Midway through my first year of residency training, I attended a teaching session where something remarkable happened. In front of a packed auditorium of junior residents, a highly respected senior physician candidly reflected on a personal encounter with failure. Early in her career, she had a negative interaction with a patient that culminated in a formalized complaint. She felt like she had failed as a clinician, and called into question her worth and ability as a physician. Her honesty was deeply inspiring, but I became fixated on something else entirely. I couldn’t wrap my head around how a topic so important could feel so foreign. I remember thinking to myself: Why doesn’t it feel normal to talk about failure in medicine?
Physicians aren’t necessarily shy when it comes to talking about their mistakes. Mortality and morbidity rounds (where adverse or unexpected outcomes are discussed), quality improvement initiatives, and the use of reflective practice are all examples of physicians sharing their clinical mishaps in a formalized setting. It can be difficult sharing these experiences with your colleagues, but having a platform where others are doing the same thing makes it easier. At the very least, it makes any discussion around the topic feel normal.
But making a clinical error is different from experiencing failure. To me, failure embodies a sentiment of great personal defeat and rejection, and has the ability to throw your life completely off course. In medicine, failure often involves faltering at major benchmarks in your career—the CaRMS match (when Canadian medical students compete with each other for residency training positions), passing your licensing exams which allow you to practice medicine, landing a leadership position. Certain mistakes might also eventually result in a sense of failure, for example, a clinical encounter that rattles your confidence and makes you question your role as a physician.
Medicine revolves around a culture of perfectionism that almost seems anaphylactic to failure. And this probably isn’t a bad thing. Given the stakes involved, there should be an onus on physicians to strive for perfection. It’s what patients would want, and despite the immense pressures, it’s certainly what physicians want too. But if recent reports on physician burnout and mental health issues are any indication, the pressure to be completely infallible isn’t always easy to cope with. And even if you are able to cope, coming to terms with failure can throw you off course.
Is this problem unique to medicine? Being able to cope with failure is also important for other high-stress professions and as a general life skill. I suppose the difference with medicine comes from its consuming nature that often blends “work life” and “real life” together. Not that physicians aren’t well rounded or don’t have hobbies outside of work, but most would probably not describe what they do as merely a job. And that’s because being a physician isn’t just what they do, it’s who they are as a person.
To illustrate this point, an example that comes to mind is from the television show It’s Always Sunny in Philadelphia. In one episode, the characters become obsessed with an online multi-player computer game and one of them says: “When I’m doing good in the game, I’m doing good in life.” It’s a ridiculous proclamation, and not to equate medicine with an online video game, but what the two things share in common is an unnatural consuming quality that borders on unreasonable. It’s hard to overemphasize the need for success in medicine; for a lot of us, it feels like a direct reflection of our success in life in general.
Trainees do talk to their friends and close colleagues about personal failure in private. But these conversations don’t necessarily feel “normal” outside of these confined settings. In fact, outside of my CaRMS tour where I was asked to provide examples of failure as part of the interview process, I can’t recall any other instances during my medical training where I was asked to share a personal story about failure.
I believe that changing the culture in medicine so that failure is normalized would make it easier for physicians to cope with these inevitable events in life. And seeing our mentors in medicine talk about failure might help start to change things. It doesn’t necessarily need to happen in a large lecture setting, but it should be part of the medical education curriculum in some capacity. There need to be formalized sessions, perhaps in small-group settings, built into the curriculum where senior physicians share their own personal stories of failure. These sessions might bridge to discussions about failure by trainees as well, but it needs to start from the top.
Everything trickles down in the medical training process. Speaking openly about something as a resident may impact more junior trainees, and the same is true at the medical student level. There have been many pieces written about the rising number of unmatched graduates during CaRMS recently, including this powerful personal reflection from a medical student who experienced the failure of not matching. I was amazed and inspired by her honesty and had my eyes opened in a new way to a process I went through a few years ago. It goes to show that sometimes, things even trickle upwards.
Simply talking openly about the subject might not be the definitive solution in reshaping medicine’s cultural aversion to failure, but I truly believe it’s a good starting point. I can’t say that I’m a shining example of someone who speaks openly about failure, but because of that session in my first year of residency, I definitely think a lot about the value of sharing my own experiences and will be looking for opportunities to do so as I move forward in my career. It might seem like a small step to normalizing a culture of failure in medicine, but at least it’s a step in the right direction.
The comments section is closed.
Real problems are in the foundation of medicine. See my long article: Initiatives for Building Infrastructure For Preventing and Curing 90% of Chronic Diseases and Saving Lives on The Planet. https://osf.io/j8qvf
I really enjoyed reading your article. I am a second year resident and already feel like I’ve faced my fair share of failure in my very short career. It’s been very challenging at times and I’ve dealt with a lot of grief and have struggled with my confidence. Your statement from Its Always Sunny really resonated with me. It’s vey challenging at times to disconnect from your role as a physician, which can often adds extra stress and strain. I agree that being more vocal and transparent about failures would go a long way. However, I’m curious how to begin this discussion, as many providers do view perfectionism as the goal and may feel reluctant to share openly in this way.
The failure of medicine is not due to problems in medicine, but the presumptions used to build the foundation of medicine. The four core presumptions: population-based approach, reductionist model, dualism, and binary disease classification are all wrong. I have studied those problems for two decades and proved them in various articles. See detailed evidence in http://www.igoosa.com. Those things discussed are small things compared with the model failure. Diseases including cancer are much more curable than they appear to be. A real solution is to fix the legal framework or the medical model. Cancer could be solved in ten years, but few people act.
I truly enjoyed reading this perspective article. However, I certainly do not agree with the authors statement. “But making a clinical error is different from experiencing failure”. As I strongly believe that patient safety is a global priority and I always had a dream of how to minimize or prevent medical errors and I wrote a letter to the Editor CMAJ (2004) “In the United Kingdom, “a mandatory no-name, no-blame national system for reporting ‘failures, mistakes and near misses’” was to be implemented in 2002 under the National Patient Safety Agency”. We badly need similar system in Canada. If we have a transparent registry -it would be a powerful learning tool- which could eventually use- clinicians daily practices to minimize and prevent medical errors.