This ‘Letter to My Daughter’ first appeared in a recent issue of a medical journal.
My daughter had just finished first year Medicine, so I wrote to her telling her about one of the pitfalls of being a doctor—making mistakes.
I hesitated before posting this: I don’t want to downplay doctors’ mistakes—some have had serious repercussions on their patients, and I know there are rogue doctors out there.
But I know the other side, too—the many conscientious, caring, and brilliant doctors who have also erred. We try very hard to be perfect, but we’re human*, and when we screw up, believe me, there follows much soul-searching, questioning and berating, usually in the middle of the night.
Congratulations on completing your first year of Medicine. I can tell it suits you—you’re the chirpiest you’ve ever been, overflowing with new knowledge. You’ve made friends, found like-minded people, possibly for the first time in your life.
I’m reminded of my own early days at Medical School—the delicious Latin; the voluminous texts; learning the intricacies and workings of a body I’d always lived in but never understood.
By the way, I can’t believe you’re allowed to see patients in First Year. What happened to those dry pre-clinical years with nary a patient in sight?
And your father’s not impressed with the timetable. Where are the nine-to-five lectures? And Chem pracs until six on Friday evenings? He’s not too sure about this online learning either—moodles, Facebook groups, podcasts. Sounds too social to be called ‘study’.
Now, I want to have a chat to you about a serious topic. I don’t want to dampen your enthusiasm, but there’s something important you need to know:
You will make mistakes.
I know you read that and didn’t believe it. You’re thinking that you won’t make a mistake. That you’ll be so good and conscientious a doctor, you won’t miss a diagnosis or prescribe the wrong treatment.
I’m sorry to tell you, but you will. You will make mistakes. Despite everything you will learn, everything you will know, and all the exams you will have passed, you will still make mistakes.
I know what else you’re thinking: you’re thinking that the only doctors who make mistakes are the inept ones, the negligent ones, the ones who make the news. But you won’t be like them—you’ll be a much better doctor. You’ll be conscientious and thorough and meticulous.
You will still make mistakes.
Most of the time, no one will know—your patient won’t suffer, or if they do, it will be minor.
Hopefully, that is all that will happen.
When you do make a mistake, at first you’ll be defensive. You’ll say something like, ‘But the scaphoid was clear on X-Ray and it was only a minor fall onto their outstretched hand.’ Or, ‘They said their chest pain wasn’t that bad, and they wanted to drive to the Emergency.’
But, you’ll feel terrible. Because you made a mistake. You’ll feel stupid. And you’ll take yourself off to a private room, shut the door and cry.
Because. You’ve. Been. So. Stupid.
No other doctor would have missed it. Just you. You should give up Medicine right now, because you’re hopeless.
You won’t forgive yourself even if the mistake happened at the end of a double shift, or if it was an obscure presentation you’d never seen before.
Sometimes, too, you’ll have to face the patient or their relative, because they’ll want to see you. Make sure you apologise. Always.
Sometimes, you’ll have to face a colleague and his or her wrath— someone who’s forgotten that they make mistakes, too.
But sometimes there’ll be the doctor, someone you hold in high esteem, who’ll call you aside and tell you not to let it get you down. They’ll tell you about their own mistakes, and before you go, they’ll remind you that you are a good doctor and even good doctors make mistakes.
You’ll return to the ward, and you’ll see your next patient, who might be a husband who thanks you for diagnosing his wife’s breast cancer.
Or it might be a mother who thanks you for spotting the rash that was their child’s meningococcal infection.
Or it might be someone who thanks you just for squeezing him in when you were busy.
And that will be enough.
Love From Your Mum.
*I use ‘we’ although I no longer practise Medicine. I tried to write ‘they’ but that didn’t sound right either. I guess part of me will always be a doctor.
Your daughter is lucky to have such a wise mum.
Thanks, Monique. I’m not always wise, though …
I know what you mean. While you’re studying no one thinks you know anything, but the minute you graduate and become registered, you’re expected to be perfect and know everything. It can be very daunting, but somehow we all manage to get through it.
