Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How to protect physicians from themselves

Paul Levy
Physician
July 24, 2015
155 Shares
Share
Tweet
Share

shutterstock_182066816

It’s often said that we learn from our mistakes. Indeed, many a business course in leadership offers that premise as a given. I’ve glibly repeated this often in my classes, speeches, and advisory work.

“You don’t learn from your successes,” I point out, “but rather from your errors.” But do we really learn from our mistakes as a matter of course?

My friend and colleague Michael Wheeler, in his wonderful book The Art of Negotiation, warns us that it is,

… all too easy to be overconfident about our ability to observe and learn. A leader who ruled his country for more than forty years put it well: “The truly strange thing in your lives is that you not only fail, but you fail to learn your lesson … No matter how much your beliefs betray you, this is never accepted by you. You are distinguished by your inability to recognize the truth, no matter how irrefutable.”

Wheeler continues:

It one thing to recognize this truth in the abstract, but it’s another to live by it. The writer was the Libyan leader Mu’ammar Gaddafi, who several years later refused political asylum even as his regime was collapsing around him. Gaddafi was captured, beaten, and killed by rebel forces.

Sometimes our inability to be reflective practitioners derives from cognitive errors and biases. Because these failures are cognitive, it is almost impossible to see them happening or, afterwards, to realize that they have occurred.

Cognitive errors show up in many forms. Of the most common are:

Anchoring. The tendency for your first observation to carry disproportionate weight in your decision-making.

Confirmation bias. Often accompanied with anchoring, our confirmation bias values evidence that seems to support our view while discounting evidence that is contrary to your view.

Recent experience. Even statistically irrelevant recent events carry more power merely because of their placement in time.

Patterning. We are prone, too, to see patterns that don’t exist. Our minds like order, and we will assert the existence of dispositive parameters — even when the actual pattern of events is totally random.

We teach doctors about these cognitive weaknesses — anchoring, confirmation bias, and patterning — but we tell them that they are unlikely to recognize that they are happening. Instead, we need them to buy into systems of group behavior that protect them from themselves.

An illustrative example comes from Joris Lemson, MD, PhD, medical director of the pediatric intensive care unit at Radboud University Nijmegen Medical Centre in the Netherlands. One day, he ordered a dose of strong medicine for a small boy. The nurse obeyed the order, and the boy almost died from the choice of medication.

Later, when the doctor confessed his distress to the nurse, she said, “I wondered about the choice of drugs. If you had been an inexperienced doctor, I would have questioned the order. But I figured, with your experience, you would know what you were doing, and so I didn’t say anything.”

We teach doctors about these cognitive weaknesses — anchoring, confirmation bias, and patterning — but we tell them that they are unlikely to recognize that they are happening. Instead, we need them to buy into systems of group behavior that protect them from themselves.

In relating the story to me, he said, “It was at that moment that I realized that I needed to be protected from my own mistakes.” He then instituted a strong training program in crew resource management (CRM). This set of techniques, derived from military aircraft cockpits, offers particular help in hierarchical situations. It empowers subordinate members of the team to interrupt a pilot, doctor, or other chief and help that person from making a serious error.

Joris is honest about the progress of this effort in his PICU. He notes improvement and general compliance with the approach and procedures, but he also notes lapses. For instance, sometimes he as leader will forget to conduct the debriefing. That’s all right, but not if the other crew members forget to remind him when it happens. A tenet of CRM is mutual responsibility and authority: If the chief forgets to carry out part of the protocol, the others are required to point this out.

Oddly, those of us in more office-based leadership positions do not protect ourselves from this kind of error. We might tell people that we want to hear when we are going wrong, but do we behave in such a way that those call-outs are encouraged? Do we greet an interruption or criticism with a gracious smile and a thank you? Or is our (perhaps unconscious) scowl of displeasure enough to teach subordinates that they are proceeding at their own risk by doing what we think we told them to do?

We need to understand that there is an uneven pattern of power in the boss-subordinate relationship. Our reports, for good reason, have learned over the years that the person who points out that the king has no clothing often ends up on the street or left behind when it comes to promotions or other career advancement. With the scowl, we cement that fear into people’s everyday lives.

