The killer silence behind medical mistakes.

The most valuable lesson I learned in my first semester of medical school.

Being a physician is something many people around the world aspire to be. The reasons behind this decision vary, but one of them is related to the fact that medicine is one of the most esteemed careers worldwide. This prestige, however, is heavily based on the dehumanization of doctors. Let me elaborate.

Not many professions have such a direct impact on people’s lives as medicine does. For example, the early diagnosis of cancer can provide a longer life span, not to mention a better quality of life; the proper execution of surgical techniques can prevent the patient from bleeding on the table or developing post-operative complications; and so on.

Painting: Sistine Chapel by Michelangelo — Via Pinterest

All these things people expect from a doctor are characteristics that strip us away from our humanities and enhance people’s perception that we have to be above life and death. In doctor-patient relationships, this is known as the God Syndrome, a situation in which patients, being in a vulnerable state, transfer their worries and doubts to the figure of this “undefeated” and “assertive” persona they believe doctors to be. However, this projection doesn’t happen strictly to patients, being an idea shared by many individuals that are not, in any way, part of the health care system.

The mistaken conceptions of what health care professionals are or should be, contradict the reality that we are flawed. We are not heroes without capes; we are not “dragon slaying” warriors; we are not “knights in shining armors” or any other cheesy metaphor you see in comic or fairytale books.

We, too, make mistakes.

So now you must be asking, how can doctors make mistakes when lives are at risk? How can doctors unintentionally hurt someone when they swore to “do no harm”?

It’s simple. The answer is: because we are only humans, and we fail, just like everyone else. And this is a hard thing to grasp for med students, doctors, patients, and their loved ones for a distinct number of reasons.

First, I guess because most medical schools don’t teach us how to accept death as an unavoidable part of life. We spend so much time learning how to help people, analyze x-rays, fix bones, and save lives that by the time we graduate, we don’t know how to deal with death, let alone if we are the ones responsible for causing it. Secondly, because, as I said before, culturally, doctors are supposed to be infallible.

The complications behind this second topic became very clear to me when a couple of weeks ago, I stumbled upon a TEDTalk by Dr. Brian Goldman. He courageously spoke up in 2012 about the mistakes he made throughout his career. In the video, he shared his experience, hoping that it would start the conversation on the importance of speaking about our failures as much as our successes. By so, he aimed to prevent others from committing the same wrongs he did and change our culture’s erroneous beliefs that doctors should be perfect all the time. Right there, it became apparent to me why being able to accept we all fail, whether you are or not a doctor, is an essential step in preventing more people from dying.

The truth is that nothing will change if people keep clinging to the delusion that doctors are incapable of failing. We are, and we do. Accepting this opens the possibility for the medical community to learn from each other’s mistakes and avoid repeating them in the future.

Right now, by believing physicians are incapable of errors, society, in general, reacts in a way that difficult doctors from speaking up about their experiences. In the comment section of the TEDTalk mentioned before, I noticed that viewers described doctors who fail as irresponsible, negligent, and incompetent. This particular social reaction, combined with the feelings of failure and disappointment that we already feel when we screw up, makes it harder for us to come forward and publicly talk about the events that happened. And honestly, I understand why some don’t do it since no one wants to be scrutinized. However, this is precisely where the problem lies.

If we don’t speak up, in part because this topic is a global tabu in and out of the medical community, we perpetuate the cycle of errors. Once the mistake is made, there are only two things we can do: apologize and prevent them from being repeated. While most physicians do the first one, the second is not frequently followed up. The consequences of ignoring the last topic can be more catastrophic than the error itself because if we keep quiet, the clinical case discussion isn’t started, and no knowledge is obtained from that. In summary, as a community, it means we have a smaller understanding of the events that lead to the error and therefore are more likely to replicate the same actions again since we didn’t learn from it.

So, as heartbreaking and devastating, it is being in a situation where a mistake was made; none of those things are reasons enough to be silent. To start a conversation, though, doctors' cultural standards and how society perceives us needs to change, and fast. Because at the end of the day, silence too cost lives.

Brazilian. First-year medical student. Love arts and social sciences.

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