The New England Journal of MedicineTo Forgive, Divine

Reflecting on Medical Errors: The Role of Compassion and Learning in Clinical Practice

In this reflective narrative, a senior internal medicine resident recounts a critical mistake made during a 28-hour call shift and the subsequent journey toward understanding and accepting medical errors. Through the lens of a serious patient care error involving anticoagulation and an epidural hematoma, the piece emphasizes the importance of compassion, mentorship, and open discussions about mistakes in fostering professional growth and resilience in clinical practice.

Key Points:

• A senior internal medicine resident admits a patient with multiple complex conditions, including cauda equina syndrome, atrial fibrillation, a urinary tract infection, and possible pneumonia.
• The resident initiates appropriate treatment for atrial fibrillation with a heparin drip, considering the patient’s risk of stroke and potential need for surgery.
• A nagging feeling prompts the resident to consult a colleague, leading to the discovery of an epidural hematoma complicating the patient’s spinal fractures.
• The resident immediately discontinues the heparin drip and administers protamine, a reversal agent for heparin, with guidance from a pharmacist.
• The attending physician responds with composure and action-oriented suggestions, highlighting the importance of reimaging the hematoma.
• The attending shares a personal story of a similar error made during his residency, providing reassurance and normalizing the experience of making mistakes in medicine.
• The resident reflects on the “toxic culture of perfection” in medicine and the need for open conversations about errors to alleviate feelings of isolation and shame.
• The narrative strengthens the argument that making mistakes does not define a physician’s competence and that compassionate mentorship can foster resilience and professional growth.
• The resident acknowledges that errors are inevitable in medicine and emphasizes the importance of continued dedication and learning despite the fear of making mistakes.
• The article concludes with the recognition that sharing stories of errors among colleagues can provide significant emotional support and promote a culture of learning and compassion in clinical practice.

“In my view at the time, cultivated within a ‘toxic culture of perfection,’ ‘good’ doctors did not make serious mistakes. Yet it was clear to me that my attending was not a ‘bad’ doctor — quite the opposite.”

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