Negativity and Mistakes in Medicine

Mistakes happen.

Things go wrong.

There are sometimes small and sometimes larger consequences to those things that happen. 

We all make mistakes because we are all human beings.

Now, being a human being who works in healthcare means that sometimes those mistakes come with heavy consequences. 

This episode is all about what to do when mistakes try to suck you down into a negative mindset spiral.

When things go wrong, whether expressly “your fault” or something inevitable that happened due to outside forces, we can get sucked down into a vortex of a negative mindset spiral.

In this situation we can feel like we are beating ourselves up over the situation, the outcome, and berating ourselves for what we could have done differently. 

I recently had this happen. 

I made a mistake at work. 

When it was brought to my attention after the fact I was, as expected, a bit defensive, but also upset with myself that this had happened. 

More specifically… that I had let this happen.

It was a day that things were out of whack, our staffing wasn’t normal, I was juggling multiple demands and if I’m being completely honest, my head wasn’t 100% in the game. I was a little distracted. I missed a step and plainly forgot to do something.

The outcome wasn’t catastrophic but it was costly. 

And having walked through this experience I realized that as I grappled with what to do differently next time, how to navigate those feelings and how to bootstrap my way out of a negative mindset spiral and into a situation where I was being proactive for next time, I thought we’d cover it here on the podcast.

Today I’m sharing 3 steps to take, 3 things to try to help you to also break out of that negative mindset spiral.

This is applicable in retroactive situations, like the mistake that I made but this approach can also be used if we get into a mental spiral of dread – where we are thinking negatively about an upcoming encounter or situation. 

These tactics are some of the things that I attempted following a mistake that I made and I thought they might be helpful in case you ever ended up in a similar situation. 

Watch on YouTube

First up – Feel the Feelings

Have you ever heard the phrase “name is to claim it” in reference to certain feelings?

The first thing that I did when this mistake happened is to feel the feelings. Immediately after this mistake was brought to my attention I was angry – at myself, mainly, I was mad, I was sad, I was disappointed. I was absolutely a little defensive, my baseline when these things are addressed with me. 

The first thing I did, before trying to launch into any of the more cerebral approaches to break this negative spiral in my mind, was to feel the feelings. 

It’s OK to be upset, to be distraught, to be angry. It’s literally OK to feel any feeling that you might be having. 

My first inclination was to be defensive directly towards the person who pointed out my mistake.

Then I felt angry with myself for overlooking the situation.

I was sad that it was a mistake that cost the practice money.

I was a little disappointed that I didn’t have a system in place to prevent this from happening.

We have, in medicine, been trained to check our feelings at the door – it’s the way that we survive seeing patients hurt, ill, dying and in pain before us without collapsing upon every single encounter.

So, given that training, whether overt or a subtle learned behavior – to set our feelings aside, to bury them, to compartmentalize them, this first step of feeling the feelings may feel very uncomfortable.  

It might be awkward and uncomfortable, but try it anyway! 

The phrase “name it to claim it” keeps popping into my head when I think about feeling the feelings.

Taking time to evaluate HOW you are feeling and name the exact, specific feeling that you are feeling is not a waste.

Those feelings have a purpose, whether to keep us safe or to keep our patients safe, to help us to understand the weight of our actions or to remind us that we are humans.

Take the time to write down, say out loud or simply acknowledge the feelings that you are having as a result of this situation. 

It may be shame or guilt. You may feel regret. 

All feelings are valid and there’s something to be said for addressing them so that you can move through the feelings to get to the more analytical part of this situation. 

It behooves us at this point to recognize that not all of our thoughts are true. In these situations I often find myself focusing only on the negatives.

Say you placed an incorrect order or missed an important diagnosis… or you simply forgot to do something that was important for a patient… inside your mind the narrative might sound something like this…

“Oh my God, Tracy. You are such a terrible provider. You are untrustworthy. Your memory is complete crap. If I were a coworker or supervising physician of yours I wouldn’t trust you as far as I could throw you. You are an embarrassment as a PA. Seriously… your patients are all in danger of you making this same mistake again.” 

And so on.

Your brain doesn’t tend to kindly remind you of the 47 things that you didn’t forget that day. We don’t focus on all the PEs that you DID appropriately catch, treat, and dispo. 

Essentially we find what we are looking for and what we are looking for is evidence that we are terrible. We forget the great things, the lives saved, the appropriate diagnosis that we’ve made. 

