What NOT to do after a medical error

If you are a doctor (or med student/health professional) and you are human, you’ve probably made a medical mistake. You’ve probably not received emotional support for the mistake. Maybe you’ve never told anyone about a mistake that still haunts you today. 

The truth is most all physicians have admitted to medical mistakes sometime in their careers. Depending on the patient outcome, many doctors carry the distress of medical errors for months, years, even a lifetime. Some may even develop PTSD.

If you’ve experienced anxiety, depression, guilt, loss of confidence, or were haunted by intrusive thoughts in the aftermath of a medical error, you are normal. In fact, you’ve had second victim syndrome—a real condition that describes the psychological trauma a physician (or health professional) experiences as a result of an error.

I just got off the phone after speaking with a highly-skilled specialist suffering in isolation with grief, shame, and guilt after a recent medical mistake. During our hour long conversation she recalled another mistake from several years prior. I then shared de-identified case studies of other physicians I know (including my own) as examples of what not to do. 

Top 3 ways NOT to respond to a medical error:

1) Do not die by suicide. I know of several physicians who have taken their own lives in the aftermath of making even a minor medical mistake. Do not kill yourself. Please. Call someone. Call me.

2) Do not respond with self-abuse. Do not take the patient’s chart home to punish yourself by obsessing on your mistake over and over again for years to remind yourself that you are not as smart as you think you are (like one doctor I know who did this). Do not allow a mistake to overshadow your years of excellent care.

3) Do not wait decades to share your trauma. One physician broke down in tears in front of me about a medical error she experienced 30 years ago. She then apologized for crying. Then she told me she had not been able to cry in 10 years! 

After a decade helping doctors heal from suicidal thoughts, self-abuse, and isolation from recent and remote medical mistakes, I’ve discovered what actually works.

Top 5 ways to respond to a medical error:

1) Talk about your mistake. The most important thing you can do after a mistake is to talk to a trusted colleague (not a spouse, not even a nonphysician). If possible choose someone within your specialty who understands innately your experience. Your conversation should be 100% confidential. You deserve psychological support. The sooner you talk, the better. Do not isolate. Please.

2)  Forgive yourself. Avoid self-punishment by recognizing that you can not be a perfectionist in an imperfect world. You are human. You have often been subjected hazardous working conditions, even human rights violations in medicine involving sleep deprivation and overwork. To understand the widespread risk of medical errors, please view award-winning film, Do No Harm: Exposing The Hippocratic Hoax, that exposes how our working conditions lead to medical mistakes and doctor suicides.

3) Have faith. No matter what your spiritual or religious beliefs are, it is important to realize that there is a a force greater than us in this world. I personally love the quote, “Do your best and let God do the rest.” As long as you tried your best under the circumstances and were not malicious in your actions, please do not punish yourself.

4) Love your imperfections. Perfectionism is impossible to achieve. Be vulnerable and admit when you need help. You are human. Embrace your humanity. Have self-compassion and teach your colleagues to do the same.

5) Become an expert. Our most difficult cases teach us the most. Honor your patient by learning how to prevent future errors. Accept your error and grow professionally. Reframe your mistake as a positive teaching moment for your team and help other doctors prevent similar mistakes. Be a voice of inspiration and education for others.

You can not only survive a medical mistake, your mistake can make you a better doctor. Above all, please don’t give up on yourself or your career.

To join a 100% confidential peer-to-peer support group retreat for physician struggling with medical errors, contact Dr. Wible.

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14 comments on “What NOT to do after a medical error
  1. Dr. Thomas W. McLaughlin says:

    Although your advice to talk to someone about your mistake is good advice attorneys generally advise not to speak to anyone (except your attorney) about the mistake. The rational is the fear that in the event of a malpractice suit you can be asked if you have discussed the case with anyone. The discussion may be used against you. I don’t agree but unfortunately this is the climate we live in.

    • Pamela Wible MD says:

      Yet a 100% confidential discussion would not really have to be disclosed to anyone. No notes. No EMR. No paper trail. And yes it is totally ridiculous to keep someone from reaching out for psychological support in the aftermath of a trauma. Is the attorney going to provide psychological support (and at what fee?). Doctors have died by suicide for lack of anywhere to get support in the aftermath of tragedies. I think we are on the same page here very likely.

