Would you admit a mistake if it meant legal action and potentially the end of your career? Doctors are put in a hard spot when it comes to making an error. Mistakes happen, no matter what your profession, but when life is on the line -- how do you come to terms with a bad decision?
Some in the medical community are now training doctors to better make mistakes, to admit to them and to learn from them. Joining us this week to discuss this approach is Dr. Neha Vapiwala. She’s a vice chair of education, radiation oncology and the advisory dean at the Perelman School of Medicine at the University of Pennsylvania. Vapiwala wrote an essay on this topic, which appeared in “The Philadelphia Enquirer.”
“There is this culture of perfection that is expected,” Vapiwala says.
When you visit a care provider, you expect the best care and you expect the lead doctor to be infallible. In many situations, there is no room for error. Some of this culture comes from the doctors themselves, Vapiwala says.
“To be fair, that’s often how these students got into medical school in the first place.” By being perfect students. This often plays, at least subconsciously, into how these doctors interact with other doctors and with patients, according to Vapiwala.
“They have to be confident. They have to make decisions sometimes with all the information, sometimes not, if the urgency of the medical care does not allow for it. And it’s difficult later to then look back and say ‘I should have just done it this way’ because a lot of times there are no takebacks.”
And while all personalities differ, Vapiwala says the career path, overall, lends itself to this kind of focus on perfection.
Mistakes and medical malpractice
Mistakes in medicine come with litigation, malpractice lawsuits and even revoking of a doctor’s license. These issues can follow a doctor for a lifetime. And, as Vapiwala says, that’s just the external consequences. Internal consequences like humiliation, loss of self-confidence and fear can also pose problems for future practice.
“There have been studies that have clearly shown that patients are far less likely to sue physicians whom they like,” Vapiwala says. “It often times means a doctor/patient relationship in which the physician is thought to be honest, forthcoming, who communicates, who gives you eye contact and who really establishes a relationship and the report that one would want in a doctor/patient team.”
Medical schools are already incorporating standardized patient programs into their curricula. It’s a way to train medical students to properly interact with patients and practice ways to be compassionate, truthful and clear.
“The idea is that you try to create scenarios,” Vapiwala says, with paid, trained actors who pose as patients. “And in a proper scenario you would have just the standardized patient and the student learner in a room that is being observed with a camera.”
Students are then graded (by the teachers observing and by the patient) on:
- Clear communication
- Eye contact
- Technical skill
They’re often given scenarios in which they have to break bad news or have to navigate a culturally sensitive issue, Vapiwala says.
“It’s not going to be perfect, but we think it’s a place to start.”