Bob Scott
Scotland

“Erring is human; not to, animal”
– Robert Frost, The White-tailed Hornet

Why is it so difficult to face up to our shortcomings? It is more than 300 years since Alexander Pope wrote¹ that a defining characteristic of humankind was to err, while granting forgiveness was at the discretion of a god. Robert Frost’s more recent aphorism pithily endorses Pope’s assertion and is more in keeping with the zeitgeist of the 21st century. A reluctance to dredge up errors is reason enough for hesitancy, for who among us relishes the opportunity to revisit their ancient omissions and blunders?

Medicine is a rewarding profession but lawyers have played a role in the lamentable growth of defensive medicine with its attendant over-investigation and unnecessary treatments. And when it comes to seeking retribution and compensation for alleged deficiencies, there is an undeniable bias against certain specialties, something which insurance companies recognize when deciding how much to charge doctors for their services. Neurosurgery, obstetrics, and plastic surgery invariably top the charts. That has as much to do with the elevated monetary recompense those lines of work offer their practitioners as it does with some individuals’ unrealistic and thwarted expectations. The risk of being sued by a damaged or disgruntled patient is significantly higher in those fields compared to less fashionable specialties, including general practice.

Patients expect that a medical procedure, ranging from popping a pill or being vaccinated, all the way through to having their brains operated on, will improve their health and well-being. In many instances perfection is anticipated, despite what nowadays is often a ponderous explanation of the risks entailed. An outcome falling short of what was expected might once have been stoically accepted with a sigh and a shrug but is now quite likely to lead to litigation. When matters went awry, my generation of medical students was instructed not to say sorry. As undergraduates, “Never apologize and never explain” was instilled into us in the belief that the possibility of being sued would therefore be reduced. This misconception was destined to fail in the face of an increasingly educated and less deferential citizenry and, as counter to that aloof stance, it is better to explain exactly what occurred, express genuine regret, shoulder responsibility for the accident.

While the range of potential slip-ups is limitless, the number of practitioners who knowingly commit acts which will damage their patients or deliberately fail to take appropriate steps to protect those in their care is minute. However, the craft is not immune to infiltration by psychopaths, pedophiles, and criminals. Among the ranks of doctors are a few who are dangerously incompetent, possess no insight into their failings, or are utterly wicked, “The sad, the mad and the bad.” In the UK, the general practitioner Harold Shipman was a freak, an aberration, a man who abused his power and position to become a murderer.

It is unintentional errors that give rise to most near-misses and cause the greatest harm. As an example, I once injected ten times the correct dose of a drug into a patient’s intravenous drip to correct a serious, life-threatening abnormality of his heart’s rhythm, a potentially lethal error on my part. Almost immediately, he became extremely drowsy, and a wide-awake medical student, with a better grasp of arithmetic than I possess, drew my attention to the concentration of the medication in the vial I had used. Fortunately, the man recovered rapidly without exhibiting any lasting ill-effects, and I resolved in the future to always have another check my calculations.

The adage “Learning from one’s mistakes” is overused to the point of exhaustion and does not always suit the occasion. For example, what did I learn from one tragic night when a woman in obstructed labor died on the operating table? She was correctly intubated. I removed and re-inserted the endotracheal tube to be certain of that, yet she suffered a cardiac arrest during the emergency caesarean section and failed to respond to attempts at resuscitation. Was it a reaction to the anesthetic drugs, or perhaps an undiagnosed flaw in her heart that caused her demise? I will never know, but there remains a nagging disquiet that something I did, or did not do, caused her death. What is undeniable and unforgettable is the dull aching void felt inside as I made my way home while dawn was silently creeping up into the eastern sky. The newborn infant survived as, of course, did the woman’s husband, who was overseas when she died. Meeting him on his return was excruciating.

There is a need to acknowledge that when mistakes are made and harm ensues; it does not automatically follow that malice must play a role in those shortcomings. The poets who introduced this essay were correct. Committing errors validates one’s membership of the human species. It is an integral component of the essence of humanity and, if not an essential part, at least one which none of us can avoid.

Twenty-two centuries ago the Roman dramatist, Terence, wrote, “Homo sum; humani nil a me alienum puto”—”I am a human being, nothing human is alien to me.” We can only wonder at what the freed African slave might have experienced in his life to allow him such an insight, but he definitely got that one right, failings and all.

Reference

1.  Scott, Bob. “Agenda: Should we allow politicians their failings?” The Herald, January 5, 2022. https://www.heraldscotland.com/politics/19821117.agenda-allow-politicians-failings/