Problem solved: How do you handle bad outcomes early in your career?

AcceptanceIt is a good insight to recognize that difficult cases are having such an impact on you. Medicine tends to attract people with strong perfectionistic traits, which can be an asset in providing care, but also contributes to a risk for burnout. One of the challenges faced as a physician is being able to evaluate and learn from difficult outcomes, while not being consumed by them. It may be helpful to recognize that in some situations, despite optimal care, negative outcomes occur. Remind yourself you did the best you could, and that good care sometimes means supporting a patient through a life-limiting illness, rather than providing a cure. Discussing difficult outcomes with a trusted colleague may help. Often, with more experience, it can be easier to learn from and process difficult cases. If you find that stressful work experiences are affecting your mental health, consider reaching out to physician health resources.—DR. KERRY GALENZOSKIBooks that helpI have found the following books to be helpful in trying to answer the question: Just how do we arrive at peace with a tragic situation? British neurosurgeon Dr. Henry Marsh’s book, Admissions: Life as a brain surgeon is filled with honesty about the reality of high-stakes surgery. The audiobook is narrated by the author, and the stories carry his voice as a mentor to all. Dr. Atul Gawande has written many essays for the New Yorker on the topic of medical mishaps. His popular book, Complications: A surgeon’s note on an imperfect science is a compelling read. Rabbi Harold Kushner has written many books on faith and suffering. While not entirely medically related, his book, When bad things happen to good people has helped many people who are in doubt find the strength to believe and carry onwards.—DR. SAMUEL WONGGet a mentorWe often think we need to take on responsibility for everything that happens to our patients. We take on the role of healer, but that often leads us down the rabbit hole of “How did I miss this?” “Why didn’t I react sooner?” I once heard the phrase, “Right call, wrong outcome.” This phrase really hit home. When we look through our charts, discuss the outcome, we see we did the right things, but nature or some other power beyond our control resulted in the patient not responding how we had hoped. The best way to deal with this is having a mentor, usually an MD with more experience, with whom you can develop a trusting relationship. We all need someone who has “been there, done that,” so that we can accept our limitations and that, “I didn’t make a mistake, human beings are just unpredictable.”—DR. CARMEN EADIEReview but don’t dwellPhysicians tend to be perfectionists and easily succumb to self-blaming when faced with difficult cases or bad outcomes. These cases used to haunt me most at night. Yet my night-time reviews often provided a clearer path that I could pursue the next day, encouraging additional steps to clear my mind. Beyond self-review, a review with a close colleague often helped. It usually wasn’t that I had done anything wrong but needed reassurance that I couldn’t have done better. Or if so, then a new or brighter light on a course correction that could bring me relief. Then get on with life in practice because too much thinking about one case when I had hundreds more that didn’t require so much scrutiny, could be demoralizing.—DR. JOHN MAXTED

Problem solved: How do you handle bad outcomes early in your career?

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