Saturday, January 7, 2012

Middle of the Night Chart Review

Whenever anything on my ward goes wrong, particularly when someone dies unexpectedly, I go through the case over and over again in my mind, searching for the thing that I could've done differently to change the outcome.  Clearly there's value in this from a learning perspective, but there's a fine line between self improvement and torturing oneself with unnecessary guilt.  Look hard enough at any chart, and you'll always find something that could've been done better.

Which is why I'm awake in the wee hours of the morning, despite being exhausted to almost my breaking point, reflecting and self berating and wondering whether I'm competent to do the work that I set out to do.  I try not to do this to myself, try to be forgiving of my own imperfections, but my brain is filled with well-established neural pathways of self doubt and blame that will fire in response to the slightest of stimuli.  So instead of sleep, I come here and try to purge myself of the false belief that if I were only better, smarter, more capable that I could somehow prevent anything bad from happening to one of my patients.  That somehow it's only my weaknesses that prevent me from reassembling the broken people who are entrusted to my care.


Miellyn said...

You are a good doctor, because you don't assume you are. Don't ask yourself to be superhuman though. First of all, it won't work, second, guilt and self recrimination take energy away that doesn't accomplish anything.

Find the balance between guilt and grief and honor people when they pass, but don't burden yourself.

Miellyn from holland

A Doc 2 Be said...

I asked my ex boyfriend, the doctor who butt kicked me to start this path, how he dealt with the death of his patients, what could I do to make things easier for him.

He only replied that he needed to vent, and that after 30 years practicing, a patient death never got easier. He only learned to cope a little more effectively.

It seems the right of passage for doctors - learning to cope with the death one cannot prevent (life is life; sometimes a person can do everything and life just ends; I say that's God's plan; for a non-believe, maybe that just entropy taking over).

You are going to be an awesome doc.

Simply, because you care.

Simply, because you want to be better.

Keep up the great work! And great writing. It helps those of us who read here to know what we have in store, if we make it to med school and residency.

A Doc 2 Be said...

S/be "rite" of passage - I am a dolt.

Rick said...

Hope things get better for you.

Old MD Girl said...

You mean it doesn't get any better as you progress through your training? I found myself lying awake at night during my medicine sub-i obsessing over the tiniest details with my patients. I was hoping as I got better, this problem would go away.


The Daze of Whine and Roses said...

Hingsight is always 20/20. All you can do is take any new insight and apply it to the next patient but know that most times, given the same information, you would have come to the same conclusions and actions.
I wish you peace my friend.

Anonymous said...

"the false belief that if I were only better, smarter, more capable that I could somehow prevent anything bad from happening to one of my patients"

Of course this is easy to say was an outsider (I have beaten myself up for patient outcomes completely out of my control too)... but I want to reinforce your sentence: it *is* a *false belief* that you can control what happens to your patients. Sure, the whole purpose of our career is to positively influence patient outcomes, but the outcomes are not wholly in our control. In a way, it's a sort of reverse/negative narcissism for us to think that have that kind of power and control, right? (I say that with the most helpful of intentions - when one of my mentors introduced the concept of reverse narcissism to me, it helped me stop being so hard on myself).

All the best,
A Canadian GP

"Dr." G said...

You and me both - I'm sure I'll be the same exact way once I start residency. To me, it means that we still see ourselves as humans, rather than doctor-Gods, and that we also deeply care for our patients. But, I agree, there is only so much that we can do, and we are not perfect, nor can be everywhere at the same time. The fact that you gave it your best is what truly matters.

medstudentitis said...

I endorse all that has been said here. Unfortunately, the regret is part of being a good doctor and caring about your patients. Can't say the big stuff has gotten any easier for me, but I don't sweat the small stuff as much as I used to. If we didn't learn from our experiences we would be good doctors, but sometimes that's all we can do and move on.

missmccracken said...

I think that's the best you can do, review it, see if there's anything you would do differently. Sometimes you do everything right and it still ends up wrong. I think it's good that you care. As long as you don't get eaten up inside from it, that caring is what makes you stand out :)

Cartoon Characters said...

Because you are in the "healing profession" you expect positive outcomes.

Sometimes all we can hope for is an outcome that isn't as painful or prolonged.

It's not so much your perceived "imperfections" but the patient's "imperfections" that is the cause of their demise.

You sound like a very good MD and I wish you would move to my hometown because I am having trouble finding an MD (shortage here in my neck of the woods)..... and you sound like one I would love to go to....

Solitary Diner said...

Miellyn - Thanks for the good advice. I'm guilty of expecting myself to be superhuman all the time, but it's something I'm workng on.

AD2B - Glad you're enjoying the preview of what (hopefully) awaits you in the near future. I read a ton of medical blogs before starting medical school, and I really enjoyed the preview too.

Rick - Thanks. They do get better.

OMDG - It definitely gets easier, but it never goes away entirely.

Daze - True, it's always very easy to manage patients in retrospect.

Canadian GP - The idea of "negative narcissism" is an interesting one. I think we need to be a bit narcissistic in medicine to do the work that we do, but I agree that carrying it too far can be detrimental.

"Dr." G - I wish some days that I could feel less human and more like a doctor-God, but I agree that it's one of the things that allows us to connect with and care for our patients.

Medstudentitis - Some days I wish I was content to be a bad doctor, as it would be way easier!

Missmccracken - It's always challenging to arrive at that balance between caring enough and caring so much that it's harmful to yourself. I'm trying to find that point.

Cartoon Characters - It's true that the patients often have more to do with their outcome than I do, but I always hate to be in a situation in which I feel like I didn't do the best thing possible.