Medical doctors need to be able to confront the fear and shame that come with medical errors, for their own sake and for the sake of their patients, says a physician and author.
Early in her career, Danielle Ofri, MD, declared an elderly patient stable and went home. The patient's altered mental status was not unusual for someone in his condition.
The next day, she learned that he had been bleeding into his brain, a problem that was later caught and addressed. If it hadn't been, the patient could have died.
The system worked. The error was caught. But it was little comfort to Ofri, who has practiced medicine at New York's Bellevue Hospital for more than 20 years.
"I was so horrified," she said at a talk at Harvard Medical School last week. "I was so ashamed, I didn't tell anyone."
She carried that shame around with her for 20 years, but was able to use it in her most recent book: What Doctors Feel: How Emotions Affect the Practice of Medicine.
Ofri's talk centered on one emotion, shame, which she said overwhelms many doctors and is a major reason many medical errors go unaddressed.
When errors are not acknowledged, even those without bad outcomes, no one learns from them, she said. And, there is little incentive for doctors to point out their shortfalls. "We want to look like we know what we are doing. When in doubt, pretend. That's what I learned in my internship. "
'Afraid of Screwing Up'
Ofri, who trained and works at Bellevue Hospital in New York City, is a prolific writer, a practicing physician and editor of the Bellevue Literary Review. Described as a "born storyteller" by the late physician and author Oliver Sacks, Ofri builds her books around narratives from her own life as a doctor in a busy public hospital.
She shares those stories in her talks as well, last week admitting to a roomful of doctors and medical students that she and other doctors must cope with another overwhelming emotions – fear. Ofri said that she "spent every waking moment terrified as a student. I was so afraid of screwing up. "
Fear, however, is not always a bad thing, she said.
When doctors have no fear, they lose some of their "grounding… Fear can be overwhelming and it can harm patients. If we eradicate all of our fears, we become one of those cocky cowboy doctors and we all know where that can lead."
Shame, Ofri said, is a particularly common emotion for doctors, who can get called out for errors in front of peers or in front of a jury. When doctors feel ashamed, they often turn that angst on themselves, she explained.
The result is a high-stress environment that can produce less-than-optimal care. She argues that hospitals can address this by creating an atmosphere where doctors can talk about their medical errors without being threatened with humiliation.
Pressure Comes from the Top
"If the dean talks about [having emotions] on the first day or medical school, or the chair, on the first day of rotation, talks about experiences with emotions…That sends the message that emotions are normal and OK."
That also goes for the grief and sadness doctors feel when a patient dies. Ofri congratulates her students when they express that they feel that way. They should feel something when a patient dies. But physicians should also have a way to process those feelings, she said.
Ofri sees the healthcare system moving toward more openness around emotions, but that more can be done. Much of the shift is patient-driven, she said. Patients want to be listened to, heard and respected.
"Good listening skills come from being emotionally solid," she said. "Emotionally stunted people they are not very good listeners. They don't intuitively know how to connect with patients and that is reflected in patient satisfaction."
Ultimately, most of medicine comes down to one-on-one encounter between two people, the doctor and the patient.
"Whenever you put two people together… emotions are in the air," Ofri said.
"They're all around us. We are all susceptible to the same emotions. What we do with that and how we use it to our advantage or disadvantage" can affect patient outcomes.
Tinker Ready is a contributing writer at HealthLeaders Media.