12: When you DON'T do not harm

The first rule: do not harm. Okay but what about when you do? It sounds like the simple, obvious and easy minimum - to not harm our patients as we care for them. But we all have a library of experiences where our treatment decisions did do harm. And that's because medicine is not just hard from a sense of needing to build and accumulate knowledge and skills to care for patients. It's not just hard because we are working to integrate multiple data points and data sources from each individual patient and synthesise that into a congruent impression. It's not just hard because executing one treatment plan can exacerbate or create another issue or reveal another vulnerability in the patient. It's not just hard because of the limitations and demands of the healthcare system that mean that we cannot access ideal clinical care conditions or even conditions that we feed are the minimum standard. But it's also hard because we are constantly working with uncertainty. And the truth is, when you're working with such limitations, complexity and uncertainty, you don't get to simply do no harm. In a doctor's professional life, there will be many instances where we cause more harm than good in the noble pursuit of doing the best thing for our patients. That reality is extremely difficult for a lot of us to face. It's important that we find a clear balance between what is in our control and what is not in our control. Both situations are equally difficult. It can be extremely difficult to know that you have made a mistake, or that your skill level contributed to the harm done to a patient. Taking responsibility is a cornerstone of growth. For doctors, however, it's easy for us to not recognise the contextual influences of the 'mistake', for example … that we work as a team in healthcare, not as an individual … that we are in training … that our skills are never perfected even when we are experienced … that support, supervision and training provision should appropriately mitigate deficits and risk … that the healthcare system 'Swiss cheese' model should usually function to prevent any domino effects of a mistake. It's common for us to over-estimate what is in our control It's common for us to take over-responsibility … And make erroneous and hindering conclusions in retrospect about how we single-handedly could have prevented something or how we have really just proven we're not the 'right kind of person' to do medicine. This is over-responsibility. To be someone who is conscientious to provide great care for our patients and, with that, to do no harm wherever humanly possible, is an advantageous trait of a doctor. Let's not use that against ourselves. There's nothing useful or empowered about trying to control something that you can't. There's nothing that will make you feel more out of control than trying to control something that you can't. We hope you enjoy this vulnerable episode about making mistakes and the suffering that we can endure from that. Let us know if you, too, have checked your bloods with great anxiety!

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