We were a bigger group of miscreants than I expected at The Holiday Inn last Saturday morning. And when a teacher-type in his mid-forties waved everyone into the small conference room - instructing us to turn off our phones, grab a name badge and pen and find a seat at one of four round tables - I was already half-regretting rising so early to make the journey across London, when I could have stayed at home and done my Speed Awareness Course online. Clearly, I wasn’t the only one feeling uneasy. A skinny guy slunk into the far corner of the room, hiding his embarrassment below a downturned cap, while another with dreadlocks and bright, scared eyes introduced himself too eagerly to those at his table. Even the women looked uncomfortable, huddled together like penitents awaiting confession. Maybe, on top of being middle-aged and not so hot at technology, we shared a more subconscious motivation for gathering here in person, I mused. Had we all come to be absolved?
I certainly had more than a minor traffic offence weighing on my mind. Back in June, when summer was still scorching the grass, I’d done something that felt worse than driving at 23 mph in a 20 zone. I had made a mistake in the operating theatre. The fact that my hospital didn’t deem it serious enough at the time to warrant investigation had done little to lessen my shame. Apologising in person to the patient hadn’t helped much either. Week after week, as I continued to push through my operating lists, I tried in vain to rationalise myself out of the nagging fear that I might do something stupid again. So when, just a couple of days before The Speed Awareness Course, I heard that my mistake had been reclassified as a Never Event, and that I would be investigated after all, I felt a weird sense of relief.
Back at The Holiday Inn, the man on my right popped another Strepsil in his mouth, and tipped his badge towards me. I wrote down my name in clear capital letters as the two teachers reminded us that there wasn’t a driver in the land who hadn’t messed up. Then, as the hours unfolded, I tried to attend to the more simple of my errors. All the while though, deeper worries threaded their way through the content of the course. As the guy teacher informed us that speeding was the number one cause of serious injury and fatality on the road, and we watched simulations of cars crashing into cardboard barriers at different speeds, I played my surgical mistake over in my mind, horrified to think of how things could have ended up. When the woman teacher embarked on the module on aggravating factors, I thought about the frequently inhospitable conditions of my work: the lack of equipment, uncomfortable extremes of temperature, constant overcrowding of my lists with too many patients. And when she walked around the room, asking each of us in turn to name the emotion we felt most at the mercy of when speeding, my eyes stung as I named “anxiety”, realising how frequently I had been feeling this lately, not just behind the wheel, but every time I reached to pick up the scalpel.
In the last exercise, we were handed a piece of paper and invited to work in groups towards a personal action plan that would mitigate our future risk on the road. And when I looked at the page we’d drawn up, I realised how plainly these road safety rules applied to the operating theatre as well. I needed to actively address and manage my emotions. It simply wasn’t acceptable to keep operating on so many patients; to do so was tantamount to reckless speeding. Perhaps most importantly, as the morning sun rinsed the room with coppery morning light, I realised that sitting and talking to others who had made the same mistake as me had shifted something. I might have come here for correction, but I’d gained much more. In a random hotel conference room, with a bunch of strangers I’d never see again, I’d experienced a sense of community in wrongdoing and even a sort of forgiveness.
Last week, after months of failing to get my hospital to listen to my concerns, I posted on Instagram, and everything changed. For the first time in 20 years, I met the senior surgical management team and had a constructive meeting about how to improve both patient and surgeon safety. The number of patients on my lists has been reduced, at least while my Never Event investigation is underway, and I have an appointment booked with Occupational Health. The issues I raised have been acknowledged and I’m looking forward to brainstorming possible solutions this week. Best of all, I’ve been able to express my view that we need a better system for supporting doctors and nurses who have made a mistake, one that goes beyond discipline to provide a sense of care and acceptance. In the months after my mis-step, there wasn’t a day I didn’t feel plagued with shame and fear. Until I found myself, quite randomly, with a group of strangers in a conference room in Regents Park. As the teachers there reminded us before we left, “We always have a choice”. That Speed Awareness course didn’t just provide a logical framework for putting new habits into practice. It made each of us believe that, though we had stumbled, we were eminently capable of doing better next time. It made us feel human. I can’t think of a better basis on which to build good clinical care.
I know something of what you’re describing. As doctors, we can ruminate endlessly over an error, replaying the incident, wondering what we could have done differently and imagining all the ways it might have turned out worse. The shame and fear can be incredibly difficult to carry alone.
Sometimes we need a safe, supportive space to talk through what has happened with people who understand. It can be almost cathartic, not excusing the mistake, but allowing us to process it, learn from it and eventually put it back into perspective.
Doctors and nurses need that support after an error. Supporting the clinician isn’t separate from patient safety; I think it is an essential part of it.
A well-written thoughtful article.
I know it's hard but I can tell you're a doctor I'd have happily worked with.
You come across as reflective, self-aware, honest and keen to learn - skills many doctors lack (I've mentored many).
I'm sorry the mistake happened. It doesn't define you - what defines you is how you respond and learn from it. Changing the system is often part of this.
Unfortunately we doctors are too hard on ourselves. We often fear 'failure' having passed exams, got through med school etc etc. it's an unrealistic expectation.
Take care, be kind to yourself and good luck with your career. It might seem difficult to see at the moment but this will make you an even better doctor on the long term.