The heart of darkness
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Objectives:To describe how physicians think and feel about their perceived mistakes, to examine how physicians’ prior beliefs and manners of coping with mistakes may influence their emotional responses, and to promote further discussion in the medical community about this sensitive issue.
Design:Audiotaped, in-depth interviews with physicians in which each physician discussed a previous mistake and its impact on his or her lift. Transcripts of the interviews were analyzed qualitatively and the data organized into five topic areas: the nature of the mistake, the physician’s beliefs about the mistake, the emotions experienced in the aftermath of the mistake, the physician’s way of coping with the mistake, and changes in the physician’s practice as a result of the mistake.
Participants and setting:Eleven general internists and medical subspecialists practicing at a community, university-affiliated hospital in Oregon.
Results:Themes emerging from analysis of the interviews were the ubiquity of mistakes in clinical practice; the infrequency of self-disclosure about mistakes to colleagues, family, and friends; the lack of support among colleagues; the degree of emotional impact on the physician, so that some mistakes were remembered in great detail even after several years; and the influence of the physician’s professional locus of control on subsequent emotions.
Conclusions:The perception of having made a mistake creates significant emotional distress for practicing physicians. The severity of this distress may be influenced by factors such as prior beliefs and perfectionism. The extent to which physicians share this distress with colleagues may be influenced by the degree of competitiveness engendered by medical training. Open discussion of mistakes should be more prominent in medical training and practice, and there should be continued research on this topic.
Key wordsmistakes physician impairment stress disclosure coping
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- 1.Paget MA. The unity of mistakes: a phenomenological interpretation of medical work. Philadelphia: Temple University Press, 1988.Google Scholar
- 2.DiMatteo MR. The psychology of health, illness, and medical care. Pacific Grove, CA: Brooks/Cole, 1991;276.Google Scholar
- 4.Coggan PG, Macdonald SC, Camacho Z, Carline J, Taylor T. An analysis of the magnitude of clinical reasoning deficiencies in one class. J Med Educ. 1985;60:243–301.Google Scholar
- 12.Terry JS, Fricchione GL. Facing limitation and failure: four literary portraits. The Pharos. 1985;Fall:13–8.Google Scholar
- 13.Christensen JF. Assessment of stress: environmental, intrapersonal, and outcome issues. In: McReynolds P (ed.). Advances in psychological assessment. vol. 5. San Francisco: Jossey-Bass, 1981;62–123.Google Scholar
- 14.Lazarus RS. Psychological stress and the coping process. New York: McGraw-Hill, 1966.Google Scholar
- 18.Fox RC. Training for uncertainty. In: Merton RK, Reader GG, Kendall P (eds.). The student physician. Cambridge, MA: Harvard University Press, 1957;207–41.Google Scholar
- 21.Festinger L. A theory of cognitive dissonance. Evanston, IL: Row, Peterson, 1957.Google Scholar
- 22.Breznitz S. Seven kinds of denial. In: Breznitz S (ed.). The denial of stress. New York: International Universities Press, 1983;257–80.Google Scholar
- 23.Lazarus RS. Costs and benefits of denial. In: Breznitz S (ed.). The denial of stress. New York: International Universities Press, 1983;1–30.Google Scholar
- 24.Peterson C, Seligman MEP. The learned helplessness model of depression: current status of theory and research. In: Beckham EE, Leber WR (eds.). Handbook of depression: treatment, assessment, and research. Homewood, IL: Dorsey, 1985;914–39.Google Scholar
- 26.Millman M. The unkindest cut: life in the backrooms of medicine. New York: William Morrow & Co., 1977.Google Scholar
- 27.Hughes EC. Mistakes at work . In: The sociological eye: selected papers. Chicago: Aldine, 1971.Google Scholar
- 29.Avery JK. Lawyers tell what turns some patients litigious. Med Malpract Prev. 1985;35–7.Google Scholar
- 35.Sorotzkin B. The quest for perfection: avoiding guilt or avoiding shame? Psychotherapy. 1985;22:564–71.Google Scholar
- 37.Bosk CL. Forgive and remember: managing medical failure. Chicago: University of Chicago Press, 1979.Google Scholar
- 38.Katz J. Why doctors don’t disclose uncertainty. Hastings Cent Rep. 1984;February:25–44.Google Scholar
- 41.Walsh KW. Neuropsychology: a clinical approach. New York: Churchill Livingstone, 1978.Google Scholar
- 43.Pennebaker JW. Traumatic experience and psychosomatic disease: exploring the roles of behavioural inhibition, obsession, and confiding. Can Psychol. 1985;26:82–95.Google Scholar
- 44.Fox RC, Swazey JP. The courage to fail. Chicago: University of Chicago Press, 1974;109–21.Google Scholar