How to face our mistakes: Using the military’s after-action review to improve morbidity and mortality conferences

Nearly three decades ago, David Hilfiker, a family medicine physician in rural Minnesota, authored an essay in the New England Journal of Medicine titled “Facing our mistakes.” In the piece, he chronicles three major medical mistakes he made during his long career practicing medicine. Some of the mistakes are horrifying and others simply tragic, but he is brutally honest and forthcoming—displaying a frank self-reflection that is too frequently absent …

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