November 4th, 2020
The Rise of the Fall
Having matched into a residency in New England, I was super excited to experience all the seasons. I grew up in tropical countries where we had two seasons — “rainy season” and “not-so-rainy season” — both of them superimposed on reasonably warm temperatures. Three years out of residency and still in New England, I enjoy all the seasons, but fall is most definitely my favorite. The vibrant colors, the earthen smell, the leaves’ different shapes and sizes — I just can’t get enough of it. Apart from how picturesque it can be, fall has also been a time for reflection for me. Every year, the leaves change colors, take on new characteristics, and then fall — only to come back again in the spring. Each year through internship and residency, we take on new responsibilities, many times rising to the occasion but sometimes falling in failure. But what matters for the tree is that its roots are strong enough to make it through the winter. In much the same way, what matters to us is having the perspective and insight to make it through our failures.
Failure in Medicine
I remember the first time my father spoke to me about failure. After graduating from his medical school in India, he had not matched into post-graduation (residency equivalent) for Internal Medicine. Instead, he went directly to serving patients of low socioeconomic backgrounds. A year of service taught him about perseverance and resilience. He then matched into his newfound interest in General Surgery and held on to the lessons learned during his hiatus. He said, “many doors have to close for you to come to the door you are meant to open.” I remember how strange this topic of failure sounded to me — I was raised to chase perfection through my school and college years to get into medical school. Failing did not seem to be an option in the profession I had chosen.
Since then, I have faced my share of failures during my journey of transitioning to the U.S. I firmly believe these have been instrumental in shaping me as a physician and the person I am today. Although we encourage improving patient outcomes by discussing medical errors and mishaps — mortality and morbidity rounds, Schwartz rounds, and quality-improvement initiatives; we rarely encourage physician well-being by discussing personal failures in medicine. Many students meet step score requirements in medical school with flying colors; many match into residencies of their choice. Many residents match into fellowships or jobs of their choice. But what about those who don’t? Also, despite our best efforts, some of our patients do well, and some do not. How can we deal with unfavorable patient outcomes or deaths if we train in a profession that does not normalize failure? Failures in life and in medicine are inevitable. Hence, we need to build a platform to initiate this discussion safely.
Failing to fail results in success. What does this mean? The fear of failure should not stop one from challenging oneself or going out of one’s comfort zone. We are bound to fail at some point in our lives and careers. Hence, one should prepare for failure with contingency plans.
We can begin by encouraging a culture in medicine where we share from our experiences: not just our positive achievements, but also our negative attempts and lessons learned from them. Listening to our mentors speak about their failures can help normalize this process. Perhaps, we can do this in small-group settings where there is one-to-one attention and encouragement. Once we are comfortable doing so, we can think of having a formalized curriculum where our senior physicians share their own personal stories of failures and help bridge the gap by discussing this vital component of our careers. Including failures as a part of our narrative helps build our younger colleagues’ perspective. Failures can be eye-opening experiences that enrich our character and provide us with tools to deal better with uncertainties. In the long term, this will help us be better physicians — explaining the anticipation of positive outcomes to our patients and coping with the negative ones.
I recognize that just talking about this is not a fix for the problem. However, I believe this small step from us can become a giant leap in the right direction for our medical community. I encourage the readers to share their experiences to help take the narrative forward.