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The heart of darkness: the impact of perceived mistakes on physicians
J F Christensen1, W Levinson, P M Dunn
1Department of Medicine, Good Samaritan Hospital, Portland, OR 97210.
Objectives:
To describe how physicians think and feel about their perceived mistakes, to examine how physicians' prior beliefs and manners of coping with mistakes may influence their emotional responses, and to promote further discussion in the medical community about this sensitive issue.
Design:
Audiotaped, in-depth interviews with physicians in which each physician discussed a previous mistake and its impact on his or her life. Transcripts of the interviews were analyzed qualitatively and the data organized into five topic areas: the nature of the mistake, the physician's beliefs about the mistake, the emotions experienced in the aftermath of the mistake, the physician's way of coping with the mistake, and changes in the physician's practice as a result of the mistake.
Participants And Setting:
Eleven general internists and medical subspecialists practicing at a community, university-affiliated hospital in Oregon.
Results:
Themes emerging from analysis of the interviews were the ubiquity of mistakes in clinical practice; the infrequency of self-disclosure about mistakes to colleagues, family, and friends; the lack of support among colleagues; the degree of emotional impact on the physician, so that some mistakes were remembered in great detail even after several years; and the influence of the physician's professional locus of control on subsequent emotions.
Conclusions:
The perception of having made a mistake creates significant emotional distress for practicing physicians. The severity of this distress may be influenced by factors such as prior beliefs and perfectionism. The extent to which physicians share this distress with colleagues may be influenced by the degree of competitiveness engendered by medical training. Open discussion of mistakes should be more prominent in medical training and practice, and there should be continued research on this topic.
Insights
Physicians experience significant emotional distress from perceived medical mistakes. Coping mechanisms and a lack of collegial support can intensify these feelings, highlighting the need for open discussion.
Area of Science:
- Medical Education
- Psychology
- Healthcare Professionals
Background:
- Medical errors are a reality in clinical practice.
- Physicians' emotional responses to mistakes are often profound and long-lasting.
- Existing medical training may not adequately prepare physicians for the emotional impact of errors.
Purpose of the Study:
- To explore physicians' thoughts and feelings about perceived mistakes.
- To understand how prior beliefs and coping strategies influence emotional responses to errors.
- To encourage dialogue within the medical community regarding physician mistakes.
Main Methods:
- Qualitative analysis of in-depth interviews with eleven physicians.
- Interviews focused on physicians' experiences with a specific mistake and its impact.
- Data organized into themes: nature of mistake, beliefs, emotions, coping, and practice changes.
Main Results:
- Mistakes are common, but self-disclosure to colleagues is infrequent.
- Physicians experience significant emotional distress, with some mistakes remembered vividly for years.
- Collegial support is often lacking, and locus of control influences emotional responses.
Conclusions:
- Perceived medical errors cause substantial emotional distress for physicians.
- Perfectionism and prior beliefs can exacerbate this distress.
- Open discussion of mistakes in medical training and practice is crucial; further research is needed.