Those first few years after graduation are really stressful, or that’s how I found them. You’re getting to know the run of the hospital, including all the admin and paperwork, as well as still learning how to be a doctor. Sometimes, you have patients, nurses, and doctors all harassing you because they want something done immediately and Why hasn’t it been done? From a knowledge and skills perspective, you’re still learning, and because there’s so much to know in Medicine, and it’s growing all the time, it’s simply impossible to know how to do everything you’re asked to do. Specialist doctors, too, often expect you to know their discipline inside-out, like they do, and sometimes show little understanding when you don’t. When I was an intern, I was scolded by a paediatric registrar for not taking the arterial blood gas on a premature neonate—I barely knew how to take venous blood from one, let alone arterial. At the time, I burst into tears, as I do when someone is being unfair, and I think he realised he was expecting a little too much. It’s a very tough time …
Wise words, beautifully and simply written, Louise. Becoming a doctor is taking on the responsibility for other people’s lives – their well-being and survival. It’s a huge ask for any of us to expect our medical professionals never to make a mistake. After all, none of us is super human and we all need to remember that, whatever side of the consulting desk we’re sitting on.
Thanks Teena. Doctors have a huge responsibility on their shoulders—they make big decisions about people’s lives and welfare. No doctor I know ever forgets that.
It’s a strange feeling as a doctor to sit on the other side of the consulting desk. By and large, my family and I have had great care, but I do have a few stories of my own …
As always so very powerful, Louise, what an amazing heartfelt letter. I wrote a blog post about a doctor apologizing to me recently and it was a really powerful experience for me and for this doctor. It just your post rang so true in light of my personal experience.
Thank you for sharing
Hi Gulara, and thank you for visiting!
I read your blog post—it’s beautiful and sums up the healing power of an apology. About a year ago, I wrote a post that I didn’t publish, called ‘The Power of An Apology’. It related to a specific incident and I didn’t want to upset the other people involved, so I didn’t post it. I might have another look at it now, as it’s an important topic to think about.
Apologies are powerful healers. Whenever I apologise—and some days I feel as if I’m constantly apologising—I can see and feel the anger in the other person dissipate. It has the same effect on me, too—it’s hard to maintain rage in the face of someone who’s apologising.
As a doctor, I always put my pride aside and said I was sorry. It was usually for running late, which wasn’t always my fault, but nor was it the fault of the patient I’d kept waiting. Sometimes, I apologised for other people’s mistakes—if I was double-booked, for example. Sometimes, it was my mistake, but a common sense one—if instead of starting antibiotics straight away, I’d waited to see if the patient would recover by themselves. Still, I always apologised. Sometimes, the patient would walk in enraged, and I’d sit and listen to criticism that wasn’t always fair. I kept silent as they talked and let them vent. I just listened and that, I think, is the key—to just listen, so people feel heard. And at the end, if it was warranted, I apologised. Some of these people went on to become my favourite patients. What could have been a disaster developed into a mutually beneficial long-term relationship instead.
The old way of thinking was not to apologise, as it was an admission of guilt and could harm your defence if you were sued. Then I attended a talk by an American neurologist who told us that the best way to avoid being sued was to be a good communicator, and part of that was apologising. People are less likely to sue you if you’ve said you’re sorry.
This made sense to me, as I know how angry I feel when people won’t admit they’ve done the wrong thing, and I don’t like backing down until they do. Sometimes, I get a bee under my bonnet about it, and take it further for this very reason. Not admitting a mistake sets up an adversarial situation, and one side has to eventually back down and let the other side ‘win’. Whereas an apology speaks empathy, and acknowledges the pain or inconvenience or distress you’ve caused.
It also says, I know I’ve made a mistake and I’ll try not to do it again. And most people accept that, as that is what we’re all doing, every day of our lives.
