Post-traumatic growth helps doctors after they have made a mistake while practicing, according to the results of a three-year project published in the journal American Medicine.
The project, called the Wisdom in Medicine study, was designed to investigate how doctors cope, learn, and change after making a medical error. Specifically, the study explored whether or not physicians move through the experience of making a harmful error and not just survive but, rather, learn something essential about themselves that promotes growth.
For the project, the research team interviewed 61 doctors from the United States who volunteered for the study and self-reported having made a serious medical error. Participants were asked to tell their story and reveal what helped them cope with the experience in a positive way.
The results revealed that the doctors who were considered “wisdom exemplars” described what they had learned and how they had changed from their experiences by looking through a lens of wisdom. Among one of the most helpful ways doctors said they coped with their error was being able to talk about it. However, many of the doctors said that at the time of the event in which the error occurred, they were not able to talk with anyone, either because they were too ashamed or were instructed not to by their lawyer.
Furthermore, these doctors also stressed the importance not having those close to them dismiss the seriousness of the situation or the reality of the mistake to try to make them feel better. “They noted the tendency of well-intentioned colleagues to minimize, dissolve, deny, or attempt to solve the error, which they did not find helpful,” the researchers explained.
“Instead, physician participants said they responded best to someone who simply “held” the feelings that they were expressing- that is, someone who really listened, acknowledged the seriousness of the situation, and helped them to put it in perspective.”
Another factor examined during the study was disclosure and apology surrounding a doctor’s mistake. The findings revealed that disclosure occurred nearly two times as much in doctors who were “wisdom exemplars” compared to the “nonexemlars”. Of note, the great majority of the doctors in both groups reported that they did not received any training on how to best approach disclosure following a medical error. “Interestingly, through, the participating physicians reported that disclosure and apology were critical first steps toward the possibility of healing a broken relationship and being able to deal openly with the event.” And when it came to forgiveness, doctors did not necessarily expect forgiveness, they did however explain that following disclosure and apology, the chance for a potential opportunity for forgiveness from their patient, or even from themselves, now presented itself.
The study looked at several other factors, such as: professionalism, spirituality, and “doing the right thing,” dealing with imperfection, learning/becoming an expert, preventing recurrences/ improving teamwork, and helping others/teaching about it.
In the end, the study focused on doctors who responded in a positive way to serious errors they had made. And the implications for medical schools training these doctors? The study asked: “What can physicians and those who teach and support them learn from the accounts of the doctors in our study who made mistakes and emerged with positive new insights?” For one, “the specific forms of ‘talking about it’ that helped doctors can be used to guide discussions within peer group programs.
“In addition, participating physicians recommended both directly addressing potential emotional reactions (e.g., contemplating leaving medicine) and guarding against isolation through active outreach.” “We suggest specific steps to help clinicians move through the difficult experience of making an error so that they avoid devastating professional outcomes and have the best chance of not just recovering but actually growing and developing wisdom,” the authors concluded. “ Understanding the factors that help clinicians learn and grow in the wake of a mistake can inform peer support programs and create an environment that fosters continuous learning and improvement, teamwork, relational care, compassion, and wisdom.”
The findings from the study were published in the February 2016 issue of Academic Medicine.