Lane, Stuart — You’ve made a mistake… Now What?

You’ve made a mistake…. Now what?

Stuart Lane

Patient

Hospital

Yourself

Critical reflection

The competency matrix

Professionalism

“The guy was fine, he was just super you know anti-coagulated for a little while, which was probably a good thing for him, you know he had a thrombus basically”

“I gave somebody a heparin bolus based on their PT rather than their APTT”

“Well it was a chain of errors.. nursing staff on this ward are more proactive in getting things done.. the wrong test was ordered.. I took over the care, checked it on the computer, saw it was low, prescribed the bolus and then did not realise till next morning”

“There was a complication during the procedure which caused the patient to have too much propofol or have a reaction to the medication..”

“…or was it because the medication and his underlying condition, bradycardia, was a risk factor for him to have that situation arise or was it completely due as a side effect”

You can’t

handle the

propofol

"I think you know in life what's a good thing to do and what's a bad thing, and I did a bad thing. And there you have it.“

NOT CRITICAL REFLECTION

Rationalisation

Euphemistic language

Advantageous comparison

Distorting the consequences of actions

Displacement of responsibility

Diffusion of responsibility

Attributions of blame

Fragmentation

Moral attentiveness

Cognitive dissonance

‘It is almost impossible for practicing physicians to deal with their errors in a psychologically healthy fashion.. The climate of medical school and residency training, for instance makes it nearly impossible to confront the emotional consequences of mistakes..

“little wonder that physicians are accused of having a God complex; little wonder that we are defensive about our judgements; little wonder the we blame the patient or the previous physician when things go wrong, that we yell at the nurses for our mistakes”

"I think you know in life what's a good thing to do and what's a bad thing, and I did a bad thing. And there you have it.“

NOT CRITICAL REFLECTION

How to avoid rationalisation?

New theories emerge

“Virtually every doctor knows the sickening feeling of making a bad mistake..

You feel singled out and exposed..

You agonise about what to do..

You question your competence..

But fear being discovered..

You know you should confess..

But dread the prospect of potential punishment and of the patient’s anger”

Professionalism?

Professional identity = person

Professionalism = society

Professional rights legal

Do the right thing ethical

In the right manner moral

= INTEGRITY

You made a mistake.. Critically reflect.. Don’t rationalise it.. Accept that it is a mistake and you need support

Reflective competence is what you require to negotiate stages of learning, and maintain it..

What do believe is your professional identity and what does professionalism mean to you?

Questions?