Yesterday’s sunrise brought for me a mix of melancholy and ecstasy. It rose over my favorite setting on the last day of my trip to the Ontario woods. After finishing up my duties as camp doctor, my daughter, my sister and I hopped in a canoe and paddled out to the islands in the middle of the lake.
My daughter led us around the islands, blazing trails in an uncharacteristically fearless fashion. But we had an eight hour car ride ahead of us, and a boat to catch to take us to that car, so we paddled back to camp, caught our boat, and that was that.
Except I hadn’t really had enough. Not far from the lake is a set of falls whose very sound can take me back more than twenty years to being young, strong, and surrounded by friends (and beer). PalKid was a bit hesitant heading up the trail from the parking lot, but once we got to the top of the falls and the granite nooks and platforms, she thought it was nature’s own wondrous playground—and she was right.
In the car later, no longer able to find distractions to delay our departure from the north woods, my sister turned to me and asked, “So, as a doctor, are you ever worried that you’ll make mistakes?”
“No,” I answered, “I know I’m going to make mistakes.”
This is something other industries—such as airlines—have understood for decades. Medicine is only starting to learn what this means. Throughout our training, we are taught over and over to double and triple check our work. We devote hours and hours to memorizing drugs and their interactions. But we aren’t taught how mistakes really happen, or even that they do. But what is made clear to us is that mistakes are not inevitable, are a sign of personal failure, and that only our own actions can prevent them.
It is certainly true that my own behavior can prevent or contribute to errors, but that is terribly simplistic. Sticking with the example of drug prescribing, I may know hundreds of drugs, their effects, and their interactions, but why should I rely on the memory of a single individual when technology has existed for years to make this process safer? My electronic health record (EHR) will check a drug prescription against the patient’s current drug list, allergies, and medical problems and warn me about potential problems. I have no pride in this regard. I’m glad I can remember these details most of the time, but every time my EHR reminds me of a potential drug interaction, I thank it silently, on behalf of myself and my patients.
Physicians are trained to work and think independently. We aren’t yet trained to understand that medicine is too complex for any of us as individuals to avoid every error. We are punished arbitrarily for our mistakes by a tort system that understands medicine the same way that we do, as a group of potentially-infallible individuals who screw up, rather than as a members of a system that is prone to error. This not only perpetuates the false idea that errors can be eliminated through individual behavior alone, but prevents the systems changes that really can prevent errors.