Concepts
Coping with medical mistakes and errors in judgment*

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Abstract

Attention has recently been focused on medical errors as a cause of morbidity and mortality in clinical practice. Although much has been written regarding the cognitive aspects of decisionmaking and the importance of systems management as an approach to medical error reduction, little consideration has been given to the emotional impact of errors on the practitioner. Evidence exists that errors are common in clinical practice and that physicians often deal with them in dysfunctional ways. However, there is no general acknowledgment within the profession of the inevitability of medical errors or of the need for practitioners to be trained in their management. This article focuses on the affective aspects of physician errors and presents a strategy for coping with them. [Goldberg RM, Kuhn G, Andrew LB, Thomas HA Jr. Coping with medical mistakes and errors in judgment. Ann Emerg Med. March 2002;39:287-292.]

Section snippets

Cognitive aspects of medical decisionmaking

A discussion of the emotional impact of mistakes on physicians must first take into consideration the cognitive aspects of decisionmaking in medicine. Substantial data support the assertion that errors are commonplace in the practice of medicine. Postmortem studies comparing diagnoses listed in patients' charts with those found at necropsy have reported diagnostic error rates of 40% to 60%. This rate appears to be stable across hospitals, countries, and even eras of practice.10, 11, 12, 13, 14,

Relevance to emergency medicine

It follows from the aforementioned considerations that the ED would likely be an error-prone environment. Superimposed on and compounding the physician's cognitive limitations are a variety of systemic encumbrances. In a typical emergency practice, physicians must make time-critical decisions on multiple patients, frequently on the basis of limited information. Unremitting pressure to move patients through the ED disposes physicians to processing errors such as premature closure and omission.

The process of coping

“The drastic consequences of our mistakes, the repeated opportunities to make them, the uncertainty about our own culpability when results are poor, and the medical and societal denial that mistakes must happen all results in an intolerable paradox for the physician. We see the horror of our own mistakes, yet we are given no permission to deal with their enormous emotional impact…. The medical profession simply has no place for its mistakes.”25

In 1984, the New England Journal of Medicine

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      Citation Excerpt :

      Unlike physicians, nurses massively used social resources (i.e., cope with their close colleagues) to deal with regrets (Courvoisier et al., 2011), and considered the support of their colleagues as essential. In contrast, physicians relied more on acceptance (Goldberg et al., 2002), a cognitive coping strategy which is rarely observed in the general population (Zeidner and Endler, 1995). Our finding that care-related regret is associated with higher levels of sick leave is in line with a previous cross-sectional study (Cullati et al., 2017).

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    *

    Address for reprints: Richard M. Goldberg, MD, Department of Emergency Medicine, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA 90033; 323-226-6676, fax 310-540-2939; E-mail [email protected]

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