Remember That Patient You Saw The Other Day?

If you’re anything like me, hearing those words will lead to almost immediate tachycardia.Those are the words you hear before you hear a story of something you missed, a patient who had a bad outcome, the story of a medical mistake.

I used to find that hearing something like that would immediately bring up a fight or flight response.  Because seeing as it’s usually frowned upon for the doctors to run hurriedly out of the emergency department, I would then get ready to fight.  I would immediately find myself on the defensive.  I needed to prove that I had done everything right.  I hadn’t made a mistake or missed anything; something must have changed.

That need to defend myself came from my perfectionism.  I was so scared of missing something, of being wrong that I needed to prove that hadn’t happened even if it had.  As a result, I often closed myself off to opportunities to improve or learn from my previous cases and, I’ll be honest, I had some interactions with colleagues of which I’m not particularly proud.

I don’t blame myself.  The medical community has a robust history of using shame and ridicule as training tools.  When you combine that with the overwhelming fear of medical malpractice, it’s understandable that the very thought that you missed something or didn’t make the best clinical decision can lead to absolute terror.

When I began to work on improving my experience as an emergency medicine physician through coaching, this is one of the first things I worked on.  I knew that I needed to find a way to let go of the constant self-doubt, second guessing, and fear that I experienced on most shifts.

But how?

The first thing I did was let go of worry.  There’s a great Eckhart Tolle quote that helped me with this.  “Worry pretends to be necessary but serves no useful purpose.”  We think that, by constantly worrying about missing a diagnosis, having a bad outcome, or getting sued, we can avoid those things.  Instead, what happens is that we live with the fear and trauma of what we’d make it mean if those things did happen – even though they haven’t.

We think our worry protects us, but, in reality, it harms us.  It causes us to live in fear of things that haven’t happened but, emotionally, our brains don’t know the difference.  The fear is real even if the things we’re afraid of aren’t.

When worry shows up, I ask myself, “Is this happening right now?”  This refocuses me on the moment I’m currently living in, not the thing I’m worried about.

The second thing I did was promise myself that, no matter what, I’d have my own back.  Before I did this, I would beat myself up relentlessly after any missed diagnosis or bad outcome.  I was defensive toward my colleagues because, if they were right, I would emotionally abuse myself for weeks, months, or sometimes even years afterwards.  I can still tell you about cases where I missed something as a medical student that I berated myself for years over.

I thought I was making myself better.  I learned the behavior by watching my attendings on rounds.  If someone got something wrong or missed something, you called them out and shamed them so I just continued the behavior internally. 

That type of abuse, however, is horrible to endure.  There is one sure fire way to avoid it – just never make a mistake, never miss anything, never have a bad outcome!

We all know that’s impossible and I knew it too. That’s why now I no longer judge myself based on patient outcomes.  I judge myself instead on how I showed up.  I made a commitment to myself to practice the best medicine I can 100% of the time.  That way I know, even if I miss something, that I did my best and my best is enough.

This has allowed me to be so much softer and kinder with myself.  It has opened me up to hearing about my cases and I’m no longer on the defensive when I do.  We all know that there’s no perfection in the practice of medicine, but we so often expect it from ourselves. 

There is also a culture of using the mistakes and misses of our colleagues to make ourselves feel better, but that is a topic for a future blog.

If you’d like to learn how to stop beating yourself up and have your own back on shift, I’d love to help you.  Start by signing up for me free course How To Feel Better On Your Next Shift, and then when you’d like to learn more about coaching, email me at