The Best Rx: Facing Up to Mistakes
Posted by Richard Conniff on February 22, 2011
A study from Johns Hopkins reveals that the father of successful neurosurgery, Harvey Cushing, a driven, egotistical figure, was nonetheless also routinely frank about admitting his mistakes. I profiled Cushing recently (see below) and was also struck that, apart from being meticulously careful in his work, he also relied on methodical record-keeping and self-criticism to improve his results. In the new study, medical student Katherine Latimer and her co-authors
… were surprised by Cushing’s frank and copious documentation of his own shortcomings. His notes acknowledged mistakes that may have resulted in patients’ deaths, as well as those that didn’t seem to harm patients’ outcomes. They said the documentation took place in an era in which malpractice litigation was becoming a growing concern for doctors. Though malpractice penalties were substantially smaller in Cushing’s day, lawsuits presented a serious risk for physicians’ reputations, the authors noted.
The authors also emphasized that Cushing practiced in a time of enormous surgical innovation. For example, patient mortality from surgical treatment of brain tumors fell from 50 percent to 13 percent during his career. While some of this jump ahead was due to improving technology, the authors propose that part of the reason was open documentation of errors, which helped Cushing and other surgeons develop fixes to avoid them.