How to cope with the aftermath of misdiagnosing a patient
Industry Buzz
You are going to make mistakes. People will die. Your job is to learn from that mistake and never make it a second time.
—@ExtremisEleven via Reddit
An intern, Reddit user @9861days, recently posted in r/medicine about a patient they can’t stop thinking about: A woman in her 70s who came to the emergency department with progressive shortness of breath, confusion, and urinary incontinence.
Her ECG and troponin were normal. Her CRP was “sky high.” The intern diagnosed pneumonia, admitted the patient for IV antibiotics, and moved on.
Days later, she crashed. The diagnosis was an aortic dissection. “The CRP was the source of my premature closure. I assumed that it couldn’t be anything other than an infection. I should have suspected a PE or something since she didn’t have a lot of symptoms of an infection. I should have ordered a CT and then she might have lived,” @9861days wrote.
More than a year later, the intern still thinks about it every day, is consumed with guilt, and wants to quit medicine because of the decision.
Most physicians have a case like this. Some are obvious and immediate. Others emerge slowly, through a later consult note, an autopsy, a readmission, or a family’s unanswered question.
Here are tips from HCPs on how to cope if this happens to you.
Related: I made a medical mistake I'll never forget1. Learn from your mistakes
“You are going to make mistakes. People will die. Your job is to learn from that mistake and never make it a second time. Some form of this is inevitable. Not everyone catches their mistake, some people just go home and die. But literally everyone has to do an M&M conference at some point [during] residency,” said emergency medicine physician and Reddit user @ExtremisEleven.
Emergency medicine physician and Reddit user @southbysoutheast94 agreed.
“You learned something about the risks of early diagnostic closure. You alone didn’t miss anything. The ED missed it, the people who took care of her after you missed it, and your supervisors missed it. As [unfortunate] as it [is] to say: your current patients are better off [having] you because you had this experience. The best thing you can do now is practice excellent medicine to honor the lessons your patients teach you,” they said.
“I once had an attending who told me, ‘You’re not a real doctor until you’ve killed a patient.’ What they were meaning is that once you’ve missed something or caused a patient harm, you’ll analyze your every move and try to stay up to date as much as possible after that out of fear that you’ll make a mistake again. You become a better doctor. Then again, all of medicine was improved based on recognizing mistakes and then trying to correct them, so your education is no different. Now that this has happened, you’ll likely never miss an aortic dissection again. So, don’t quit now—you’re just now becoming an amazing physician who will one day catch the aortic dissection everyone else missed,” said emergency medicine physician and Reddit user @loganonmission.
2. Take a break (if you can)
“You are burnt out and maybe depressed, like most of us are in this sometimes grueling yet beautiful to the point it’s toxic business called medicine,” said HCP and Reddit user @SimpleSpike. This is what you need to work on, when was your last break? Your last holiday? The last time you did [something] just for yourself or those around you you love?”
3. Seek therapy
“If you are consumed [with] guilt, you cannot help anyone [else] effectively. At this point, you’re past a healthy amount of guilt/grief/anxiety. You need to see a therapist. You owe that to your family, your partners and most importantly yourself. If you want to quit once you have a clear head about it, then you’re allowed to, but it would be a shame to quit over a mistake you made with less than a year of experience under your belt,” said @ExtremisEleven.
4. Know that some diagnoses are notoriously tricky
An aortic dissection is very easy to miss.
“Standard of care for an aortic dissection is to miss an aortic dissection. Unless this lady had a widened mediastinum or something to suggest a dissection, I think this is an impossible diagnosis to make based on her symptoms,” said HCP and Reddit user @moose_md.
HCP and Reddit user @HitboxOfASnail agreed.
“One of the hardest [diagnoses] to just pull out of thin air unless they are really bad. Most aortic dissection[s] are diagnosed because they were lucky and incorrectly looking for something else,” they said.
Related: Most commonly misdiagnosed medical conditions