Most doctors would agree that the mistakes they’ve made have gone on to shape their care for the better. So why are we so reluctant to share these missteps, asks Sarah Garber
I have a faint scar on my left shin from when I was 8 years old. I was climbing onto a boat from the water, splashing and giggling, with the carefree, giddy energy of a child in the summer, and I let my leg slip too close to the propeller. I used to remember this moment so vividly: the intense sting and burn of the cut, tears welling and overflowing, waves lapping against the side of the boat in the hot summer sun, the blood trickling down my shin and staining the bottom of the boat.
The exact details of the memory have faded in parallel with the scar itself, but the mark is still there, and I still have a flash of apprehension whenever I swim by the propeller of a boat. I imagine most people have one or two scars like mine, once painful experiences, now physical reminders of mistakes we’ve made and missteps we’ve taken.
I made my first significant mistake as an intern around the start of my obstetrics and gynecology residency. It was a particularly busy and chaotic shift. I did a cervical exam on a patient and was excited to tell her and her partner, “It is time to start pushing and have a baby!” After 30 minutes of pushing, my clinical suspicion that something wasn’t quite right arose. I called a more experienced provider into the room to check my cervical exam. Immediately, their expression sobered and they turned to the patient and said, “Stop pushing. You are not fully dilated.”
In that moment, I felt a visceral wave of panic, the emotional sting and burn of realizing my mistake, and every possible negative ramification and potential adverse patient outcome of misjudging that cervical exam flew through my head. I felt like a horrible doctor.
My patient later needed a cesarean section, and as I sat in the provider room wanting to cry, I couldn’t help but pour over whether or not it was my fault, if I could have helped her avoid surgery if I hadn’t miscalled her exam.
It took me a while to share this story with my colleagues. When I finally did, I was surprised at the consistency with which everyone had a similar story of a mistake, or multiple mistakes, over the course of their training. For almost all of my colleagues, these missteps live with them, cuts that have healed but scars that remain.
As doctors, we all make mistakes. We are pupils of a constantly evolving body of knowledge, learning throughout our careers the different ways in which our systems glitch and crack, and witnessing infinite clinical scenarios and often unpredictable outcomes. Yet like our physical scars, we don’t often share the mistakes we have made—maybe because they feel embarrassing, hard to relive, unsightly. Maybe we feel afraid that people will judge us by these imperfections in a profession where perfection is demanded.
Yet some of the best clinical advice I’ve been given has come from people feeling vulnerable enough to share the times they’ve messed up. I’ve learnt that making an incision during a cesarean section one layer at a time is crucial to prevent cutting a baby, that double checking fluid orders is critical if you have a patient with sepsis, that identifying certain structures will help you confirm if a baby is head down on an ultrasound before delivery.
Now much of the pain from my mistake has healed, but the scar lives on, shaping my practice, making me a more cautious obstetrician, reminding me to ask for help in moments of uncertainty.
I will continue to be open about my scar with others, in the hope it will contribute to a medical world where we can all share the imperfections that make us the providers we are.
Sarah Garber is a first year obstetrics and gynecology resident at Case Western Reserve University/ University Hospitals Cleveland Medical Center. She received her medical degree from Michigan Medicine. Twitter: @Sarah_Smith_926
Competing interests: none declared.