Michael Wheeler summarizes the issue by saying, “You have to monitor your own behavior to make sure it aligns with your intentions.”

Paul Levy is the former president and CEO, Beth Israel Deaconess Medical Center and blogs at Not Running a Hospital. He is the author of Goal Play!: Leadership Lessons from the Soccer Field and How a Blog Held Off the Most Powerful Union in America. This article originally appeared in athenahealth’s Health Care Leadership Forum. 

Image credit: Shutterstock.com

Prev

Patients just want their doctors to care. But too many don't.

July 23, 2015 Kevin 12
…
Next

Dr. Sorry's video has been removed

July 24, 2015 Kevin 18
…

Tagged as: Hospital-Based Medicine

Post navigation

< Previous Post
Patients just want their doctors to care. But too many don't.
Next Post >
Dr. Sorry's video has been removed

More by Paul Levy

  • a desk with keyboard and ipad with the kevinmd logo

    Health care networks: A mistake we will pay for

    Paul Levy
  • The triple aim has been hijacked by powerful political forces

    Paul Levy
  • a desk with keyboard and ipad with the kevinmd logo

    Bridging the gap between planning and reality

    Paul Levy

Related Posts

  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • The risk physicians take when going on social media

    Anonymous
  • Beware of pseudoscience: The desperate need for physicians on social media

    Valerie A. Jones, MD
  • When physicians are cyberbullied: an interview with ZDoggMD

    Monique Tello, MD
  • Surprising and unlikely rewards of social media engagement by physicians

    Lisa Chan, MD
  • Physicians who don’t play the social media game may be left behind

    Xrayvsn, MD

More in Physician

  • The power of business knowledge for medical professionals

    Curtis G. Graham, MD
  • Using the language of art to create work-life balance

    Sarah Samaan, MD
  • Lively communication in the service industry

    Deepak Gupta, MD
  • Reigniting after burnout: 3 physician stories

    Kim Downey, PT
  • Inside the grueling life of a surgery intern

    Randall S. Fong, MD
  • The shifting landscape of gastroenterology manpower and compensation

    Brian Hudes, MD
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • 5 things to know about weight from a bariatric surgeon

      Maria Iliakova, MD | Conditions
    • Balancing motherhood and medicine [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Misunderstandings about opioid use disorder

      Amy Baxter, MD | Conditions
  • Recent Posts

    • 5 things to know about weight from a bariatric surgeon

      Maria Iliakova, MD | Conditions
    • Out-of-office infusions in oncology care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The power of business knowledge for medical professionals

      Curtis G. Graham, MD | Physician
    • Using the language of art to create work-life balance

      Sarah Samaan, MD | Physician
    • Levamisole is good for your dog, but bad for your cocaine

      Robert Killeen, MD | Meds
    • Physician autonomy and patient interactions in corporate health care

      Michele Luckenbaugh | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 32 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Long COVID Rare in U.S. Kids, Has Affected 7% of Adults
  • Vascular Conditions Offer No Clarity on Pollution-Dementia Link
  • FDA Staff Voice Serious Concerns About Investigational ALS Cell Therapy
  • Primary Prevention Benefits of Lowering LDL Also Apply to the Elderly
  • Doctors Should Stay Away From 'Grateful Patient' Fundraising

Meeting Coverage

  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • ERS Roundup: Cell Transplant Boosts Lung Function in COPD Patients
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • 5 things to know about weight from a bariatric surgeon

      Maria Iliakova, MD | Conditions
    • Balancing motherhood and medicine [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Misunderstandings about opioid use disorder

      Amy Baxter, MD | Conditions
  • Recent Posts

    • 5 things to know about weight from a bariatric surgeon

      Maria Iliakova, MD | Conditions
    • Out-of-office infusions in oncology care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The power of business knowledge for medical professionals

      Curtis G. Graham, MD | Physician
    • Using the language of art to create work-life balance

      Sarah Samaan, MD | Physician
    • Levamisole is good for your dog, but bad for your cocaine

      Robert Killeen, MD | Meds
    • Physician autonomy and patient interactions in corporate health care

      Michele Luckenbaugh | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How to protect physicians from themselves
32 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...