The secret doctor.
When I was still a core trainee, I looked at a chest x-ray for less than ten seconds, closed it and I wrote: ‘CXR – no evidence of pneumonia’.
I was on-call and reviewing an elderly lady with multiple co-morbidities who the FY1 was worried about. Her septic screen had returned a mixed growth in her urine, but despite five days of antibiotics, she remained pyrexial and her inflammatory markers climbed.
Three days later she developed shock and we discovered a diverticular perforation. My heart raced when I pulled up that chest x-ray, knowing I was about to be confronted with what I did not want to see.
Air under the diaphragm. It glared back at me; because of course now you can see it and everyone can see it and how could anyone have missed it?
But I missed it. Common and clichéd; my mistake of inattentional blindness.
I told the consultant my truth and he looked at me earnestly and said: ‘This is not your fault, you looked at it and you missed it; I didn’t look at it and I would not have missed it.’
The thing about responsibility is that if you take it seriously, somebody telling you ‘it wasn’t your fault’ doesn’t help you deal with it. You struggle to take the ‘get out of jail free card’ because it is just harder to tell yourself those sorts of stories.
I carried my mistake around alone; heavy on my chest and close around my throat. There were days when I didn’t even think about it, but it was always there; still and looming as the reason I was afraid to think at all.
After a week, I knocked on the same consultant’s door and said nothing except ‘I just can’t stop thinking about it’.
He sat me down and talked about how the burden of responsibility requires accepting that you will sometimes do your best and make mistakes.
He told me that I must always be brave and responsible enough to look at and examine my mistakes honestly, but that this is not the same as just punishing yourself. Then he told me about his mistakes and I was no longer alone.
So I think this; tell yourself, tell your friends, tell your colleagues. Even the ones who you don’t like, the ones who you think will judge you like you fear you will judge yourself.
Tell them you made a mistake; we owe each other that.
This is an abbreviated version of the full post That mistake was mine at BMA Connecting Doctors.
Everyone makes mistakes. All doctors make mistakes. We have to learn to live with that, as well as with how to minimise them, and learn from them.
- More posts from posts from The Secret Doctor (bma.org.uk)
- The comments beneath beneath the full post are supportive and helpful
- Image courtesy of Dr Sagoscha Sorrentino at Radiopaedia.org
- More on subdiaphragmatic free gas from Dr Avni Skandhan at Radiopaedia, and (more extended) on pneumoperitoneum (Dr Jeremy Jones)