Wisdom in Medicine: What Helps Physicians After a Medical Error?
OBJECTIVE
Confronting medical error openly is critical to organizational learning, but less is known about what helps individual clinicians learn and adapt positively after making a harmful mistake. Understanding what factors help doctors gain wisdom can inform educational and peer support programs, and may facilitate the development of specific tools to assist doctors after harmful errors occur.


METHODS
Using "posttraumatic growth" as a model, the authors conducted semistructured interviews (2009-2011) with 61 physicians who had made a serious medical error. Interviews were recorded, professionally transcribed, and coded by two study team members (kappa 0.8) using principles of grounded theory and NVivo software. Coders also scored interviewees as wisdom exemplars or nonexemplars based on Ardelt's three-dimensional wisdom model.


RESULTS
Of the 61 physicians interviewed, 33 (54%) were male, and on average, eight years had elapsed since the error. Wisdom exemplars were more likely to report disclosing the error to the patient/family (69%) than nonexemplars (38%); P < .03. Fewer than 10% of all participants reported receiving disclosure training. Investigators identified eight themes reflecting what helped physician wisdom exemplars cope positively: talking about it, disclosure and apology, forgiveness, a moral context, dealing with imperfection, learning/becoming an expert, preventing recurrences/improving teamwork, and helping others/teaching.


CONCLUSIONS
The path forged by doctors who coped well with medical error highlights specific ways to help clinicians move through this difficult experience so that they avoid devastating professional outcomes and have the best chance of not just recovery but positive growth.
M. Plews-Ogan is associate professor of medicine, Division of General Medicine, University of Virginia School of Medicine, Charlottesville, Virginia. N. May is associate professor of research, Division of General Medicine, University of Virginia School of Medicine, Charlottesville, Virginia. J. Owens is associate professor of research, Division of General Medicine, University of Virginia School of Medicine, Charlottesville, Virginia. M. Ardelt is associate professor of sociology, Department of Sociology and Criminology & Law, University of Florida, Gainesville, Florida. J. Shapiro is associate professor of otolaryngology, Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts. S.K. Bell is assistant professor of medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Margaret
M
Plews-Ogan
Natalie
N
May
Justine
J
Owens
Monika
M
Ardelt
Jo
J
Shapiro
Sigall K
SK
Bell
D000223:Adaptation, Psychological; D000328:Adult; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control / Q000523:psychology*; D008875:Middle Aged; D061214:Patient Safety; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D012189:Retrospective Studies