Admitting mistakes

Abstract

The physician is captain of the ship, and demonstrations of leader humility and the ability to admit mistakes helps to foster a climate of patient safety where causes of error can be addressed in a nonpunitive fashion. All members of the care team should feel empowered to call out patient safety hazards, and patient safety should come before pride and ego. Health care professionals might not report errors for fear of retribution, including the loss of professional licensure. This lack of reporting can result in further patient harm if the root causes of the mistake are not corrected. Just culture has been proposed as a means of facilitating discussion of medical errors and managing fear of retribution.1Rogers E. Griffin E. Carnie W. Melucci J. Weber R.J. A just culture approach to managing medication errors.Hosp Pharm. 2017; 52: 308-315Crossref PubMed Google Scholar A culture of patient safety starts at the top. In a study of leader humility, Hu et al identified key characteristics essential to foster honesty and team creativity.2Hu J. Erdogan B. Jiang K. Bauer T.N. Liu S. Leader humility and team creativity: the role of team information sharing, psychological safety, and power distance.J Appl Psychol. 2018; 103: 313-323Crossref PubMed Scopus (192) Google Scholar These included being open to admitting limitations and mistakes and giving appropriate credit to others. They demonstrated a positive relationship between leader humility and information sharing within a team.2Hu J. Erdogan B. Jiang K. Bauer T.N. Liu S. Leader humility and team creativity: the role of team information sharing, psychological safety, and power distance.J Appl Psychol. 2018; 103: 313-323Crossref PubMed Scopus (192) Google Scholar Professionalism is now identified as a key competency during residency training. Many programs include a dedicated professionalism curriculum, but data suggest that residents can identify unprofessional behavior and still engage in it.3Nagler A. Andolsek K. Rudd M. Sloane R. Musick D. Basnight L. The professionalism disconnect: do entering residents identify yet participate in unprofessional behaviors?.BMC Med Educ. 2014; 14: 60Crossref PubMed Scopus (17) Google Scholar The challenge is the transition from knowledge to culture. Peer evaluations and 360° feedback evaluations can help, and annual self-assessments are associated with improvements in professionalism.4Hochberg M.S. Berman R.S. Kalet A.L. Zabar S.R. Gillespie C. Pachter H.L. Surgical Professionalism and Interpersonal Communications Education Study Group. The professionalism curriculum as a cultural change agent in surgical residency education.Am J Surg. 2012; 203: 14-20Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar Admitting mistakes is never easy, but when correcting the medical literature is involved, admitting mistakes is especially important.5Fox S. Nair V. Dudley N. Admitting to mistakes in the medical literature.J R Soc Med. 2009; 102 (Comment on J R Soc Med. 2009 Jan;102(1):1): 357Crossref PubMed Scopus (1) Google Scholar We base important therapeutic decisions on published articles, and bad data can result in bad outcomes. When flaws in a study are identified, there is a strong tendency for authors to defend their methods and data when the best response might be to admit the limitations of the study and suggest improvements for further studies. A culture shift is needed, and we should applaud authors willing to engage in candid discussions of the limitations of their work. It is not a badge of shame to admit error; it's a badge of honor and professionalism.