Every doctor makes mistakes: can we talk about that? From student doctors to registrars, even the most experienced medical professional can have an off day.
That’s the truth, but it isn’t an excuse---especially when there are guides like this to help you get wise to the dangers of mistakes in your first year as a resident doctor.
Here are the most common problems you need to stay vigilant against:
1) Not learning
You’ve worked hard to reach this point. From high school to medical school to your first placement, becoming a resident doctor is nothing but hard graft. Along the way, you’ll have learned a thing or two, and it can be easy to think that you’ve got the answers. But, as you’ve learned, what’s “easy” isn’t always “correct”.
The reality is that you’ll make mistakes in your first year as a resident doctor. About 13 per cent of all admissions to public hospitals are associated with an adverse event i.e. a medical error, and at least some of those will be the result of your actions.
But this isn’t a time to feel afraid. This is the time to be vigilant, and willing to learn from your mistakes. Work with your colleagues and seniors to spot these mistakes before they happen, and rectify them when they inevitably occur anyway. Show up, own up, fix it: simple.
2) Uninformed consent
Getting consent from your patients is a lot more complicated than a simple “yes” or a signature on a form. There will be times when the procedure is complex for the layman, and your patient must understand it in order to provide informed consent.
These are the challenges that every doctor faces, from fresh graduates right through to specialists. It is one thing to perform a procedure or provide a curative programme, but quite another to explain how and why it works, and what any potential negative outcomes might be, in a way that someone not trained in medicine can understand.
Failing to get informed consent can result in a whole host of issues, not least of which is a patient that suffers unduly from unexpected side effects of your care. Here’s a rule of thumb to follow: if a procedure, pill or programme can harm a patient in some way, make sure they know the potential negative outcomes and how to recognise them. Take the time to explain in full what your chosen treatment will entail, and ask your seniors if you’ve covered everything. Don’t dip into medical jargon, and repeat as many times as necessary to get it across.
3) Failure to work as a team
Doctors are not the only healthcare professionals at work in the hospital. Nurses, physiotherapists, specialists and other healthcare workers all operate as a team to provide care to the patients that come through the hospital doors. New doctors often make the mistake of misunderstanding or underestimating the capabilities of other members of the healthcare team.
Take nurses, for example. All of those medications and treatments you’ve been prescribing will often be administered by a nurse. Now, if a nurse with decades of experience came to you and queried a prescription you made, it would be wise to listen.
The same goes for the other healthcare staff in your hospital. You can’t be with every patient at all times, so even an orderly who mentions a patient is in discomfort should be listened to if you want to provide the highest level of care. You’re in a team; take advantage of the support this provides!
4) Poor recordkeeping
Good record-keeping can be the difference between a healthy patient with the right treatment and a once-healthy patient that is suffering from an unknown malady.
Any correction to the patient record must be clearly shown as an alteration, complete with the date the amendment was made, and your name.
Without each and every one of these requisites filled, treatment could be misinterpreted and applied incorrectly---especially if there is the need for more than one correction. Don’t doubt the importance of record-keeping: if an adverse event does occur, good record can prove your actions were the right ones, for the right reasons.
5) Unclear prescribing
On the topic of record-keeping, you should also remain vigilant against prescription errors. An extra 0 at the end of a dosage can seriously hurt your patient, as can providing something the patient is allergic to. In fact, these kinds of mistakes are so prolific that they can be the cause of up to 70 per cent of medication errors.
Usually, prescription errors aren’t the result of ignorance or incompetence on the part of the prescriber, but rather simple communication errors: doctor’s handwriting has a notorious reputation for illegibility, after all, while the use of abbreviations for certain medications can make it even more unclear.
6) Breaching confidentiality
You’ll have had patient confidentiality drilled into your head since day one, and here we are about to do it again. But as many times as you may have been told, it’s still very easy to breach confidentiality and get yourself in serious trouble.
A reminder of what’s included in patient confidentiality: names, descriptions, photos, demographics, treatments, place of treatments, personality, quirks, and so on. Anything that could be used to describe the patient should be confidential.
You should be wary of breaching confidentiality even while still in the hospital. Lifts, canteens, printed documents, open wards, A&E departments---they’re all spaces where people talk about their patients or to their patients. The same can be said for social media outside of work. Even if you are talking to your colleagues, always be aware that people can overhear. If in doubt, don’t shout it out.
Summary
Learning, consent, teamwork, record-keeping, prescriptions and confidentiality: if you can master these six easy doctor mistakes, you’ll have eliminated one of the major pain points for malpractice in New Zealand.
If you’d like to learn more about beginning life as a resident doctor and avoiding the common pitfalls of doing so, download the RMO handbook.
