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We can learn from our mistakes, but how willing are we to talk about
them? And what happens when those making mistakes are physicians, who
are often expected to be infallible?
A new University of Iowa study shows that most general practice
doctors in teaching hospitals are willing to discuss their own patient
care errors with colleagues, but about one in four do not. At the same
time, nearly nine of 10 doctors said that if they wanted to talk about
a mistake, they knew a colleague who would be a supportive listener.
The findings are reported in the Oct. 1 issue of the Journal of Medical
The results suggest that it is important to ensure that learning
occurs not just in the person who made the mistake but also among their
peers, said the study's lead author, Lauris Kaldjian, M.D., Ph.D.,
associate professor of internal medicine at the University of Iowa
Carver College of Medicine.
"Discussing medical errors can be a form of professional learning
for doctors. Mistakes should be considered shared commodities and used
for all they're worth," said Kaldjian, who also is director of the
college's Program in Bioethics and Humanities. "The findings also point
to some challenges for physicians seeking emotional support after
making an error."
The study results were based on surveys of 338 faculty and resident
physicians at teaching hospitals in the United States. Previously
published findings by Kaldjian and colleagues, based on the same data
set, showed that doctors' actual communication of medical errors to
hospitals and patients seems to occur less than it should when compared
to physicians' positive attitudes about communicating such errors.
The two earlier studies also found that the more serious the outcome
or harm from a hypothetical error, the more likely a doctor said they
would communicate it to patients or hospitals. Similarly, the current
study used hypothetical scenarios to reveal the likelihood of doctors
discussing an error that results in no harm at 77 percent, minor harm
at 87 percent, and major harm at 94 percent.
Kaldjian pointed out there is much value in sharing all errors.
"Sometimes you make a mistake and nothing happens. Other times,
something bad happens," he said. "But in both cases, we need to focus
on the mistake because near-misses -- where no harm was done -- are
also valuable learning tools."
The most harmful types of errors trigger automatic institutional
reviews. However, other errors may not. "Along with helping improve
patient care, discussing both types of medical errors can provide
important opportunities for learning and emotional support for
physicians," Kaldjian said. "However, the formal settings in which
shared learning takes place are unlikely to be optimal for providing
the individual support needed by the physician who made the mistake.
"Physicians can go through a lot of turmoil when they make a
mistake, even if it hasn't caused serious harm to a patient. "While
there are some formal group settings in the profession for learning
from mistakes, emotional support may require the privacy and
reassurance that are found in one-on-one conversations with trusted
colleagues," he added.
More than half of the physicians in the study (57 percent) said they
had tried at least once to promote the value of discussing errors by
discussing one of their own errors in front of students or physicians
"It's encouraging that physicians try to be role models, especially
for medical students and younger physicians, and some hospitals even
have peer-support teams to help physicians in the aftermath of an
error, though such teams appear to be rare," Kaldjian said.
Kaldjian also noted that doctors who consider themselves their "own
worst critic" and do not discuss their errors with others lose out on
"There can be wisdom and comfort in the words of our colleagues,
especially when we have reason to trust their insights," he said.
"Medical science also encourages an investigative attitude about errors
and can motivate us to be as objective as possible about errors and
their circumstances without denying the profound need for emotional
Overall, Kaldjian said, increased discussion of errors amongst
medical professionals is extremely important for professional learning
and emotional support. Such discussions may also help physicians
encourage each other to disclose errors to patients as part of patient
care and to report them to institutions to improve patient safety.
The investigation involved researchers with the Center for Research
in the Implementation of Innovative Strategies in Practice at the
Department of Iowa City Veterans Affairs Medical Center; Hospital of
St. Raphael in New Haven, Conn.; Yale University School of Medicine;
and Penn State College of Medicine and Hershey Medical Center.
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