From triple helix - winter 2013 - Making medical mistakes [p10-11]
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Emma Hayward writes about the feelings of guilt and remorse that can accompany making medical mistakes and the resources available to Christians for meeting them.
Why did you enter medicine? Probably at least part of the reason was to care for people. In general no health professional turns up to work aiming to harm the patients under their care. Nevertheless most of us have experienced the heart-stopping moment when we realise that we have made a mistake. Whether it's an error of judgment, a missed diagnosis, or failing to execute a procedure correctly, we can be filled with a host of feelings: guilt, remorse and dread as we think about the consequences, both for our patient and also for ourselves.
Despite expectations of us, doctors are fallible, fragile human beings. For the most part we are painfully aware of our limitations and those of modern medicine. These limitations are a result of living in a world spoiled by man's rebellion against God. This does not mean that every mistake is a moral failure, but that post-fall we live in an imperfect place. To quote a thoughtful BMJ article, 'Most errors in clinical reasoning are not due to incompetence or inadequate knowledge but to frailty of human thinking under conditions of complexity, uncertainty and pressure of time.' (1) This is a new way of stating the Latin proverb Errare humanum est (to err is human) and acknowledging that as part of fallen humanity, we all make mistakes. (2)
However, we cannot blame all of our errors on living in a blemished world where bad things happen. As well as being sinful by nature (3) we may also act or hold attitudes that are contrary to God's moral laws; (4) in other words, we sin. Sadly, in the same way that a speeding motorist who usually gets away with it can sometimes cause harm, we may by act or omission also harm our patients. Failing to reflect properly on our work, (5) providing inadequate support for juniors, (6) failing to speak out when an organisation is using unsafe practices: (7) all could be considered falling short of God's moral code and lend themselves to developing an environment in which mistakes and harm are more likely. So, if we make a mistake, however unintended, we might also need to examine the underlying factors leading to that mistake and repent of any failing on our part.
As Christian doctors we have assurance of forgiveness if we come to our loving heavenly Father and confess our error (8) but we live in a society which does not readily forgive. This, combined with high expectations of what medicine can achieve, can leave doctors feeling incredible pressure, especially when things go wrong.
Not all clinical errors physically harm the patient but even these situations can lead to considerable stress for those involved. The patient and their relatives, sometimes motivated by the desire to improve things for the future, may embark upon a complaint. If they have a reasonable cause for complaint it is hoped that by addressing their concerns and apologising the situation can be resolved because 'a gentle answer turns away wrath...' (9) Many people are critical of our rapidly developing 'compensation culture' but in some cases restitution, usually mediated by defence bodies, may be appropriate. (10) (11)
At other times we may find ourselves drawn into prolonged grievance procedures, perhaps thinking 'I was only doing my best. Why is this happening to me?' There are no easy answers to this kind of suffering, especially if the complaint is a disproportionate response to the original mistake. Experiencing suffering due to other people's actions is another result of living in a fallen world. In these circumstances we have instruction to forgive those who seek to do us harm, (12) to pray for them (13) and also to remember God's promises to strengthen and help us no matter what difficulty we are facing. (14)
Our pride may be hurt and there might also be a fear of losing a hard-won career in medicine. Many doctors' sense of identity is inextricably wrapped up in their professional life and the thought of not being a doctor any more is horrifying. I recently heard an idol defined as 'something you feel you couldn't live without' and had to repent of having made my profession an idol. If God chooses, by whatever means, to prevent me continuing as a doctor then that is something I need to submit to. If I am allowed to continue practising medicine then that is only by his grace, not because of anything I have done to earn the right. Ultimately, no matter the outcome of any mistake we make, there is reassurance that God is a God of justice and forgiveness and that he will never leave or forsake us. As God is gentle and forgiving, are we also able to be gentle and forgiving with ourselves?
Apart from ultimately being forgiven of all our mistakes there is more comfort for the Christian doctor when considering this issue. We know that in all things God is sovereign and that nothing can quench his love towards us, not even making a fatal error as we serve him as doctors. (15) We should beware the trap of believing that just because some of our mistakes can cause physical harm that they are somehow more heinous than others. Is a prescribing error causing physical symptoms really worse than a teacher undermining a student's confidence and damaging their self-esteem, just because the effect is more immediate and visible?
God cherishes each patient we see. God is a redeeming God and can bring good out of even dire circumstances. He will not cease to work in our patients' lives because they have suffered a medical mishap. It may even be in these circumstances that they are drawn closer to him. I can give a small illustration of this from personal experience. When pregnant with my first child I suspected she was breech. However, several midwives and doctors who examined me reassured me that she was heading in the right direction, head down. It was only a late scan (which was not medically indicated) which revealed that our unborn child was indeed in the extended breech position. A successful procedure to turn her meant that she was safely delivered four weeks later. It was only afterwards that I heard from a friend the other end of the country. She had been praying for our baby's safety during the week of the scan. We continue to thank God for his intervention.
It is thanks only to God's grace that we are able to heal or to relieve sickness at all. An example of God's common grace (blessings bestowed on people regardless of their standing with him) is also demonstrated in giving skill to people called to be doctors. This calling and grace does not make us infallible. We have been gifted with the ability to be doctors but as part of fallen humanity we have our limitations; hence the book of Proverbs instructs us to 'trust in the Lord with all your heart and lean not on your own understanding'. (16) We can remain thankful that, owing to God's common grace again, mistakes probably don't occur as often as they might otherwise and we can prayerfully seek his blessing and protection on our work. A doctor's prayer (conveniently available on CMF bookmarks) at the start of a busy day might be a helpful tool:
Heavenly Father, we thank you that through your Son, our Saviour, we receive new life and hope. Lead us by your Spirit in our work today. Enable us to fulfil our medical calling in love, wisdom and integrity. Give us knowledge and diligence in the prevention, diagnosis and treatment of disease. Help us to bring comfort to the anxious and sorrowing. Free us from selfish ambition. Grant us sincerity in all that we say and do. Strengthen us to persevere in the face of fatigue. Keep us always mindful of your redeeming purpose and maintain our confidence that death will finally be overcome through Jesus Christ our Lord. Amen.
I am indebted to Dr Marshall Brown and Rev Elaine Sutherland for sharing their insights and wisdom with me during the preparation of this article.
Emma Hayward is a GP and Clinical Educator based in Leicester.
1. Scott I. Errors in clinical reasoning: causes and remedial strategies. BMJ 2009;339:22
2. 1 John 1:8
3. Ephesians 2:3
4. Grudem W. Bible Doctrine. Grand Rapids, Michigan: Zondervan, 1999
5. Romans 12:3
6. 1 Thessalonians 5:14
7. Proverbs 31:8
8. 1 John 1:9
9. Proverbs 15:1
10. Luke 19:8
11. Leviticus 6:1-5
12. Colossians 3:13
13. Luke 6:28
14. Deuteronomy 31:6
15. Romans 8:31-39
16. Proverbs 3:5