical students, a nurse came rushing in because my patient that had a C-section that morning had a huge hematoma at her incision site. I was humiliated and couldn’t even have the luxury of agonizing over it privately.
During my abdominal imaging fellowship on one of my earlier call shifts, I came across a CT scan for a patient that had pretty fulminant acute pancreatitis. The patient had a lot of inflammation, edema, and collections throughout his entire abdomen. A hyperdense collection adjacent to his spleen caught my eye and it was not something that I had seen before. It didn’t look like a typical peri-pancreatic fluid collection and it didn’t seem to look like something vascular or a mass. So I read the preliminary report that my excellent resident wrote and agreed that it was a nonspecific collection with higher density material which could be blood, debris, or infectious material.
Two days later, an Interventional Radiology resident contacted me right after they performed an artery coil embolization on a patient. Turns out, that “nonspecific collection” I found on the CT was actually a splenic pseudoaneurysm, an outpouching off of the splenic artery, that was bleeding. One of the most painful parts of my miss is that pseudoaneurysms are one of the main things we search for when someone has acute pancreatitis because they can quickly become life-threatening.
Of course, there’s many more tales that I can tell you about where I felt like an utter, complete let down. But failing many times does not make me a failure. And the saying rings true - I learned a lot more from my failures than I did any one of my successes.
One of the great takeaways was the kindness and forgiving nature of patients. So if you ever make a mistake, remember to be kind, always apologize and be completely honest. The post C-section patient without the steri-strips? She came right back to triage and told me I had nothing to worry about. The patient that received the unnecessary chest radiograph? She laughed it off and jokingly said she “probably needed one anyway”. The patient with the incisional hematoma? She was also extremely gracious and after we patched her up, she thanked us for taking such good care of her and her baby. As for my splenic pseudoaneurysm patient, I never got a chance to meet him but I did look into his chart 6 months later, and luckily, he’s doing well.
I also felt enormous support from other physicians, because trust me - they have all been through the same thing. We always strive for perfection in our jobs because we have to – we take care of lives. But each and every time I screwed up, my fellow physicians told me stories of when they had their very own shortcomings.
But most of all, every time I felt like a failure, time healed, I learned a lot and eventually moved on. And you can bet I didn’t make those same mistakes twice. I know in my career I’m going to keep “failing” but that’s okay. We all do. It’s just what we gain from the experience that is going to make all the difference.