The psychology behind admitting a fatal mistake

Researchers at the University of Pennsylvania School of Medicine believe that better training in the social psychology behind how we're affected by making mistakes can help doctors to be more open when things go wrong.

In the US, medical errors are the leading cause of death – way higher than those caused by terrorism and gun crime, with some researchers estimating 250,000 deaths a year are caused by medical mistakes.

Duty to be honest

In the same way that a statutory duty of candour was introduced into the NHS three years ago in the UK to encourage transparency, the US medical community has been working to improve patient care and safety by making it easier for errors to be disclosed and discussed.

But what the researchers behind the study published this month in the journal Medical Education believe is lacking from these initiatives is an understanding of the psychological reaction to making a mistake – which generates what they call the 'barriers' of fear, shame and guilt.

Psychological battles

For clinicians to consider that admitting a mistake may eventually result in better outcomes for patients, researchers say that doctors must first be trained to overcome the psychological challenges they battle when faced with having to disclose a mistake, something lead researcher Neha Vapiwala admits is even harder to do when so much is scrutinised on social media.

Apparently, the two cognitive processes that prevent someone admitting a mistake are the tendency to overestimate one's role in a situation and the tendency to overestimate the impact and duration of negative consequences, while underestimating the ability to recover from those circumstances. Both these tendencies generate enough self-blame to inhibit admission. Clearly you would expect the more serious the mistake, the more extreme the human reaction.

Reflex reaction

According to Dr Vapiwala, overcoming these reactions is like suppressing a reflex, which requires self-awareness, practice and, most importantly, training. What the study suggests is that rather than overstating one's own role in a mistake, it's helpful for doctors to look at systematic reasons for why that error occurred.

Taking into account sectors such as the airline industry, where mistakes can have huge consequences, the researchers suggest that actors playing patients could be used to 'practice' difficult situations and interactions with family, peers, and administrators to teach behaviour and coping mechanisms.

They also believe that Virtual Reality may soon be able to offer immersive and realistic technology to design exercises that recreate certain situations. An example given was allowing doctors to experience the perspective of a 12-year Syrian refugee to encourage understanding and compassion.

Transparency with patients

In my experience, there are medical professionals who admit mistakes following a serious incident and who do all they can to speed up acceptance and settlement, and there are others who do all they can to hide mistakes.

My colleagues and I have written before about the urgent need for public and private health care providers to reduce the suffering of patients and families caused by the refusal to readily admit obvious cases of negligence.

Particularly in catastrophic and fatal cases, medical staff need the right procedures in place and the support of the trust involved for there to be any hope of generating transparency. In that respect, any initiative that improves the consequences of a medical mistake – for doctors and patients - is welcome with open arms.