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

  • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

    Kevin Haselhorst, MD
  • The hidden truths of hospital life: What doctors wish you knew

    Emily Stanford, DO
  • The heart of a Desi doctor: Balancing emotions and resources in oncology

    Dr. Damane Zehra
  • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

    Montreh Tavakkoli, MD
  • The harmful effects of shaming patients for self-education

    Maryanna Barrett, MD
  • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

    Wendy Schofer, MD
  • Most Popular

  • Past Week

    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • Breaking free from a toxic relationship with medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Breaking free from a toxic relationship with medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

      Kevin Haselhorst, MD | Physician
    • The hidden truths of hospital life: What doctors wish you knew

      Emily Stanford, DO | Physician
    • 10 commandments of ethical affiliate marketing for physicians

      Aaron Morgenstein, MD & Amy Bissada, DO | Finance
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast

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

  • Journal Shows Its Commitment to Exploring AI in Medicine
  • Do Away With 'Lockout' Period in iPLEDGE, FDA Advisors Urge
  • Cluster Headache, Migraine Linked to Circadian System
  • Smaller Liver Transplant Candidates Wait Longer, Less Likely to Receive Organ
  • A 'Double Whammy' for Gastric Cancer Risk

Meeting Coverage

  • Oral Roflumilast Effective in the Treatment of Plaque Psoriasis
  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Less Abuse With Extended-Release Oxycodone, Poison Center Data Suggest
  • Novel Strategies Show Winning Potential in Ovarian Cancer
  • Most Popular

  • Past Week

    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • Breaking free from a toxic relationship with medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Breaking free from a toxic relationship with medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

      Kevin Haselhorst, MD | Physician
    • The hidden truths of hospital life: What doctors wish you knew

      Emily Stanford, DO | Physician
    • 10 commandments of ethical affiliate marketing for physicians

      Aaron Morgenstein, MD & Amy Bissada, DO | Finance
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • 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...