The heart of darkness: the impact of perceived mistakes on physicians.
OBJECTIVE
To describe how physicians think and feel about their perceived mistakes, to examine how physicians' prior beliefs and manners of coping with mistakes may influence their emotional responses, and to promote further discussion in the medical community about this sensitive issue.


METHODS
Audiotaped, in-depth interviews with physicians in which each physician discussed a previous mistake and its impact on his or her life. Transcripts of the interviews were analyzed qualitatively and the data organized into five topic areas: the nature of the mistake, the physician's beliefs about the mistake, the emotions experienced in the aftermath of the mistake, the physician's way of coping with the mistake, and changes in the physician's practice as a result of the mistake.


METHODS
Eleven general internists and medical subspecialists practicing at a community, university-affiliated hospital in Oregon.


RESULTS
Themes emerging from analysis of the interviews were the ubiquity of mistakes in clinical practice; the infrequency of self-disclosure about mistakes to colleagues, family, and friends; the lack of support among colleagues; the degree of emotional impact on the physician, so that some mistakes were remembered in great detail even after several years; and the influence of the physician's professional locus of control on subsequent emotions.


CONCLUSIONS
The perception of having made a mistake creates significant emotional distress for practicing physicians. The severity of this distress may be influenced by factors such as prior beliefs and perfectionism. The extent to which physicians share this distress with colleagues may be influenced by the degree of competitiveness engendered by medical training. Open discussion of mistakes should be more prominent in medical training and practice, and there should be continued research on this topic.
Christensen
J F
JF
Department of Medicine, Good Samaritan Hospital, Portland, OR 97210.
Levinson
W
W
Dunn
P M
PM
D002983:Clinical Competence / Q000592:standards*; D003951:Diagnostic Errors; D006764:Hospitals, Community / Q000592:standards; D006801:Humans; D007388:Internal Medicine / Q000592:standards; D007406:Interview, Psychological; D008318:Malpractice; D008505:Medical Staff, Hospital / Q000523:psychology* / Q000592:standards; D008508:Medication Errors / Q000523:psychology; D009922:Oregon; D012649:Self Concept; D000078329:Workforce