Do house officers learn from their mistakes?

Mistakes are inevitable in medicine. To learn how medical mistakes relate to subsequent changes in practice, we surveyed 254 internal medicine house officers. One hundred and fourteen house officers (45%) completed an anonymous questionnaire describing their most significant mistake and their response to it. Mistakes included errors in diagnosis (33%), prescribing (29%), evaluation (21%), and communication (5%) and procedural complications (11%). Patients had serious adverse outcomes in 90% of the cases, including death in 31% of cases. Only 54% of house officers discussed the mistake with their attending physicians, and only 24% told the patients or families. House officers who accepted responsibility for the mistake and discussed it were more likely to report constructive changes in practice. Residents were less likely to make constructive changes if they attributed the mistake to job overload. They were more likely to report defensive changes if they felt the institution was judgmental. Decreasing the work load and closer supervision may help prevent mistakes. To promote learning, faculty should encourage house officers to accept responsibility and to discuss their mistakes.

[1]  E. Freis,et al.  A study of diagnostic errors. , 1957, Annals of internal medicine.

[2]  J. Williamson,et al.  Research in medical education. A classification of physician performance in internal medicine. , 1968, Journal of medical education.

[3]  J. Williamson,et al.  Physician Performance and Its Effects on Patients: A Classification Based on Reports by Internists, Surgeons, Pediatricians, and Obstetricians , 1970, Medical care.

[4]  I. Janis,et al.  Decision Making: A Psychological Analysis of Conflict, Choice, and Commitment , 1977 .

[5]  S. Bok,et al.  Lying: Moral Choice in Public and Private Life , 1979 .

[6]  D. Light.  Becoming psychiatrists: The professional transformation of self , 1982 .

[7]  Charles L. Bosk,et al.  Forgive and remember : managing medical failure , 1980 .

[8]  R. Delgado,et al.  To tell the truth: physicians' duty to disclose medical mistakes. , 1980, Specialty law digest. Health care.

[9]  Telling patients about medical negligence. , 1983, Canadian Medical Association journal.

[10]  The Mystique of Medical Training: Is Teaching Perfection in Medical House-Staff Training a Reasonable Goal or a Precursor of Low Self-esteem? , 1983 .

[11]  D Hilfiker,et al.  Facing our mistakes. , 1984, The New England journal of medicine.

[12]  J. Katz,et al.  Why doctors don't disclose uncertainty. , 1984, The Hastings Center report.

[13]  T. Mizrahi,et al.  Managing medical mistakes: ideology, insularity and accountability among internists-in-training. , 1984, Social science & medicine.

[14]  J. McCue.  The distress of internship. Causes and prevention. , 1985, The New England journal of medicine.

[15]  A E Voytovich,et al.  Premature conclusions in diagnostic reasoning. , 1985, Journal of medical education.

[16]  Learning medical fallibility. , 1985 .

[17]  B. Devlin.  Confidential enquiry into perioperative deaths. , 1985, Journal of the Royal Society of Medicine.

[18]  R. Gillon.  Doctors and patients. , 1986, British medical journal.

[19]  W. Applegate.  Physician management of patients with adverse outcomes. , 1986, Archives of internal medicine.

[20]  J. Hart,et al.  Be your own coroner: an audit of 500 consecutive deaths in a general practice. , 1987, British medical journal.

[21]  R H Brook,et al.  Preventable deaths: who, how often, and why? , 1988, Annals of internal medicine.

[22]  S. Mcphee,et al.  The ravelled sleeve of care. Managing the stresses of residency training. , 1989 .

[23]  W. Levinson,et al.  Coping With Fallibility , 1989 .

[24]  L. Forrow,et al.  Physicians' attitudes toward using deception to resolve difficult ethical problems. , 1989, JAMA.

[25]  M. Paget,et al.  The Unity of Mistakes: A Phenomenological Interpretation of Medical Work , 2004 .