Can Wisdom Follow a Medical Error?

The authors of an article in Academic Medicine (Wisdom in Medicine by Plews-Ogan et al., [PMID 26352764]) suggest that “wisdom”, partially defined as comprehending “the deeper meaning of the interpersonal and intrapersonal aspects of life, [tolerating] ambiguity and uncertainty as well as [understanding] the limits of his or her knowledge,” is not only a wished-for but possible outcome of a serious medical error that may or may not involve litigation.

Sixty-one physicians, 33 (54%) of whom were male, were interviewed who had a mean time of about 8 years from a self-described serious medical error. Of these, 13 (21.3%) reported an associated lawsuit. Using both qualitative (interviews) and quantitative (objective scales) methods, the researchers assessed whether or not the individual had achieved what they determined to be “post-traumatic” wisdom. In addition, at the end of each interview, the physician was asked to assess whether their experience of coping with a medical error “made them a wiser person.” Based on all the data, the researchers scored the participants as a “wisdom exemplar” (physician who demonstrated wisdom) or a “non-exemplar.” Of all participants, 45 (73.8%) were scored as wisdom exemplars.

The interviews with wisdom exemplars reinforce a number of themes suggested in the earlier literature: what helped the most was “being able to talk about it” not only with someone outside the profession but most especially with someone inside the profession with clinical experience. Although a smaller percentage (15.5%) of wisdom exemplars had been sued as compared with wisdom non-exemplars (37.5%), it is unclear how many of both groups had been delayed by legal advice in their ability to “talk about” their situation. For all of these doctors, talking helped in acknowledging the mistake, accepting the feelings, understanding their emotional response, and recognizing that they were not alone.

Another theme among wisdom exemplars was their reliance on disclosure (68.9%) as compared with wisdom non-exemplars (37.5%). Talking about the incident with the patient and their family as well as others, such as colleagues who could listen carefully and objectively, were often first steps in their path toward “wisdom.” Only 6 (9.8%) of any of these 61 physicians had any formal disclosure training.

This study extends our knowledge base about this important subject. The early studies that focused on coping with the personal and professional impact of litigation were followed by Wu’s identification of the physician who experienced an adverse event as a “second victim”. A focus on the longer term effects of physicians’ experience of having made a serious error with or without litigation provides further evidence of the basic health and resilience of the majority of practicing physicians and their dedication to their patients and their profession. The authors also provide a framework for the development of peer review programs that could benefit not only health care institutions and their staff but the patients they serve as well.

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