Brian Goldman, an emergency physician in a hospital in Toronto, says learning from mistakes is an essential part of education. “If I can’t come clean and talk about my mistakes, if I can’t find the still small voice that tells me what really happened, how can I share it with my colleagues? How can I teach them about what I did, so that they don’t do the same thing?” asks Goldman.
There lies the key to Goldman’s talk on NPR radio hour: to talk of your mistakes gives a chance to avoid similar mistakes in the future. In pursuance of this thought, Goldman hosts a CBC radio show titled “White Coat, Black Art”, where he asks doctors about their worst mistakes.
Goldman’s interview comes in the wake of his talk on TED where he spoke on the subject with examples from his own life. “I was an obsessive compulsive student…I memorised everything…I was amassing more and more knowledge and I did well. I graduated with honours, cum laude. I wanted to be the smartest physician I could be so that I wouldn’t be like those other physicians who were less competent, who didn’t learn as much as I did, and — it’s interesting…when I talk to medical students today, many of them, you know, have that look in their eyes that, you know, they’re pristine, they’ve never made a mistake, and they never will, and, you know, and of course, until it happens.”
Until it happens…is a crucial phrase when it comes to making mistakes. The talk airs snippets from Goldman’s radio show where two doctors admit to having overlooked or missed a certain symptom and so the core of the problem. Goldman himself says he was also “feeling pristine” and invincible till he met Mrs. Drucker. “Well, that’s not her name, of course…”
When Goldman was a resident at a teaching hospital in Toronto, Mrs. Drucker was brought to the emergency department of the hospital. “I saw Mrs. Drucker, and she was breathless and when I listened to her she was making a wheezy sound. And when I listened to her chest with a stethoscope, I could hear crackly sounds on both sides that told me that she was in congestive heart failure. And I set to work treating her. I gave her aspirin, I gave her medications to relieve the strain on her heart, I gave her medications that we call diuretics, water pills, to get her to pee out the excess fluid, and over the course of the next hour and a half or two, she started to feel better, and I felt really good. And that’s when I made my first mistake. I sent her home...” says Goldman. “I disregarded a little voice, deep down inside, that was trying to tell me, Goldman, not a good idea, don’t do this. In fact, so lacking in confidence was I that I actually asked the nurse who was looking after Mrs. Drucker, do you think it’s okay if she goes home? And the nurse thought about it and said, very matter-of-factly, yeah…I signed the discharge papers…All the rest of that day, that afternoon I had this kind of gnawing feeling inside my stomach…and at the end of the day, I packed up to leave the hospital, when I did something that I don’t usually do. I walked through the emergency department on my way home.”
To his shock and dismay, Goldman saw Mrs Drucker back and in a near-death state. “About an hour after I’d sent her home, she collapsed. She had a blood pressure of 50 which is in severe shock. And she was barely breathing and she was blue. She had irreversible brain damage.”
Goldman says, “Most of the greatest successes in medicine come from failure. And I can tell you, I’ve saved a lot of people off the backs of the people who paid for my mistakes.”
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