OPINION
DOCTORS ' Lounge
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Failure , A History
Mary G . Barry , MD Louisville Medicine Editor editor @ glms . org
Learning to practice medicine is an exercise in failure . Over and over , we don ’ t know the answer , from the first cut in Gross Anatomy to the final oral exam as seniors on the surgery service . Our guesses at the answer progressively improve , but medical school for many of us was best described by Sir Winston Churchill : “ Success is stumbling from failure to failure with no loss of enthusiasm .”
Internship is a trial not by fire , but by fear . For the first time we are making minute to minute decisions that could hurt or kill somebody . Medicine eternally has guarded against that by the chain of command . The shaman has his apprentices just as the Attending has an entourage . But at 0300 when only real Coca Cola can sustain you , it is your decision whether to go with your own brain and gut , or call for your higher power . The price of asking for help can mean losing the chance to trust your own eyes , ears and heart . But in not asking for help , you can lose your patient . That is why the practice of medicine is so collaborative : you do what you know , you ask when you don ’ t know , and over time your repertoire of disease pattern recognition grows by leaps and bounds . You spend that year
34 LOUISVILLE MEDICINE testing your diagnostic skills to the limit , then expanding that limit , again and again .
Through residency you gain enough confidence to be cocky , but inevitably get shot down at Morning Report . You face the wrath of the subspecialists when you have been admitting for GI and failed to do the Trail Test with your waterlogged cirrhotic ( inside you grumble , at least he can breathe now , whaddya want ?). But we learn that with increased responsibility comes increased guilt . I don ’ t know a good doctor who cannot instantly come up with 10 or 20 epic mistakes and when they tell someone about them , the shadow of that guilt is almost visible in the room .
Failure of medical knowledge is thus essential to scientific learning . We are spurred by the sting of not knowing , and inspired by the hope of helping someone better the next time .
But it ’ s not just knowledge . It ’ s the personal failures of not trying hard enough , of not being kind enough , of not listening well enough , of needless hurry , of not truly seeing the person in front of us at that moment , that plague us all . We fail to comfort , or fail to teach , or fail to grasp the real worry behind the stated chief complaint . These are part and parcel of modern medical life , beset as we are by the slings and arrows from everybody in the whole damn world who is not a doctor but trying to make our lives miserable in a myriad of ways . Nonetheless , as we navigate the intricate waterways of what gets paid for how , by whom and how many forms do I fill out and how much do I have to type of which buzzphrases just to get my guy a CT scan ? And on and on – you get out of breath just describing it .
What interests me is that this culture of trial and failure bolstered by the relative protection of the medical hierarchy does not translate well into other realms , except the armed services . Businesses where competition is the norm for advancement pay a lot of attention to failed initiatives , lessons learned can propel or sink a career .
But the fight to get into the premier universities has so poisoned the well of ordinary teenagerhood that colleges these days have had to develop whole programs on failure . Students who achieve admission are models of perfection in every endeavor and have managed to stand out from their peers in some admirable , individual way . Their failures have been rare . But college life brings all kinds of opportunities to screw up , and about 10 years ago colleges began to find that distraught students sought coun-