Medicine is a rich, complex journey full of developments and often fulfilling experiences, peppered with uncertainty, responsibility and emotional intensity. Taking time and receiving support to reflect on these experiences is vital to your personal wellbeing and can positively impact patient safety.
Medical mistakes happen more frequently than any of us would like. The NRLS receives over two million reports of medical incidents from the UK’s NHS alone and a 2018 Johns Hopkins study claims that medical errors are the third-leading cause of death in the US. Errors tend to stem from divided attention, poor communication skills or lack of experience.
Following the 5 golden rules when mistakes are made is always important, however the last rule is vital to avoid reoccurrence.
5 Golden Rules
- Be honest
- Tell someone you’ve made an error as soon as possible.
- Apologise to the patient
- Write an account or statement of events while the incident is fresh
- Think about the approach you would take next time
Rather than being a distraction from patient care, introspection and reflection help to consolidate learning and identify opportunities to improve effectiveness both personally and systemically.
There are several practices that you can incorporate into your daily routine that will enhance the quality of your reflection. One of these is journaling. Just 15 minutes a day in the morning or evening can help you evaluate and rationalise experiences. The way we interpret events can have a greater effect on us than the events themselves and writing down our feelings and insights can provide valuable learning opportunities that might not come from a purely scientific analysis.
Stoicism is another useful approach to develop. Similar to mindfulness, stoicism is built on the cardinal principles of wisdom, self-discipline, justice and courage, and is championed by author and entrepreneur Tim Ferriss. The qualities of stoicism include being rational, calm, strong, flexible, moral, honest and reasonable, all of which can enhance the ability to perform under pressure and remain focused on continuous improvement.
The Reflective Practitioner has been jointly developed by The Academy of Medical Royal Colleges, the UK Conference of Postgraduate Medical Deans, the General Medical Council and the Medical Schools Council as a resource for doctors and medical students to aid reflection in medicine, sharing the ‘What? So What? Now What?’ framework.
Whatever practice you adopt to stay reflective, it’s useful to contemplate what is within your control and what falls outside the scope of your jurisdiction so that you can maintain some perspective.