In his TED talk, Brian Goldman, MD, uses baseball to eloquently portray the current perfection driven culture within medicine. A baseball player with a batting average of 0.400 hits the ball into the outfield four out of 10 times — this player would be eligible for induction into the hall of fame with all-star status. However, a patient with appendicitis referred to a surgeon with a 0.400-batting average for appendectomies is horrifying. Physicians are sent out into the world with the expectation of never making a mistake. When they do, they often feel isolated, ashamed and unsupported. These expectations of perfection are instilled during the first days of medical school.
On the day of my white coat ceremony, in addition to taking the Hippocratic Oath, I made a vow to myself to always perform to the best of my abilities. Perfection was the standard by which I compared myself. This was how I would secure a promising future in neurosurgery. In our pre-clinical years, this translated into sleepless nights memorizing human anatomy, going through thousands of flashcards weekly and constantly seeking out the most effective study strategies. In the latter half of medical school, I aimed for clinical and operative perfection. Little did I know that such an idealistic goal is unattainable.
As a third year medical student, within a team of residents, fellows and attendings, no matter how well prepared I was, I was always the least experienced and least knowledgeable. This in and of itself is a humbling experience and continually reminds me how much I have to learn. My surgery rotation was the most difficult transition to make. After standing next to the operative table for hours closely watching the surgeon and resident perform an appendectomy, the surgeon turned to me, handed me the needle driver and pickups and said, “You’re up.”
I started off strong. With my left hand, I softly lifted the edge of the skin with my pickups while, in my right hand, I rotated the needle driver, following the curve of the needle. After my first stitch, I looked at the clock and realized it had taken me five minutes … I quickly returned to my work, but now, I was frazzled by the time. I began fumbling over the next few stitches in an effort to move more quickly. In the back of my mind, I wondered what others in the room were thinking as I struggled to complete my task. The fear of incompetence took over as I felt the resident’s gaze. My hands began to tremble. It was then that the resident took over. I was devastated and embarrassed for the rest of the day. In this moment, I felt that I had failed, and was concerned that the resident and attending would never give me another chance in the OR.
The next day, I was in the same OR with the same attending and resident. At the end of the case, after a successful cholecystectomy, to my surprise, the surgeon turned to me and handed me the needle driver; “Ready for round two?” In that moment, I realized that in order to learn a skill, I needed to make mistakes. It is through these mistakes that I can learn to become a neurosurgeon. What hinders our improvement isn’t the mistake itself, but our inability to cope with them.
As students pursuing neurosurgery, where the stakes are high, we must become comfortable making mistakes. Errors help us learn and grow. Through these mistakes, we can develop the skills necessary to remain calm and collected while attempting to protect the essence of an individual. This healthy response to mistakes represents an opportunity to learn from each other. When we share our experiences with one another, we grow together and are able to focus on problem solving — rather than the problem itself. Emphasis on solutions allows us to acknowledge and move beyond fear to engage and be present, even when things get stressful. It is under these circumstances that we can learn to provide the most optimal patient care.
