We internalize these and then are afraid to share them for fear of legal or social identification as a ‘bad doctor.’ This all feeds into the impostor syndrome that many physicians note. —Peter Weisskopf, MD
Explore This IssueApril 2023
“Most of the common errors as described by the Agency for Healthcare Research and Quality (www.ahrq.gov) are systemic errors—that is, errors that involve more than one individual,” Dr. Weisskopf said. These require process improvement efforts and aren’t commonly something that a physician can fix alone. “Regardless, our sense of responsibility takes over, and we can become guilt-ridden and ineffective over our role in the mistake. The most personal errors—surgical mistakes would be a common one—can be even more devastating. This is where the stress of surgery comes to a head: ‘There is only one set of hands working on this patient, and I own them, so the error is entirely mine,’” Dr. Weisskopf said.
While resiliency and community can help in instances of medical errors, barriers exist. “Burnout, which seriously drains our resiliency reserves, is at an all-time high for surgeons. And in modern practice in the United States, our community may also be our competitors. Concern over legal jeopardy mutes our own self-evaluation and ability to discuss and process the incident,” Dr. Weisskopf said.
“Surgeons develop a moral injury as they try to balance the needs of legal, ethical, and personal response to the error. Being caught without an obvious solution may cause emotional paralysis, leading to inaction and a complete shutdown. The most extreme example would be the ‘shell shock’ described in World War I, where soldiers would simply freeze in place, feeling that there was no escape.
Nearly as bad would be a tendency to go to one extreme or another of responsibility. “Either convincing oneself that it ‘wasn’t really my fault,’ or that it was ‘completely my fault’ and believing that there’s no way to mitigate it in the future feels like ‘I failed,’” Dr. Weisskopf said. “Any of those responses prevents healthy examination of the incident and the ability to learn from it to become a better surgeon.”
Physician burnout is associated with increased rates of self-reported errors. Burnout has been amplified during the COVID-19 pandemic due to increasing workloads, financial pressures, and challenging working conditions. “At the height of the pandemic, the stress and anxiety related to aerosol-generating procedures was a prominent feature. As the pandemic has receded in the United States, the pressures to increase productivity and recoup financial losses are compounded by supply chain disruptions and workforce shortages,” Dr. Brenner said.