Medical students are enthusiastic about doing it right for ourselves and for our patients, even from the first time. When the nice patient offers us their arm so we can practice cannulation, it’s only natural that we don’t want to cause any pain or bleeding. When the upset patient shares with us their very personal concerns about their prognosis, it’s only human to want to comfort them. High expectations for ourselves make every day a learning opportunity, a fun challenge, a reason to jump out of bed in the morning…until we have that horrible experience of ‘failing’.
One of my most vivid ward-round memories involved a patient (some details changed for confidentiality) who was having chemotherapy for an aggressive cancer. The doctors suggested it was a good opportunity for me as their medical student to practice my lower limb neurological examination. Since one of the side-effects was neuropathy, he was expected to have signs to be elicited. I introduced myself and asked if I could examine his legs. He agreed and reported that he had no pain. The legs looked wasted. There was no muscle tone. He couldn’t move at all. I couldn’t elicit any reflexes. By the time I got to sensation and realised that that he was completely numb from the thigh down, I couldn’t keep my tears in. “You think it’s bad, I can see you crying. You don’t know if I’ll recover”. I had just upset the patient, who I was supposed to be looking after. What do I say now? ‘Good’ doctors don’t let their patient down. Am I going to be that useless as a doctor? I string together something about needing to document my findings in his file and escape his room as fast as I can without actually running.
The always wonderful unit registrar stops me at the doctor’s workstation. She reminds me that it’s normal for empathetic people to feel for their patients and what a rewarding experience it is to be involved (as a doctor) in providing care and comfort to people when they need it most. My PBL group ask me if I’m okay when they see me. I share my story and that I’m feeling a bit better already. It’s clear that everyone has recently had a similar experience, I’m not alone. When I get home and tell my parents that I had a discouraging day, they reaffirm that regardless of what mistakes I might make, they always support me.
It could have been easy to avoid the possibility of situations like this ever arising by avoiding patients and ward rounds. There’s always the fear of causing pain while I’m focussing on eliciting the rare examination sign. The helplessness of not knowing the right treatment. The awkwardness of being in the way of the doctors’ lifesaving work and wanting to avoid being a nuisance to those who you respect. I could have made an unrealistic goal as an excuse: “I’m not ‘fit’ to see a patient until I’ve memorised all of Harrison’s…and the Therapeutic Guidelines”. It’s easier to sit in the library and know that I’ve turned 20 pages (even if I don’t retain a page after a week) than face the unknowns of the real world of the future doctor.
Instead, the next morning I turn up to ward round sat the usual time. I follow the team to every patient, including the one I described before. When asked if I’d like to practice my abdominal examination (on another patient), I say yes.
The reason is simple. It’s fine that I don’t have the ‘right’ answer. I know I’ll have a better answer the next time. I just ask myself, ‘how should I do it next time’?
I might misdiagnose the patient the first time, but better I do it now, when there are still doctors who will point out the signs I missed. I might mentally formulate a treatment plan that won’t work, and the patient will still get best practice care. I might be lost for words but I’ll watch as the consultant reassures the patient.
Once, I was asked the question – what would you do if you knew you would never fail? I’ve come to realise, that if I couldn’t fail, I would lose the excitement of the unknown. The motivation to take a risk and see what happens. What’s the point in conducting an experiment when I know the result beforehand? Where’s the fun of a game where I don’t influence the result by chance or my moves? If I knew I wouldn’t fail to live forever, why should I make the most of each day as if it were my last? Failure isn’t negative, it’s a sign of you living life and fulfilling your wellbeing.
Embrace the possibility of failure, because the more mistakes you make, the more chances you’ve given yourself to learn and the more you will learn and make yourself a better doctor. Remember that no matter what you do, there are people who have done it before, know what it’s like and want you to succeed.