There have been many times in my career as a palliative care and family physician when I have worried that I didn’t do enough—or, perhaps even (I shudder to think) made a mistake. Maybe I didn’t diagnose someone soon enough, or maybe I prescribed medication that caused a bad side effect. Maybe I didn’t advocate as much as I should have for my patient, and their test or treatment didn’t occur quickly enough. 

When I reflect on past mistakes, I want to scream, “I tried my best!” The problem is that sometimes my best doesn’t feel good enough. I want to find out why this feeling is so pervasive throughout the physician profession, and I want to find out what we, as a medical community, can do about it.

 

Our mistakes are different

 

When confronting perfectionistic behavior, people are often told that mistakes are normal—mistakes happen, and we need to learn to be ok with it. But if ‘good enough’ isn’t good enough, then what’s good enough?

When we make a mistake in medicine, it can have a significant and serious impact on the lives of others. Even when the mistake is fairly small, it is often met with outsized emotions such as anger and blame by the patient whose life is affected. 

I have made mistakes. We’re all human, aren’t we? But even as I write this, admitting to it feels wrong.

Because of this, mistakes in medicine feel “different” than mistakes in everyday life. Before medical school, many of us as physicians had never had to confront our perfectionistic behavior because, frankly put, the stakes were never high enough. 

We worked hard, achieved success—or didn’t—and moved on. Many of us, if we ever had to deal with failure, just pushed through and eventually achieved success. We hid our shame, told no one, and tried again. No harm, no foul. 

In fact, we were often applauded for it—told we were determined, hard working, and had great attention to detail. But the mistakes in medicine are often much more serious in nature, as we are dealing with people’s lives. 

But the mistake is rarely just one person’s “fault”. And sometimes, it’s not actually a mistake, but rather an inability to “fix” someone or to meet their expectations. It’s hard to adopt a “tried my best” mentality if we are constantly met with anger and blame every time we don’t achieve perfection in the eyes of our patients. 

After all, we all went into medicine because we wanted to help people, right?

 

Off on a bad foot

 

In fact, many patients enter a physician’s office already angry or put-off. 

According to the AAMC, the percentage of the public that has no confidence at all in medical scientists rose from 15% to 22% from just 2016 to 2021.

Boyle P. Why do so many Americans distrust science? AAMC. May 24, 2022.

Simply put, almost a quarter of our patients don’t believe or trust in Western medicine. 

 

Recently, I had a patient’s daughter shake my hand, stare me straight in the eyes and say “I don’t trust doctors.” 

No “hello” or “how are you?” She simply wanted me to know, even before I tried, that she didn’t like me, and that I would be wrong. 

 

What do we do?

 

First, let me tell you why we need to do something. Physician burnout may actually stem from moral injury.

Shufeldt AJ. Physician burnout. Why it is really moral injury. Forbes Books. January 25, 2022.

 

 

As I said before, we went into medicine to help people. Sometimes, whether it be patient expectations, system failures, or a series of actual or perceived “mistakes,” we don’t help them. This hurts, but the more we bury that guilt, shame, and fear, the faster we burnout. When we burn out, we help no one. 

There are many things outside of our control—an overburdened healthcare system to start—but there are some changes that we can make to protect our own moral well-being, and ultimately become better physicians for our patients.

First and foremost, we need to begin by building our support systems. This means creating a safe, supportive environment to discuss these “mistakes”, difficult cases, challenging patients, and poor outcomes. Whether it be in your office or hospital, developing a place and means to review these cases on a regular basis, with the ability to hold emergency meetings, is ideal. 

This is a place to be vulnerable, feel safe, and remove the blame. The environment needs to change, and we need to push to do this together. This provides support and helps to prevent the same “mistake” from happening in the future. This is how growth happens. This is how we improve. 

Secondly, we need to learn how to make mistakes by taking care of our own mental health. 

Perfectionism is often associated with anxiety. Therefore, perfectionistic behavior may be a warning sign of an untreated and overlooked mental health condition. Take time to explore this and how it affects your day-to-day life. Speak to a counselor. Speak to your own physician. And make small mistakes on purpose! 

Show up 5 minutes late for a coffee date. Forget to make your bed in the morning. See what happens (hint: probably nothing). Learn to be ok with mistakes. Better yet, learn how to learn from your mistakes. Share your mistakes, read more about what you could have done better, grow as a physician, and grow as a human. 

Nobody’s perfect, but we’re not stagnant either. We all have the capability to learn and grow, but without speaking about it and supporting each other, we never will.