"He who thinks he knows doesn't know. He who knows that he doesn't know, knows." -- Joseph Campbell
I have made clinical errors, also known as mistakes, at various points in my 40-year career. Fortunately, I don't think there have been many. One of them resulted in a long-settled malpractice suit where six different neurologists, including me, missed the diagnosis of rare disease. Presented with the same facts, I admit that I might make the same mistake again. I classify my mistakes in three broad categories:
- Mistakes that didn't cause the patient any harm.
- Mistakes that resulted in serious problems.
- The mistakes I still don't know about because I either never recognized the error or the patient went someplace else.
All doctors make mistakes, because it is impossible for an individual to be perfect - any endeavor that involves humans will involve errors. The man who has the wrong leg removed at surgery makes the headlines of the six o'clock news, but the larger problem resides in the 10 to 15 percent of times where the doctor fails to make the correct diagnosis.
I have always taken pride in the fact that I can trust my clinical judgment, almost always making the right decision at the right time. I sometimes get frustrated watching physicians paralyzed by their indecision. But an article in the New England Journal of Medicine last month has forced me to reconsider my decision-making process. Dr. Pat Croskerry from Dalhousie University in Canada explains that most of our everyday thinking is flawed, and that doctors are no different than the average person. It is not a lack of knowledge (15 years of higher education followed by continuing education requirements take care of that end). The problem lies in the manner in which we approach "clinical thinking."