Blame Culture

One of the biggest challenges facing doctors is the difficulty of balancing the need for accountability and avoiding the often quoted “blame culture”. It is a semi catch-22 situation, in that you cannot victimise people for making the wrong decisions, as we are all human and our choices are not perfect, however, you cannot continually let people make mistakes which endanger the lives of patients with no consequences. 

Medicine is an interesting arena where, more than any other profession, we have been indoctrinated to cover up and ignore our mistakes. The very fact that there are forums emerging, urging us to speak up when things are handled badly, and encouraging us to believe that there is nothing to fear from raising concerns, shows us that as professionals we are very bad at dealing with clinical errors. 

There is a belief in the general population that medical professionals should always know what to do, and should consistently make the right choices in often very difficult situations. It leaves us, as doctors, in a weird limbo between a God complex, and feeling constantly unable to live up to the excruciatingly high standards that our patients expect from us. 

At medical school, we are taught to be confident, competent, and consistent. We are taught not to show weakness, not to show doubt, to be the best. As a result, we hide our areas of inexperience, instead of asking for help to improve them. 

Of course, we all know that doctors are not infallible, the media is full of glaring examples of our errors. We are not allowed to quietly make mistakes, hope that no one notices and carry on with our lives. Our mistakes are aired at monthly morbidity and mortality meetings, they are dissected by patient’s relatives, discussed at Incident panels. They are, at worst, held up in courts of law and splashed across tabloids. This is as it should be; we are not innocent victims – we chose this profession and we did it because we wanted to improve people’s quality of life. We knew going into it that our mistakes are inescapably more consequential than they would be if we misbalanced a client’s account or lost our company money. 

However, our mistakes are inevitable. And the result of holding them up for the world to see is an inescapable inertia, where people are reticent to suggest or initiate anything that they are not 100% convinced about. A work day spent second guessing yourself and never actually getting round to doing your job.

I have experienced this first hand – mistakes made on a previous job have led to me berating myself so fiercely that I have lost all confidence in my ability as a doctor. Take this feeling and multiply it exponentially, and you come close to the effect of media scrutiny, patient expectations and the pressure placed on us by the NHS as a whole to never screw up.

This leaves us at an impass. We need meetings to dissect mistakes and ensure that they are not repeated. We desperately need tailored training opportunities, targeted at our personal areas of weakness, instead of generic programs that are irrelevant to most of us. We need forums in which we can admit to our errors without fear of looking stupid. 

The crux of the matter is that doctors are flawed, often overworked, overwrought, short-tempered human beings trying to do a job which requires a robotic attention to detail and superhuman diagnostic powers. The expectation placed on us as individuals is unrealistic and unsustainable. The first step towards rectifying the disparity between our idealistic view of healthcare provision and the reality is to recognise that we need help. That there will always be that 4am incorrect dosing or the split second indecision about management. Being a good doctor does not mean you never make mistakes, it means that you don’t make the same one twice. Through discussion of clinical errors we get to learn from not just our own mistakes, but also those of others, and this is no bad thing. 

This rant is, at its heart, a plea for understanding from both the medical community and the general public as a whole. Medical professionals need to exist in a culture where they are not victimised for their errors. A culture where they can feel free to admit mistakes and are presented with the opportunity to learn from them. And then if they don’t, then they should be publically flayed. 

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