Learning from my mistakes

This doctor believes in the saying, "Admitting error clears the score, and proves you wiser than before."

By Eric Anderson, MD
Family Practitioner/San Diego

Most of us learn from our mistakes. I know I do. Indeed, I’ve heard my wife say with a smile, "Eric never makes the same mistake 10 times."

To err is excusable, to a degree–as long as we figure out where we took the wrong turn and never venture that way again. After all, that’s how we gain experience.

The mistakes that I’ve committed during 40 years of medicine probably stemmed less from intellectual weakness than what my scoutmaster would have called personality flaws.

One of my basic foibles was pointed out by a patient who sold men’s clothing in a department store. He found me one day looking at sportcoats for minutes on end–then deciding not to buy. "You are the worst customer we have!" he declared. "We call your type ‘replacement shoppers.’ You’re never in the fashion lead, and don’t buy until your clothes wear out."

Maybe I’d do better at practicing medicine if I were more like the hare and less like the turtle. Old "Mr. Grove," a patient of mine three decades ago in a small New Hampshire town, might have thought the same thing.

For years, Mr. Grove complained about his hip arthritis. He asked my opinion on the then-new technique of hip replacement, but dropped the matter after I sounded some discouraging notes. I pompously told him that I never wanted to be the first on the block to try something new. My patients weren’t going to be guinea pigs.

About five years later, Mr. Grove and I revisited the subject of hip replacement. He was suffering intensely at that point. I conceded that the procedure now seemed well established and referred him to an orthopedic surgeon.

For years afterward, every time I passed the auto dealership where Mr. Grove worked, he’d shake his fist at me. Not because the operation had gone badly, but because it had gone so well–and I had been too conservative for too long. As if to underscore this point and show how he had improved, Mr. Grove would dance a little Irish jig, smiling like a leprechaun. But still shaking his fist!

Granted, medical conservatism has its place. Too often, doctors rush into unnecessary surgery and encounter complications that can’t be undone. Yet with today’s more rapid dissemination of medical knowledge and people’s increased health consciousness, we must be quicker to change our treatments when the evidence shows the advantage of a different approach. Our patients, most of them anyway, are more sophisticated and more prepared to try something new, provided the risks and benefits are duly explained. That’s now more apparent to this cautious Scot.

That I was an emigrant to this country probably set me up for another mistake: my failure to appreciate cultural differences.

I had my first exposure to American customs in rural Texas, where I practiced for four years. I thought that the casual manner in which Texans related to each other was the American way. I’d introduce myself to patients, "Hi, I’m Eric Anderson." If they wanted to call me Eric, that was okay because I probably was going to call them by their first names, too. It was all very folksy.

When I relocated to New Hampshire, though, it struck me how odd and disrespectful it was to call a favorite patient, who was close to 80, by her first name. "Does it bother you when I address you as ‘Agatha’?" I asked.

She hesitated and then said, "No, that doesn’t bother me. But I don’t like it when you call me ‘Honey.’ "

That word caused me further embarrassment at about the same time, when I delivered a young woman’s second baby. The mother’s first name, unknown to the nurse anesthetist who had worked with me on many deliveries, was actually Honey. After several admonitions from me to "Move farther down the table, Honey," and "This is going well, Honey" and "One more push, Honey, and we’ve got this baby," the anesthetist whispered to me while trying to keep a straight face: "It sounds as if you have a personal relationship with this patient. I believe the Hippocratic oath says it’s not ethical to deliver your mistress."

Although Edmund Burke once said that people defend their errors as if they were defending their inheritance, I got the message, and the obvious lesson: We should ask patients how they wish to be addressed. It’s clearly patronizing to call patients, especially those older than ourselves, by their first names, unless they have explicitly asked us to do so. It’s demeaning enough to sit in a stark exam room, wearing a skimpy gown, without being addressed like a child.

I’ve had to improve not only my bedside manner, but my deskside manner, as well. During my New Hampshire sojourn, a new patient in my office was writhing in agony with a kidney stone. Our 36-bed community hospital was full; I knew that because half the inpatients were mine. Hospitals were crowded in the late 1960s, and hospitalizations for ailments less critical than a kidney stone were common.

I asked the head nurse if she’d put up a stretcher somewhere–in the emergency room annex, if need be–because my patient would require Demerol and observation until he passed the stone. She said the new administrator had a firm rule: When the hospital was full, he wouldn’t admit another patient until a bed became available.

I took my cause to the administrator. "This patient needs to be admitted somehow," I told him sternly. "There's no other hospital nearby. We’ve never closed our hospital before. This man is an emergency. I really must insist."

We argued for a few minutes. I was insufferable, a prize pain in the neck, pulling rank as the busiest doctor in town, the one who kept filling beds, and browbeating the new administrator. Reluctantly, he bent. I preened, and admitted my patient.

An IVP revealed a large stone. After two agonizing days, the patient passed it and left the hospital. Then it was the hospital’s turn to experience pain–an unpaid bill. Turned out that the name and address he’d given were false. His insurance was false, too. What was real, however, was the enmity the administrator bore me for the five years he oversaw our small hospital. He crossed swords with me every chance he got–and usually won.

Looking back, I realize that I should have approached him with more humility and respect. After all, he was running the hospital, not I.

"I realize that I’m putting you in a difficult situation, given the new rule you’ve established," I might have said. "Could you give the patient at least one night? Maybe tomorrow I can discharge another one of my patients ahead of schedule to free a bed. If you can accommodate me, I’ll owe you one."

By challenging the administrator, I fought the wrong fight. I should have been fighting my own hubris.

Over the years I’ve learned that mistakes serve a purpose–but only if we benefit from them. As the late Laurence J. Peter, author of The Peter Principle, once said, "If you don't learn from your mistakes, there's no sense making them."

Eric Anderson. Learning from my mistakes.

Medical Economics

2001;1.