Hi Louise, thank you for sharing with your thoughts and insights. I am impressed at your engagement with your readers and enormously grateful for time and energy you put into this exchange. You are an absolute inspiration: as a writer, mother and a doctor too! Such an honour to follow your writing. You are a beautiful model to your children and me personally. I think you have already written a blog post just in this comment. Look forward to reading more about your exploration of the power of apology.
Hi Gulara, I think this ended up in my Spam for some reason … I’m glad you returned and commented again!
Oh, good, so I sent it off after all, that was what I was on about in my not very coherent comments the day after 🙂
Hi Louise, yesterday, I wrote a reply on my page (as your reply appeared there but I don’t think it’s gone through). Or maybe my high fever is affecting my skills to deal with technology…
Anyway, this is just to say thank you for all your wisdom and generosity in sharing with us. You are an absolute inspiration! Take this post – I am so impressed at the level of engagement you have with your readers. I am grateful for the time and energy you put in this reply. In fact, it’s a blog post in its own right 🙂 I look forward to reading more about your exploration of the value of an apology. With much love, gratitude and sheer admiration. Gulara
I’ve just got your reply and thank you. I’ve been away from the internet today, as I’m devoting myself to writing while my husband’s home over the Easter break and can mind the kids! I apologise that I haven’t replied sooner.
I’ll definitely resurrect that blog post!
Thanks again for your comments and we’ll stay in touch! xx
I love this letter Louise. You are such a diligent and caring mother. Of course doctors make mistakes… they’re human. But the fact that only the most elite of our academics are chosen to study in the field is very reassuring to the rest of us. You must be very proud of your daughter.
I’m proud of all my children, Pinky, as I’m sure you are of yours. She puts her heart and soul into everything she does and I know she’ll be a great doctor. Thanks for visiting. x
Well said Louise. Bet you were a great doctor. Medicine’s loss, readers’ gain!
Thanks, Iris! Such nice words, and so nice to hear from you! Hope all is going well with your writing and we miss you at the BPLG!
This is a very grounded, loving letter carrying great wisdom. I wish I had the opportunity to read this before I qualified although I suspect it means just as much now (if not more) and indeed not just relating to my medical career – we all make mistakes doctors or otherwise and potentially in all realms of our lives. Thank you so much for sharing so generously.
There were doctors who tried to tell this to us as students, and I can remember thinking all of the things I wrote in this post: That won’t be me. I won’t make mistakes. Blah-blah-blah. It was helpful to have heard it, and later when I did make a mistake, I knew that other doctors, people whom I admired, had done the same thing.
And yes, we’re always making mistakes in every aspect of our lives. In fact, the mistakes I made as a doctor pale into insignificance compared to some of the others I made. And still make …
Oh Louise if anyone told me that I must have been in such deep denial that I didn’t even hear them. If anything I suspect medicos are a highly perfectionistic group – perhaps pathologically so for our own sanity but the job comes with great responsibility and enormous trust from others. Mind you so do many other occupations … It is such an important issue to have brought up for discussion. Many many thanks x
I’m sure you’d remember if they did tell you. I remember well who told us about their mistakes, and it was more than one of the consultants, and how much I respected them for it. You’re right, the job comes with so much trust and responsibility, and we can never lose sight of that. It’s finding some way to forgive ourselves if we do make a mistake.
Lovely letter Louise – and once again, I feel for doctors, hoisted up on that pedestal whether they like it or not, and then have stones thrown when they fail to know everything, every single time, for years and years, oh and in ten minute slots while we’re at it. Hats off to anyone doing it!
Yes, doctors are put on a pedestal. For a good reason—we have a huge responsibility: there is nothing more valuable than a person’s health and life. With that responsibility comes intense pressure as it’s impossible to not make a mistake. Hopefully, when you’re a junior doctor, a senior doctor will be looking over your shoulder, and you’re always conscious of how much to defer to the senior doctors, and how much independence and responsibility to take on. Of course, with experience, it settles.
You’re right, too, the public do like to beat doctors up when we make mistakes, but, believe me, it’s nothing compared to the beating we give ourselves. We feel it very viscerally.