Sacrifice and Resentment: Isn't this just part of the territory in medicine?
How learning from medical errors has lead to self-realization
Whenever you learn something, you make mistakes.
Most people would argue that making mistakes is part of learning. Workplaces like Facebook say things like "Move fast and break things" because this leads to accelerated learning and growth.
Unfortunately, in medicine, the unsaid mantra is "move fast and don't break anything". It can be very stressful. The day-to-day may not always be stressful. However, anytime you realize that you may have made an error or missed something that could potentially cause harm to someone, the feelings of guilt and fear can be overwhelming.
I have been practicing for seven years and I have had these incidents happen to me. Fortunately, many of these errors did not result in patient harm. Though some instances of not catching something on time did delay treatment. Regardless of the outcome, the knowledge that you may have done something that could cause harm to your patient is difficult to take on emotionally.
The emotions range from anger, defensiveness, guilt, fear of harming your patient, fear of retaliation from your patient, fear of punishment, and fear of embarrassment from your peers. I have seen myself experience all of these emotions. I know from talking to my peers that everyone experiences these errors and these feelings at some point. Especially with the demands to see more patients in shorter periods of time, these instances are part of the territory.
We do grow from these instances. We create better protocols for ourselves and our practices. We set rules and try to enforce boundaries to ensure we can do our job well. If we work in an environment that is too high risk, either due to disorganization or high census numbers, we leave to work at a safer place.
We also grow as people. We recognize that the initial defensive response is fear and we appreciate this is a normal human response to try and avoid seeing a difficult situation. We see how some of our initial emotions are related to how we are being perceived either by our patients or our peers. We learn about why we care so much about what other people think of us. I see how this growth from errors has made me into a more understanding, empathetic person who takes ownership of her actions.
The part that is still hard for me to cope with is the fear that I have potentially harmed my patient and also the fear of potential litigation. Fearing harming my patient is the more virtuous of the two fears and I don't think anyone would argue about the difficulty of coping with that.
Fearing potential litigation or a lawsuit is less virtuous. The idea that I would spend months or years thinking about an error that I made or that I would have to pay a monetary cost is painful. Feeling pain is understandable but pain is not the only feeling that comes up. Having heard my peers' experiences, I know another emotion that people often experience is resentment. Resentment is a sign of bad boundaries.
I know I would experience resentment if I ever experienced litigation. I would feel that resentment because of how much I sacrificed to practice medicine. For me, the main sacrifice is the countless hours of my personal time that have gone to practicing medicine. In my case, I work in family medicine, and I have a lot of work to do after hours. I have spent most evenings and many parts of weekends doing unpaid work to ensure my work gets done with reasonable quality. Work has been my life since I entered family medicine. I have tried to get more done at work and made small progress but ultimately most of my hours go to work.
This sacrifice of time is what would make me feel resentful of litigation. That is a bad boundary. If I only spent an appropriate amount of hours doing work, I would feel pain with a lawsuit but I would not feel resentment. The resentment reflects my feeling that I am giving something up for medicine.
Ken Honda, the author of "Happy Money", talks about how when we feel we are sacrificing for a job we are actually not doing anyone a favor. Our energy is tainted with feelings of martyrdom rather than joy. He feels that the universe is filled with people who love all different types of activities. What I consider a sacrifice would be a pleasure for someone else. By doing many hours of work that we resent, we both take that opportunity away from someone else who would love that job and we prevent ourselves from doing the things that fill our highest excitement.
I realized that I am resentful about how many of my waking hours go to my job and I am also learning how to own that resentment. We can only change the things we own. I am choosing to work many hours and after hours. I believe that I am sacrificing to help others but I am really only upsetting myself.
Realizing this helped me begin the plans to design a life that I will enjoy. Initially, I had thought of leaving medicine completely. However, after reflecting on my mood throughout the day, I realized I don't hate my job, not even the charting. I am generally content and even often happy when doing these activities. I actually like charting sometimes because it gives me time to think deeply about my different patient's situations and research other treatment options.
What I do not like is that these activities currently take about 60+ hours of my week. I realized that if I spent less time on work, likely <30 hours total including work hours/charting and commute, I would have more time to pursue my other interests. I won't know the exact hours until I try out different structures, but the realization has been liberating.
The resentment I felt led to an awareness of the poor boundaries that I had at work. This ultimately led to the ownership of my resentment and a plan to move from a place of working for sacrifice to a place of living with joy. I have a plan for creating a life where I act from a place of joy rather than sacrifice, but I am still currently working full-time. I know that my current work will help set me up to be in a position to structure my life so that I can follow my highest excitements in a few years with less financial insecurity. This framework has helped move me from a place of resentment to a place of gratitude. I am not perfect and I still experience feelings of both sacrifice and resentment but I don't assume this is "part of the territory" anymore. I designed my territory and Im also designing my way out to freedom.