By Dr James Davidson
Founder of MedCourse
Black Wednesday is upon us once again – a day where most trainees change their rotation and thousands of freshly qualified doctors hit the wards with a new sense of responsibility.
As a new FY1, this can be a terrifying experience. No matter what your peers tell you, the confidence they appear to have, or the bluster on display – every single foundation doctor is anxious about this new stage of their working life.
I still remember the butterflies and nausea I felt walking through the double doors to the ward that day. The anxiety I had prescribing my first dose of paracetamol. The double and triple checking of every entry in the notes. The impostor syndrome, creeping in every time I was asked to make a decision.
One question loomed large - will I make a mistake?
I desperately wanted to be perfect. To hit the ground running, make a difference in every single patient’s life, and never make an error of any sort. I wanted my patients and colleagues to like and respect me, and thought the best way to achieve this was to be flawless.
The truth is that, as a new FY1 doctor, you will make mistakes.
Sometimes,
You will be slow,
You will miss things,
You will upset patients,
You will annoy colleagues,
You will make a prescribing error,
You will add to someone else’s workload,
You will make your senior’s job more difficult,
And that’s okay.
You are not alone.
As humans, it’s in our nature to make mistakes. As doctors, we often beat ourselves up over mistakes big and small, but it doesn’t need to be this way.
In 2014 Dr Sinead Millwood surveyed 17 of her FY1 colleagues at Yeovil District Hospital. Every single person surveyed reported that they had made a mistake in the first 5 months of FY1.
Every single doctor – 100%.
Of 736 errors (an average of 43 per person), 3 were reported as having significant harm.
It’s easy to think that significant errors are something that happens to someone else. Someone with less knowledge. Someone who was careless. Someone for whom it was inevitable.
But that’s just not the case.
Errors big and small happen to all junior doctors, for so many reasons – stress, mental fatigue, lack of sleep, a shortage of resources or support.
Every single healthcare professional will make all manner of mistakes throughout their career – it is inevitable. Instead of ruminating and getting stuck in a spiral of shame and guilt, the most important thing you can do is learn from your mistakes.
Mistakes are how you gain experience.
Experienced colleagues aren’t known as such because of their theoretical knowledge – it’s because they have learned from all the errors that they have seen and made throughout their career.
Think about it – the first time you took blood, did you do it perfectly?
Perhaps a small number did – but what about the first 10 times? Perfect every time?
You’re given the knowledge of what to do while you’re a medical student, but it takes experience to master these skills. The only reason I was better at cannulation than a new FY1 was that I had made enough mistakes that I knew what not to do.
If this isn’t enough to convince you that making mistakes is okay, let’s get a bit more personal.
Making Mistakes as a Junior Doctor
My First Mistake
For the 5 years I worked as a junior doctor, I probably made well over 1000 mistakes. Some were trivial, some not so much.
Even before I had qualified as a doctor, I faced my first near miss. During an emergency transfusion of a resus patient suffering from a catastrophic gastrointestinal bleed, I was asked to write the patient's details on the transfusion blood bottles and activate the major haemorrhage protocol.
Feeling meek and insignificant as a fourth-year medical student, my questions about the patient’s details were drowned out by a cacophony of senior doctors attempting to save this patient's life. I saw an alternative – copy details from the patient's notes.
I dutifully copied every detail onto the blood bottles and forms.
I like to think at this point that I would have double-checked this with the patient before sending these to the lab. Knowing the degree of insecurity and fear I felt at this moment, however, I can’t be sure.
Fortunately, I was given the opportunity to catch my mistake before I made a major error. Across the din of the shop floor, I heard my consultant attempting to rouse the patient.
“Steven, can you hear me?”
Wait ... Did my consultant just call the patient Steven?
But the patient’s name is Mark… isn’t it?
Unbeknownst to me, one of the members of the crash team had laid down a set of notes – Steven’s notes – among the clutter now forming around the patient’s bedside. This was the set of notes I had used to copy details from.
I was mortified.
I was so close to sending off an incorrectly labelled transfusion sample, which would have delayed life-saving treatment for this patient.
The shame, guilt, and embarrassment I felt in the subsequent weeks didn’t help me or the patient at all, nor did the telling-off I received from my consultant after he saw the incident report.
The lessons I learned, however, were invaluable.
From this point forward, I followed transfusion guidance to the letter.
If ever my voice wasn’t heard, I talked louder.
Each and every time I sent off a transfusion bottle, I double and triple-checked the patient’s details before sending them off to the lab. Patient safety became my utmost concern.
Looking back, I wish I had shown myself more compassion. I was guaranteed to make mistakes throughout my career, and I handled this particular mistake well – I owned up to my senior and learned the lessons that I needed to learn.
Mistakes I made as a Foundation Doctor
Here is a collection of the mistakes I can remember making as a foundation doctor:
- I sent two blue-topped (aerobic) blood culture bottles off for a patient with sepsis, meaning I had to re-bleed the patient after they had received antibiotics to get the anaerobic culture.
- I didn’t ask for help on my first FY1 on-call ward cover shift and had to hand over 16 jobs to the (rightfully) pissed-off night team.
- I told the wrong patient’s relative that they might have cancer, backtracking quickly when I realised that I was speaking to the daughter of a patient who was already on their way back home.
- I cancelled a CT scan while the patient was halfway through the scanner, and had to briskly find my registrar to advise the radiographer on whether to abandon the scan or not – with the patient still halfway through the doughnut.
- I ordered an “urgent” ultrasound doppler on Friday at 5 pm for a patient with possible DVT, without calling the radiologist. Hint – the scan wasn’t urgent, and the radiologist wasn’t happy.
- I prescribed a 1-gram dose of IV paracetamol for a cachexic patient under 50kg without realising. Thankfully, their cannula was causing enough issues that I was able to fix my mistake before the patient came to any harm.
I had fantastic mentors as an FY1 doctor, who helped me to deal with these mistakes by doing the three things that you should always practice every time you make a mistake:
I owned up – reporting the mistake to a senior and dealing with immediate patient safety concerns.
I reflected on my mistake – learning what went wrong and how I could do it differently in the future.
I moved on – practising self-care and compassion.
Ultimately, most of the mistakes I made as an FY1 doctor were trivial and were often made in order to save face. I said yes when I meant no. I didn’t set boundaries and allowed interruptions. I didn’t ask for help.
Foundation years can be stressful enough without placing an additional burden on yourself for mistakes that you will definitely make.
When you’re slow – ask a colleague for advice.
When you forget things – start writing them down.
When you upset patients – listen to their concerns.
When you annoy your colleagues – apologise and move on.
When you make a prescribing error – ask your senior how to fix it.
When you add to someone’s workload – reflect on if you can change this.
You will make mistakes. Small Mistakes. Big Mistakes.
But we are human, and that’s okay.
Any patient details in this article have been changed to preserve confidentiality. All incidents were reported.
If you're struggling with your mental well-being, there is plenty of help out there - here are some free resources for doctors.
