“I made a mistake!”: a narrative analysis of experienced physicians’ stories of preventable error

Abstract

Rationale, aims, and objectives: The complexity of healthcare systems makes errors unavoidable. To strengthen the dialogue around how physicians experience and share medical errors, the objective of this study was to understand how experienced generalist physicians make meaning of and grow from their medical errors. Methods: This study used a narrative inquiry approach to conduct and analyze in-depth interviews from 26 physicians from the generalist specialties of emergency, internal, and family medicine. We gathered stories via individual interview, analyzed them for key components, and rewrote a 'metastory' in a chronological sequence. We conceptualized the findings into a metaphor to draw similarities, learn from, and apply new principles from other fields of practice. Results: Through analysis we interpreted the story of an elite athlete (physician) who is required to make numerous decisions in a short period of time within the construct of a chaotic sports field (clinical environment) among spectators (the patient's family) whilst abiding by existing rules and regulations. Through sharing stories of success and failure, the team coach (clinical mentor) helps optimize the players' professional and psychological development. Similarly, through sharing and learning from stories, team members (colleagues) and junior team members (trainees) also contribute to the growth of the protagonist's character and the development of the overall team (clinic/hospital) and sport (healthcare system). Conclusion: We draw parallels between the clinical setting and a generalist physician's experiences of a medical error with the environment and practices within professional sports. Using this comparison, we discuss the potential for meaningful coaching in medical education.

Values, culture, narrative and medical education: The case for a renewed focus

“…10 The analysis of narrative, therefore, holds great promise for understanding culture and values, because the stories people tell about themselves, and tell to their trainees reveal how they make sense of who they are, how they have changed, and who they seek, endeavour or aspire to be. 4,9 | 889…”

“…4,9 Understanding culture, therefore, requires an awareness of the incessantly evolving and inherently social nature of thought as people constantly construct, co-construct or reconstruct a shared understanding or social representation that characterises who they think they are, and how they view the world. 4,9 This perspective explains why, when people encounter the unexpected, they often embrace the 'first story' that provides comfort and control 10 regardless of its veracity. This 'first story' converts the intangible and unfamiliar into something that is 'known' by an individual and seemingly true, but in fact, can be a cataclysmic error of judgement.…”

“…10 Better understanding, therefore, how narratives are constructed and used to make sense of life through intertwined, dynamic, social and cognitive processes that create culture is to better understand education. 4,9 When people encounter the unexpected, they often embrace the 'first story' that provides comfort and control…”

“…1 Recent literature, including Bearman et al's contribution in this issue, underscores the imperative by exploring the relationship between culture, values, narrative and medical education. [2][3][4][5] Culture is a contested concept, but it influences pedagogy, teaching and learning, 2,3,5 so there is a compelling case for further research and theory development to bring about a better understanding of culture with its concomitant values and narratives both in medical education and healthcare writ large. Justice, prudence and fortitude or courage are thought to be chief among the values that enable people to flourish, experience joy and find fulfilment.…”

“…There are gaps in medical education that have been subject to little or no critical scrutiny 1 . Recent literature, including Bearman et al’s contribution in this issue, underscores the imperative by exploring the relationship between culture, values, narrative and medical education 2‐5 . Culture is a contested concept, but it influences pedagogy, teaching and learning, 2,3,5 so there is a compelling case for further research and theory development to bring about a better understanding of culture with its concomitant values and narratives both in medical education and healthcare writ large.…”