I once worked with a beloved physician whose skills were excellent.  Unfortunately, a patient initiated a malpractice lawsuit. Hurt by the experience, the doctor never returned to practice. Another physician was unable to face her patient’s post-operative DVT. She avoided contact, refused to speak with the patient, and eventually left her
practice. Neither of these reactions left room for understanding and healing – and they wasted the hard earned knowledge and experience the physician might have contributed to the health of future patients.                    (photo from the dailygood.org)

How do we show compassion for our patients and for ourselves when complications arise?

Yet another physician was asked to appear before a committee when a patient complained about their interaction. The doctor was apprehensive about what the patient might say – and how she might react. Deciding that she would meet the challenge head on, she established three goals for the meeting: to give the patient an opportunity to explain her perspective and to share her own; to learn something from the interaction; and to avoid becoming defensive.  She entered the room, greeted the patient warmly, and stated her desire that both would share their ideas of what had happened so they could understand each other better. During the conversation, she repeated her intention to provide excellent care and her regret that this hadn’t been what the patient experienced. She realized the patient’s recollection was quite different from her own and understood that expectations, perceptions, and selective hearing all color our experiences.  There was no way to verify which version was correct.  She could only accept and express her regret that the patient’s experience hadn’t matched either of their expectations.  She remains in practice, happy to be a doctor.

In showing compassion to patients who feel they have been wronged, we must first give them the chance to be heard and have their disappointment validated.  We can apologize for a mistake or express regret that they did not have the desired experience.  By verbalizing our intention to provide competent and compassionate care and providing an explanation both of where things went awry and what will be done differently in the future, we leave the door open to resume a therapeutic, trusting relationship.

And what about us?  How do we muster our self compassion and go on, confidently and with renewed passion for our work after we make a mistake?  Many of us are perfectionists.  Since one error can cost a patient his life or result in permanent disability, we tend to perseverate on our mistakes.  By opening a discussion with our patient, we learn and grow from the experience and honor our commitment to lifelong learning, a pillar of medical practice. We can restore the relationship with our patient, a major source of most physicians’ satisfaction.  By discussing our complication with colleagues, we educate others. The complication thus acquires a positive meaning that can offset the negative one we more readily feel.  (This is the concept that underlies the practice of M&M conferences.)  Finally, keeping a file of successes – a personal journal or a collection of thank you cards from happy patients – can be a reality check whenever our infrequent misses overshadow our more common successes.

Wise Native Americans intentionally place an error in each handicraft, emphasizing that we are human and not godlike.  Errors will always be part of the human experience.  Compassion toward ourselves allows us to learn, grow and continue to contribute to our patients and the world around us.  We physicians are a precious resource and it’s essential that we use all of our wisdom and abilities to keep ourselves engaged and in the game.