Most people imagine that their worst injuries will come from unpredictable, horrific accidents. But mine came from my pediatrician nearly a decade ago, as I sat in his office one afternoon complaining of minor discomfort in my right ear.
To get a better look at my eardrum, the physician began to irrigate the ear using a large, silver syringe—a common procedure, with such low risk that it hardly required caution.
But in my case, the syringe fit my ear too snugly. Before I could signal distress, the pressure in my ear built up rapidly until, like an overly inflated balloon, the eardrum burst. All of a sudden, I had become deaf in one ear.
The pain and the disability that accompanied this injury were significant. But in retrospect, the worst harm was not physical. Even as my mother and I insisted that something had gone wrong, my physician reassured us that this was a routine outcome and sent us home. When our need for his guidance became more urgent, he did not answer or return any of my mother’s calls.
The worst injury was emotional – the feeling of betrayal, of being lied to about my health. For the longest time, I was not able to find closure. Why did my physician deceive me? Did he not feel any guilt in turning his back on me?
It has taken nearly four years of medical school for me to finally be able to answer some of these questions. As a trainee during clinical rotations, I have made too many errors to recall. Thankfully, these were almost always corrected by my residents and attending physicians before they could cause any harm.
In the classroom, we practice difficult clinical scenarios with actors playing the roles of "standardized patients." The curriculum recognizes that doing, in addition to knowing, the right thing is the true challenge.
My first learning experience in this setting was to help a young woman overcome her fear of the health-care system so she could get an operation that she needed. Another time, my objective was to persuade a mother not to give unnecessary antibiotics to her child. As my peers watched, I cajoled, reasoned, and pleaded with each of my "patients." Each task proved harder than I expected and humbled me.
But I will never forget a real patient from my surgery rotation who came into the hospital with severe heart failure. Given his steadily dropping blood pressure, the team was not sure whether he would make it through the night. Our attending physician asked whether someone could place an arterial catheter so we could monitor him more closely. Having grown more confident over the year and craving greater responsibilities, I volunteered.
The patient greeted me warmly from his bed when the resident and I walked into his room, with a levity that did not reflect how sick he was. When I told him that I was a medical student, he mentioned that his niece was also a trainee, and that he was happy to be in a teaching hospital. I explained to him what I was about to do, and began to set up the supplies.
The needle and the wire advanced into the artery smoothly. There was hardly any bleeding. However, as I tried to place the catheter, I felt significant resistance.
“Ow!” he said. “Is everything all right?”
“Yes,” I replied. “It’s just part of the procedure.” I pushed the catheter with more force.
“Should it hurt this much?”
“Just bear with me a little longer.”
I desperately hoped that the catheter would go in if I just pushed harder. But I only caused the patient more pain.
At this point, the resident stepped in, removed my catheter and deftly placed a new one. Feeling ashamed, I hurriedly cleaned up and left the room before the patient could say anything to me.
Hours later, as I reflected more on what had happened, I came to a heart-stopping realization — the way that I behaved here was no different from how my pediatrician treated me 10 years ago. Though I knew from hard experience what a patient needs most in this setting, I was neither explaining nor apologizing to my patient.
I immediately went back to the room to apologize to this gentleman for making him feel as if he were being practiced on. I asked him to forgive me for running away from my error when I should have reassured him.
“It’s all right, you are a student at a teaching hospital. I’m happy to be a part of that," he replied. "Thanks for coming back.”
The Perelman School of Medicine is expanding the "standardized patient" program to include more scenarios, including learning how to disclose errors. Perhaps with more deliberate practice, I would have done a better job with my heart failure patient. Perhaps I would have admitted and apologized for my error more readily, humbly and gracefully.
Jason Han is a fourth-year medical student in the Perelman School of Medicine at the University of Pennsylvania.
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