  2. John Shigo says:

    Thank you Pamela And I agree with all the points in our email. The problem is is that Doctors make mistakes feel guilty put undue pressure on the shelves by recording and talking about it to other people. Many times we feel it’s not anybody’s business To talk about our frailties but they’re own.
    Hard as it is, we must learn to trust people and confide in them about our problems.

    When I cannot solve a patient’s problem or treatment program, I told him nicely that I do not have all the answers as a doctor. I will refer them to an appropriate specialist. I believe in God and his intervention in our lives. I believe a supreme being is part and serves every religion, whether Christian, Jewish or Muslim.

    Best regards,
    John

  3. Cheryl Oenbrink says:

    Dear Pamela

    This is one of the best articles you have written.
    I think it belongs at every conference for all
    medical personnel. I have heard from other
    Drs about the mistakes they have made
    but have yet to see anyone give any actual
    advice on how to handle them.

  4. Anonymous Physician says:

    This is so powerful. And I had some interesting reactions…

    I found myself bristle at the term “medical mistake or error” with regard to my recent situation. I think of a mistake / error…as giving a med to the wrong patient, writing the wrong dose (when you meant something else) or operating on the wrong body part (or patient).

    I think “medical regret” is a more accurate term for what I am experiencing – and I bet it extends to 100% of physicians (in varying forms). The “if…then” scenario. If I would have known the outcome, THEN I would have done X or Y or Z. IF I would have had the information, THEN…

    It is almost worse. Because it gets into a loop of if / then…instead of “I am human and errors occur.”

    I agree that many of the same emotions surround “regret” vs “error.” What’s crazy is that is almost seems easier to forgive an “error.” We all believe…”to err is human.” But what is the precedent for forgiving regret? I think this is where the two diverge…and uncharted water lies.

    Having said that, I had a beautiful moment of peace last night after our conversation. It really helped alot.

    I am back in some of the previous patterns today…but I am focusing on NOT being a second victim. I do not want to retreat or stay stagnant. I want to excel. I am not a victim and I won’t let myself play that role.

    I will elevate.

  5. JF says:

    Dear Pamela. Thank you writing this piece. It is full of wisdom and so reassuring. I recently wrote up 100mg in stead of 10 mg on an inpatient chart. Luckily it was picked it up before any medication was given. Pamela you have a very special place in the medical profession. God blesses you with your work. Kind regards

  6. Bernie Siegel, MD says:

    keep a journal of the painful AND the joyful experiences

    my wife said i never put the funny things in my journal that happened at the hospital and woke me up

    but truth is decades later you remember what went wrong not what went right
    hut i can forgive myself for being human

  7. Donald says:

    I do not want to read or hear ‘nobody is perfect’, duh. boo-boos are amongst the many daily learning experiences. perfection is the goal the asymptote.
    the ideal is to learn from all possibilities, and to teach, and to grow, to gain practice knowledge experience maybe even wisdom. Faith, for those who
    have it, may be a good thing, IF it is egalitarian communal. There is far too much fake faith, particularly of the christian variety. I do know a few people
    who do follow the teachings of their Christ, and I respect and honour them for it. I am glad they have their gods, now keep it to themselves.
    Sometimes someone simply needs to talk, to vent, and does not need response other than a nod of acknowledgment, yet other times feedback is a
    good thing a helpful thing. Self-flagellation is not acceptable and is not progressive; be curious to learn and to do better. To bottle it inside is destructive.
    Even smart people do dumb things and deserve a kick in the butt, but the goal is forward, not backward. And to quote the old adage,
    Since Death is very still, keep moving. Breathing is a good thing; do it with gusto. Cheers to Pamela. Yay. Donald

  8. Alan Caroe says:

    Dr. Wible: I have great respect for your amazing practice. Your email two days ago about responding to Medical error is excellent and on point. I would encourage you to consider adding one other venue for a safe discussion of a medical error. Many institutions provide a morbidity and mortality conference that offers a venue for discussion and education to reduce future medical errors. During one such conference, I personally heard two outstanding surgeons learn that their operative procedure for cholecystectomy was insufficient to avoid a 1 in 1000 risk for transection of the common bile duct. I personally presented a mortality case during a project ECHO substance abuse teleconference. It helped me deal with the suicide of one of my patients.