We tend to see the negative experiences, other mistakes, things that we’ve done wrong in the past, when we get in this negative mindset. 

Take time to remind yourself, as you navigate the feelings in the fallout, that you do great things each day. Check in with yourself if that negative track is running inside your mind. 

So, that’s the thoughts and feelings step. Moving on to some objective analysis of the situation.

Second – Perform an Objective Analysis

Next step in hauling your ass out of the negative mindset spiral is to perform your own objective analysis of the situation. 

Sometimes you need a little time and space for thoughts and feelings – see step 1 – before you can complete step 2.

This is looking at what happened objectively, to the best of your ability, and identifying what you did wrong. Ouch.

Yep. What did you do wrong?

What could you do differently in this situation in the future?

What systems or processes were missing that contributed to this outcome? 

So for my mistake there was someone who was out that day. Typically this person performed this task. And because they were out it fell to me to take care of it.

The problem? I didn’t have a system to remind myself to do the darn thing. I went about my typical day and I overlooked that this task was my responsibility. At the end of the day I packed my stuff up and hit the road, forgetting to do it.

What could I do differently next time? 

Well, I could make it a habit to check and make sure it was being done, every day, before I left the office – regardless of whether it was my responsibility or not.

I could put a post it note on my computer or a reminder on my phone to check and make sure the task was done on days when the primary performer of the task is out. 

I could write a little check item on my to-do list to make sure that the task is done before leaving the office. 

Ultimately, all three of these make it my responsibility to check that it’s done and serve as a reminder, a prompt, or a fail-safe to ensure that the task is completed. 

Sometimes the analysis puts more weight and focus on what you did wrong and sometimes it will highlight the systems that need to be tweaked in order to make changes down the line.

The bottom line here is that this analysis should lead to action. If this is something preventable that wasn’t prevented, how can we change that in the future? Do that thing! 

Also – be open to the idea that it was a fluke. The perfect storm of a situation where the stars aligned in a bad way. There are mistakes that are solidly on our shoulders and also there’s a time to realize there are many factors beyond our control.

If this was just that – the stars aligning or a series of unfortunate events – let the results of your analysis show that. And then the action that we take is working to let it go and not hold yourself responsible for things that you cannot control. 

Third – Debrief with a Trusted Coworker

It can feel hard to be objective about a situation where you are intimately involved. The “can’t see the forest for the trees” analogy and all that. 

Step 3 is to debrief with a trusted coworker. In the multitude of counsel there is wisdom and seeking counsel about a situation is a great way to take this analysis and processing of a situation one step further. 

Take some time to explain what happened to someone who gets it. Someone who works in medicine. 

Ideally someone whose opinion you trust and who will extend you the grace that you deserve.

Talking through the situation can give you an outside perspective and someone can tell you that they’ve been there, done that, got the T shirt.

They can also help you to brainstorm how to do things differently in the future. And they can also give you some outside perspective and identify if this was a fluke or something to improve on your part.

Life is not meant to be lived alone and, although it might feel vulnerable to open up about a mistake or a hard situation, opening up can be a powerful experience.

Dealing with Mistakes

The bottom line is that, as with all things, we need to extend ourselves grace. If a coworker of mine had made the mistake that I made I would not have been berating them.

I would not have been railing on them the way that I was inside of my own mind. There is no way that I would have taken the tone and used the cutting words that the negative voice inside my head was taking as a part of that situation. 

Hopefully, I would be gracious to a coworker who made a mistake. Even in pointing it out to them, I would hope that I was kind and compassionate. 

Don’t you deserve to extend that same grace and compassion to yourself? You are a human, just like everyone else.

That humanity makes you imperfect. The goal here isn’t perfection. The goal is mastering these situations and feeling slightly better prepared for the next time a similar situation arises.

We can be as proactive as we want, have all the systems and checklists and safeguards in place and still end up missing things. 

What matters most is cultivating a system to deal with that. 

What matters most is building a skillset to help you navigate mistakes with resilience and a willingness to admit that you were wrong, but also to be kind to yourself in the process. 

You are not alone in making mistakes.

You are certainly not alone in feeling like those mistakes are trying to suck you down a negative mindset vortex.

The great news? You are in charge of the narrative inside your head. You get to make that negative spiral into a positive upwards pull!

Enjoy this type of content? Check out this post on overcoming clinical imposter syndrome and this post on completing the stress cycle as a healthcare worker.