Hard to Tell It Like It Is

One of the reasons I like sort of sharing this space via blog roll links with other psychiatrists is that I have ready access to widely differing perspectives on various themes in psychiatry. I recently got an announcement from my colleague about the next installment of the “Finding Meaning in Medicine” group for physicians, the background for which you can find out more about from a June post at “Finding Meaning in Medicine”: Update from Dr. Janeta Tansey! – The Practical Psychosomaticist.

Anyway, it turns out the theme for the upcoming group is “Mistakes.” There was a paper attached as a reading, and it was a research study about how physicians communicate with each other about making mistakes in their practices [1]. There were no psychiatrists in the study, which I thought was interesting.

So the Shrink Rap bloggers recently gave readers a link to a post about anti-psychiatry groups, which I think tend to perpetuate the notion that doctors have to be perfect and to deny they make mistakes. They’re very critical of psychiatrists and Dr. Dinah Miller acknowledges that, and goes further by acknowledging that psychiatrists need to admit it when they make mistakes, Responding to antipsychiatry protestors : Clinical Psychiatry News. On the other hand, my takeaway from the article is that the abrasive approach of most antipsychiatry protesters would tend to make us less amenable to admitting we make mistakes.

Dr. George Dawson’s blog post about less than perfect parents (Real Psychiatry: Adapting to a Problematic Mother) who make mistakes in parenting tends to remind me of psychiatry textbook historical descriptions of “schizophrenogenic mothers” and how early theories in psychiatry could also make us less liable to admit to making mistakes in general. Dr. Dawson warns us to avoid blaming parents. It took a long time for us to discard the blaming and inaccurate schizophrenogenic mother notion for the good enough mother concept.

Although Carmack is pretty analytical for much of the paper on medical mistake narratives, she does mention that some of the doctors she interviewed cried as they told their stories about their mistakes.  And she points out that many Morbidity and Mortality (M&M) conferences where physicians are supposed to feel at ease and not harshly criticized about their mistakes actually turn out to be shame and blame sessions for all the efforts to prevent that.

It’s pretty hard to just tell it like it is. For starters, we need a safe space in which to tell it.

Reference:

1. Carmack, H. J. (2010). “Bearing witness to the ethics of practice: storying physicians’ medical mistake narratives.” Health Commun 25(5): 449-458.

Medical mistakes are often referred to as the “hidden epidemic” of health because doctors, patients, and hospital administrators remain silent about mistakes. This study relies on in-depth interviews to explore how physicians story their medical mistake experiences. Narrative theory is used to understand how these physicians story the complexity of medical mistakes, highlighting how these physicians bear witness to medical mistakes by sharing and listening to medical mistake narratives. Moreover, this study showcases the implications of how practitioners and scholars bear witness to the oft-times emotional telling and retelling of health narratives.

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