    I also want to make you aware of an ongoing teleconference that is providing mental health support of a broader medical audience than just physicians. I do not wish for your practice to be oversubscribed but wanted to pass along the opportunity to listen in, if you wish, on any Monday, 1-2PM Pacific Time.

    https://hsc.unm.edu/echo/institute-programs/first-responder/

  9. Shahram “Shay” Hosseinion MD says:

    That’s great Pamela!

    Something I took away from my training into practice was to recognize that a mistake doesn’t happen in a vacuum, it happens because of multiple factors that come together to allow the mistake to happen.

    My hospital in residency would investigate all the details of a mistake to learn about all the factors that contributed to the mistake happening; the purpose was to learn how to make changes in all those factors to prevent mistakes in the future.

    I take the same approach in my private practice; I use the mistake as an opportunity to make policy change to prevent it from happening in the future.

    And I do apologize to the patient that the mistake happened, and I tell them what my plans and policy changes are to prevent it from happening again.

    This opens a dialogue and I think this whole process has a therapeutic effect for the sadness, frustration and fear that do come with a mistake.

    Thank you for naming it. Doctors don’t talk much about their mistakes. It feels therapeutic for you to even open the door to contemplate the feelings that are still inside us tied to those mistakes.

  10. Aaron Wittenberg says:

    We are forced to relive these errors. The system is rigged to force doctors into depression/PTSD. An error never never goes away. Example: I made a mistake. It happened once in 14 years and I felt terrible. Apologized to the patient. Apologized several times to the family. Their lawyer sent a demand letter. I said, look I screwed up, I feel terribly sorry. I will tell my malpractice company to come to a settlement. Now, I have to explain this settlement to every single hospital where I am on staff. Fill out the form, write a narrative, to 8 different hospitals. Now I have a “ding” on the NPDB and it seems that every other week I get a letter form someone asking me to “explain the NPDB notification”. The AZ medical board is investigating, because they investigate every single malpractice settlement. So now I need ANOTHER lawyer, paid for on my own this time, to represent me in front of the board. No doubt, the board will have an expert review it, who will probably “sensor” me, and then I am going to have to explain this medical board action to all of the places where I had to explain the settlement. It never goes away and I am forced to literally beat myself up over this again and again and again. Sometimes it just sucks to be human (and to be a doctor). To err is human, to forgive, devine. yeah, right!

    • Pamela Wible MD says:

      I am so sorry Aaron. Such a tragedy that we are never allowed to be human. I do hope you are not suicidal. If you ever need to talk, please reach out. Devastated by this recent case: (not even an error!) —> Dr. Anoop Krishna, a young aspiring orthopaedic surgeon from Kollam has died by suicide.
      He did his MBBS from Trivandrum medical college and MS (orthopedics) from Tirunelveli medical college.
      He offered to do a pseudoarthrosis of tibia correction surgery at his clinic for a 6 year old child with congenital heart disease free of cost due to poor financial status of the child. Unfortunately the kid post operatively developed ventricular fibrillation(abnormal rhythm of heart), a likely complication of anesthesia in a child with disease and expired.
      Following the surgery and unfortunate death, he was lynched by mob both in social media, public and local tv channels. He died by suicide.
      Moral of the story:
      1. Doctors are not Gods.
      2. Patients may not behave the same in the Pre procedure and post procedure
      3. Compassion is a bad habit
      4. Nobody gives a damn if you help 1000 people, but that one wrong turn can destroy your career.
      RIP. (Shared with permission from a Indian physician friend of mine)
      https://www.msn.com/en-in/news/other/kerala-doctor-dies-by-suicide-days-after-child-e2-80-99s-death-in-surgery-led-by-him/ar-BB19DW8a?fbclid=IwAR0qmc9VQbrnsKYDBY2VuT5cOPcDTv0beCktzYCa1bjOJjb7ybeedT3-Ex4

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