What medicine can learn from the Titanic

April 15th marked the 100th anniversary of the sinking of the Titanic, yet the mystique surrounding its demise has not faded. When the colossal vessel first collided with the iceberg, eyewitness accounts described an eerie sense of serenity that pervaded the ship. Passenger J.J. Astor even remarked, “We are safer here than in that little boat,” before later drowning.

To prefer drowning over safety strike us as irrational, but this behavior makes sense when we look at the passengers’ point-of-view. To them, the Titanic seemed invincible even after its immediate impact with the iceberg.

Throughout our medical training we build our foundation of knowledge, our clinical reasoning skills, and our role in healing others. Many times, it also entails building our own myth regarding our abilities; it may take a Titanic moment in the form of the inevitable medical error to realize this vulnerability.

In his book Night Shift, medical journalist and emergency room doctor Brian Goldman describes such a moment. A patient presented with what looked to be a kidney stone in one of his emergency shifts. When the kidney x-ray came back normal, his colleague performed a reassessment and noticed tenderness in the right lower quadrant. Another patient presented with diarrhea, and though Goldman ordered fluids, he asked his colleague to reassess. Again, his colleague noted tenderness in the right lower quadrant. Both were diagnosed with appendicitis and referred to the surgeons while Goldman languished. Two misdiagnoses in one night shattered his myth of infallibility.

The support of fellow colleagues can alleviate this sense of self-injury, but ruminating over our failure leaves us helpless to help those facing a similar situation. Daniel Mendelsson writes in the New Yorker that when the Titanic sunk, two ships were in its immediate vicinity; the Carpathia picked up the first distress calls and rushed to the rescue though 58-miles away while the Californian, who avoided the icebergs, sat just 10-miles away ignoring the Titanic’s calls for help. In fact, “No one has ever sufficiently explained why the Californian’s captain, officers, and crew failed to respond to what seemed like obvious signs of distress,” Mendelsson notes, “The second officer merely thought it strange that a ship would be firing rockets at night.”

Unlike the Titanic’s tale, we can avert disaster through one of medicine’s ideals – humility – in accepting the counsel of another. One of my professors once took her residents out for lunch, and in this casual atmosphere, one of the residents ordered a beer. None of the other residents said anything, but my professor told the resident to take the rest of the day off instead of returning to the hospital without giving a reason. The next day, she sat him down and asked about his drinking habits. He indicated he always enjoyed a beer with his meals, and she gently reminded him of how patients might feel of a physician with the smell of alcohol on his breath. Though she realized he was not an alcoholic, she intervened out of recognizing the importance of professionalism, and he too became aware of this principle.

As esteemed members of this community, we each set sail on our careers with our coats and our credentials. Medicine’s expectations can compel us to construct our own myth, but when we do err, our humility enables us to progress past ruminating over the remnants of our legend.

Rushil Patel is a medical student. 

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