Learn to live with your mistakes

It is the fear of caregivers, as well as their main taboo. Out of shame, fear of damaging their careers or out of vanity, they do not easily talk about the professional mistakes they make. A silence which can leave serious psychological consequences and which prevents capitalizing on one’s faults to prevent them from recurring. This twofold observation inspired this series. Read: Dr. John Crosby: Physician tips: How not to get yourself sued “The subject is delicate.” “Sorry, I took the time to think about it, but no situation came to mind.” “I must admit that it’s quite embarrassing to talk about it.” “My mistakes, I live with them and I keep them to myself.” The omertà around the errors that health professionals commit is not a chimera of journalists: Profession Santé experienced it by trying to collect testimonies. “We don’t even talk about it between us,” confessed Montreal Children’s Hospital’s Dr. Sherif Emil, one of the few who agreed to break this wall of silence because he finds that “the medical community as a whole is really not doing enough about it." Among physicians, “this taboo is linked to the image of the perfect doctor,” explained Dr. Claude Johnson, medical consultant for the Quebec Physician Assistance Program (PAMQ). “On the one hand, medical culture pushes for perfectionism. On the other hand, the population expects doctors to be irreproachable, and they do not hesitate to blame them for their mistakes. This does not encourage them to talk about it.” Among pharmacists and nurses, it is above all the feeling of having failed in the task that prompts them to conceal their faults. “Their mission is to take care of people, to save lives, not to harm them. So when that happens, it’s hard to admit and it traumatizes them,” observed psychologist Danièle Lapointe, who also offers psychological support to doctors on behalf of the PAMQ. The health system itself does not help facilitate communication on the subject. “Several colleagues are disgusted to send incident reports. It becomes anxious, because it is usually the same problems that are repeated, but we hardly ever talk about them to find solutions. We just get lectured, then we return to the floor,” a nurse from Quebec's North Shore confided anonymously for fear of reprisals. At all levels, “error is still associated with blame and shame,” noted the president of the Espace Santé Group, dentist Benoit Gareau. He considers it normal to make mistakes, “but if we want to reduce them, we have to clear the floor by creating spaces for exchange between professionals.” In a context where these spaces are almost non-existent, health professionals often find themselves alone in the face of their mistakes, thus promoting psychological consequences. Dishonor, guilt, anxiety, insomnia, decreased motivation, loss of self-confidence, depression, etc., these impacts were widely documented and summarized by the concept of “second victim” put forward by Dr. Albert W. Wu in an editorial in the British Medical Journal published in 2000. “In a car accident, there is a culprit and a victim. Both will have consequences. Their shape differs, but they are very real for the one who holds the wheel,” illustrated the president of the Order of Psychologists of Quebec, Christine Grou. Stress and loneliness When the error is presented before a disciplinary board or a court, the situation becomes worse for the professionals concerned. Procedures can last for months or even years, and these caregivers are exposed to the critical eyes of the public as well as the judgment of their peers. “It’s terribly difficult to live with and it facilitates the impostor syndrome,” observed Lapointe. Added to this is the fear of the unknown: how will the procedure unfold or what will be its consequences, in the short term and in the future. “Doctors experience great loneliness, because they tend to believe that they are the only ones to whom this happens,” said Dr. Steven Bellemare, director of practice improvement at the Canadian Medical Protective Association (CMPA), the mutual defense organization that supports and represents some 100,000 physicians across the country. “When they call on us, we try to play down the situation by telling them that they are neither the first nor the last and by explaining to them how things are going to turn out. We are not psychologists, but we understand their emotions, we can help them put things into perspective and, if necessary, we send them to the PAMQ,” specifies the medical adviser. At the Canadian Nurses Protective Society (CNPS), the process is much the same. “It is a great torment to come to the conclusion that one may have caused harm or failed to prevent it. Nurses are encouraged to consult their healthcare professional for the support they need. The psychological impact, to one extent or another, must be anticipated. So it’s usually a question that we raise up front, before our beneficiaries request it,” said Vanessa Schwarz, director of communications at CNPS. For its part, the Professional Liability Insurance Fund of the Ordre des pharmaciens du Québec has set up an assistance program for its members after having observed “a certain need,” indicated Carmina Magana, director of claims. “When they bring us a complaint,” she continued, “we feel (how) very shaken (they are). It calls into question their careers, their skills.” Shy whispers If the culture of silence remains stubborn, the workers consulted by Profession Santé observe that things are changing, timidly, but they are changing. “There is a societal openness on the question,” said Lapointe who notes that doctors consult more than before within the framework of the PAMQ. “Young people in particular talk about it more easily. We also feel that the College of Physicians is concerned” considering that the management of medical errors should be addressed during the training of all caregivers. “It would normalize them and encourage caregivers to talk about it later in their careers.” To do this, “we must not only work at the level of individuals, but also at the level of organizations by changing our view of adverse events,” said Dr. Johnson. The idea is to make sense of the mistake and see it as an opportunity for learning and improvement in order to “build the positive from the negative. This requires a climate of psychological security, benevolence and mutual aid to free speech,” said the doctor, who promotes the establishment of policies of “just culture,” free of guilt and blame within establishments of health. Recommended by Accreditation Canada, these policies based on teamwork to prevent prejudice are gradually being applied in Quebec “It’s starting to become commonplace,” said Dr. Johnson. Originally ran on our sister brand in Quebec, Profession Santé. Translated from French.

Learn to live with your mistakes

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