ConceptsCoping with medical mistakes and errors in judgment*
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
References (45)
To err is human: an interview with the Institute of Medicine's Linda Kohn
J Qual Improve
(2000)Circadian rhythm, shiftwork, and emergency medicine
Ann Emerg Med
(2001)- et al.
The potential for improved teamwork to reduce medical errors in the emergency department. MedTeams Research Consortium
Ann Emerg Med
(1999) - et al.
Human error in medicine: promise and pitfalls, part 1
Ann Emerg Med
(2000) - et al.
Human error in medicine: promise and pitfalls, part 2
Ann Emerg Med
(2000) Managing medical mistakes: ideology, insularity, and accountability among internists-in-training
Soc Sci Med
(1984)- et al.
Evidence-based emergency medicine: integrating research into practice
Ann Emerg Med
(1997) - et al.
To tell the truth: ethical and practical issues in disclosing medical mistakes to patients
J Gen Intern Med
(1997) - et al.
To Err Is Human: Building a Safer Health System
(1999) - et al.
Reducing errors in emergency medicine through team performance: the MedTeams Project
Demonstration of high-fidelity singulation team training for emergency medicine
Acad Emerg Med
Diagnostic pitfalls identified during a study of 3,000 autopsies
JAMA
Necropsy: a yardstick for clinical diagnoses
BMJ
The necropsy as a tool in medical progress
Bull N Y Acad Med
The value of the autopsy in three medical eras
N Engl J Med
A study of diagnostic errors
Ann Intern Med
Misdiagnosis at a university hospital in four medical eras
Medicine
The autopsy: its role in the evaluation of patient care
J Gen Intern Med
The clinical reasoning of randomly-selected physicians in general medical practice
Clin Invest Med
Scripts and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research
Acad Med
Cardiac auscultatory skills of internal medicine and family practice trainees: a comparison of diagnostic proficiency
JAMA
Cited by (107)
Hilfiker in Perspective
2024, Mayo Clinic ProceedingsTo Err is human, but what happens when surgeons Err?
2023, Journal of Pediatric Surgery“You Remember Those Days”—A Qualitative Study of Resident Surgeon Responses to Complications and Deaths
2022, Journal of Surgical EducationBuilding a Program of Expanded Peer Support for the Entire Health Care Team: No One Left Behind
2021, Joint Commission Journal on Quality and Patient SafetySecond victim phenomenon in a surgical area: online survey
2021, Revista Espanola de Anestesiologia y ReanimacionAssociations of emotional burden and coping strategies with sick leave among healthcare professionals: A longitudinal observational study
2021, International Journal of Nursing StudiesCitation 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).
- *
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]