The Goal

My mind was reeling with ideas and questions after the first day of the conference. Where to start? There’s so much we can do. It was both exciting and paralyzing. Today, I was especially interested to hear Mr. Nance’s discussion of his book. I had this sinking feeling I might hear, again, that we’re not doing enough. We’re not safe enough, smart enough or reliable enough. We need to change everything, and fast. Starting with x,y,z (work less, decrease distractions, don’t come in tired). If aviation could do it, what’s wrong with our field?

I had settled in for the boom, but instead was given encouragement, strength, and validation. Medicine IS difficult; there are complexities unique to our field.  I’m (usually) very happy to be a doctor. The acknowledgment of its challenges felt like grace. It was a comfort to find that familiar passion for our profession start to creep back in.

Who knows if this is what he meant to say (12.5% right?), but this is what I heard:

Simplify it. Patient-centric care: Our goal is only: Do the best for our patient and have fun working in this high-calling (when you can). This is doable! We’re distracted by notes, unmet curriculum requirements, and research projects. But the kid in the bed is first priority. Always.

I need to get comfortable expecting to make mistakes. I have no trouble saying it. My head knows the statistics don’t lie. I make errors daily. But in my heart the truth is: I’m hoping and praying and studying; trying to stave off an error that kills or devastates someone’s child and replaces my joy for pediatrics with crippling fear.

What complicates accepting mistakes as the norm is the fact that I adore the kids I take care of (again…usually:). Honestly, that hasn’t always been true. I used to remove myself a little. Smile at the kids. Talk to the parents mostly. Over time I found myself  talking to patients as equals, mostly about Paw Patrol or their breakfast cereal of choice (which often mirrored mine) and I kind of fell in love with these little humans.  They’re quite smart. After I’ve listened to their abdomen and guessed what they had for breakfast, I ask quietly, like it’s just our secret, if they have any questions. Their honesty kills me: what’s wrong with my eye? is it going to get better? can you bring me McDonalds before heart surgery?

What does it look like to expect to make mistakes that hurt them?

I’m currently applying for Pediatric EM fellowship; I love to wake up and go to work in that environment, but the error chips seem stacked higher in that specialty.  Correctly make a diagnosis after one 10-15 minute interview? Code a patient then go back and finish the work-up on the other 4 patients? Compared to a scenario on inpatient where we spend most of our residency: Watch a kid for a day or more, then give the reassuring conversation that this is just a virus, not sepsis or Kawasaki Disease. Am I more likely to make an error with less time to think about and talk to the patient in the ED? Probably. But fearing errors seems like a terrible reason not to do what you love.

Today, that fear was tempered by hearing again that to err is human. When errors happen, it will not mean I chose the wrong field. It will not mean I’m a bad doctor. It will not sit well with me but I will learn and get back up to take care of other children. Decisions don’t have to be made on an island. The pervasive, hero archetype physician who does it all, perfectly, is doomed to fail. Knowing we, like every other human being, are prone to error makes finding practical solutions to decrease human error the next logical step. It also encourages dependence on other team members’ expertise. Today, I realized for the first time, that the collegial team model Children’s Mercy trained me up in has not made me weaker, as I once thought. It has kept my kids safer. And at the end of the day, that really is the only goal.

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