The process of becoming a physician requires a compulsive need for near-perfect academic achievement. Once in medical school, many doctors are obsessed with the idea that they must memorize every possible medical fact, as though the life of their future patients depends on it.
Then, when they begin practicing medicine, this can translate into the worry that anything less than perfection can result in harm or even the death of their patients. This dread of professional failure is often considered the No. 1 fear of doctors, and it is often rooted in perfectionism. MDLinx interviewed experts to determine how this fear impacts the lives of doctors, and what they can do to manage these pressures. Here are their insights.
Setting realistic expectations
“Fear of failure plays a role in physician burnout, depression, and can actually interfere with one’s performance as a physician,” said clinical psychologist Tamar Chansky, PhD, and author of Freeing Yourself from Anxiety: The 4-Step Plan to Overcome Worry and Create the Life You Want. “When we’re focused on not doing things wrong, we can miss the bigger picture of what’s going on with a patient. It’s siphoning off some of our attention, rather than having our full focus on assessing the problem at hand and thinking about the best solution.”
Physicians who can adopt more realistic expectations of their abilities will be more open to solutions, more empathetic, and able to glean helpful information with their patients, Chansky added. They will be better able to collaborate with others for the best outcome for patients, too.
How can physicians let go of their fear of failure? “It starts with accepting that you’re human,” said psychiatrist Philip R. Muskin, MD, professor of psychiatry at Columbia University’s Irving Medical Center. “Patients want us to be omnipotent and omnipresent because that reassures them, and they want us to be available 24-7."
However, that’s a trap that leads to misery. “The next thing you know you’re in the hospital on Christmas eve, and on Thanksgiving day and never taking a vacation,” Muskin added. “For many doctors, there’s no work-life balance.”
Accept that mistakes happen
There are two types of doctors: Those who make mistakes, and those who don’t admit it when they do, according to Brian Goldman, MD, an emergency room physician in Toronto and radio host who gave a TED Talk titled Doctors make mistakes. Can we talk about that?
“What I’ve learned is that errors are absolutely ubiquitous,” Goldman said during the presentation that has been viewed more than 1.6 million times. Many factors play a role in physician error: the pervasiveness of sleep deprivation; the increasing pace of change in the practice of medicine; patients’ varying ways of describing their symptoms; and even physicians’ own cognitive biases.
Seek support from peers
Goldman said that when physicians make a mistake, they want and need to tell their story and share what happened with their peers. However, the culture of medicine has shunned that concept, and physicians get uncomfortable talking about errors. He called for “a redefined medical culture” where it is acknowledged that humans run the system, and thus mistakes do happen from time to time. He said discussion of medical mistakes should not only be allowed but should be encouraged and rewarded.
Chansky said everyone, physicians and patients alike, would benefit from such a culture shift in medicine that would allow for open discussion of medical errors. “It’s very likely that what’s happened to you has happened to someone else, and if you can talk about it, you can innovate and come up with a solution.”
Embrace a ‘growth mindset’
A growth mindset—the belief that one’s most basic abilities can be developed through hard work—helps physicians get through the extensive learning process required to care for very ill patients and save lives. “The growth mindset doesn’t have to end when our training program ends; we can keep it as a way of life,” Goldman said. “When we see ourselves as learners, we give ourselves more permission to not have to be perfect and to not have to do everything right. In this approach, life becomes more of a grand experiment rather than a final exam.”
When Goldman makes a mistake, his goal is to learn something from it that he can teach other physicians, to help bring about systemic change so that the mistake can be avoided in the future.
Practice positive self-talk and self-care
When feelings about failure crop up, Chansky advises physicians to avoid the mistake of “over-interpreting” the significance of one occurrence. She coaches clients to visualize a red pen that is editing their thoughts for accuracy. “Instead of thinking, ‘I’m a total failure,’ they can correct themselves to think, “In this one case, it didn’t turn out how I had hoped. I’m having failure feelings because I’m upset.”
Muskin advises physicians to give themselves a break, figuratively and literally—without guilt. “Sometimes you should say no. There are other good people who can do this work.” He advises taking time for social connections with spouses, friends, and colleagues; cultivating hobbies and pleasurable activities; and taking a few minutes to get away from work regularly for a short walk, some deep breathing, or meditating. He said he recently taught himself origami and took a break from his hospital work for just a few minutes to make paper frogs, mindfully focusing on all the folds. On a recent weekend, he worked on perfecting a homemade chocolate ice cream recipe and watched old movies.
“We’re often lax about taking care of ourselves because we have this duty. But doing a little bit of that without guilt really can sustain us throughout our career,” said Muskin, who has practiced inpatient psychiatry for nearly 50 years.
Fear not the malpractice suit
Fear of failure is also tied to fear of being fired, concern over malpractice lawsuits, and the loss of income and reputational damage that goes along with these outcomes. According to a personal account published in the Journal of the American College of Radiology, the menace of medical malpractice litigation has faded in recent years because the medical and legal professions have grasped that medical error is not the same as negligence. True negligence, otherwise known as malpractice, is defined as “failure to meet the standard of practice of average and qualified physicians,” wrote Leonard Berlin, MD, a radiologist at Chicago’s NorthShore University Health System.
Berlin wrote about his experience viewing the radiograph of a patient who injured her hand while playing tennis. He noted at the time that she had a dislocation of the proximal interphalangeal joint of her right fifth finger. When she returned for routine follow-up x-rays a few weeks later, Berlin also noted the presence of a small chip fracture on her fifth finger. Two years later, the woman sued Berlin for failing to note the bone chip on the first report. Berlin wound up counter-suing, alleging the lawsuit against him was frivolous because the bone chip was not visible on the first x-ray. Not only was the malpractice suit against Berlin dropped, but he proceeded with his case and won.
Because the cost of litigation is so high, the likelihood that a patient’s medical injury will lead to a lawsuit is less than 2%, Berlin added. When a medical malpractice lawsuit is filed, 60% are withdrawn or dismissed, 35% are settled out of court, and only 5% that go to trial end with a jury verdict in favor of the plaintiff.
For more information, see The biggest stressor of being a physician, unraveled on MDLinx.