The Big Impact of Small Mistakes

November 6, 2018
Eric Postal, MD
Eric Postal, MD

Just because a mistake is small doesn’t mean it can’t affect your work.

Outside my regular rad-work, I intermittently wind up with some CDs of MRIs to look over. This gives me occasion to see how a cross-section (get it? I’m a Body Imager, after all) of facilities does things differently from one another.

Step away from the major hospitals and the more robust imaging-centers, and a lot of these wrinkles are, shall we say, less than flattering to the profession. Now, I totally get that not everyone has the same wealth of knowledge and deep pockets with which to bankroll it; some facilities are going to have a leg up on others.

Related article: We All Make Mistakes

That said, even if you happen to be working with last decade’s equipment and the best on your staff are still C-listers, you can still exert some degree of effort to put your best foot forward. As opposed to, say, sticking it in your mouth or shooting it. Really, sometimes it seems like folks are trying to make themselves look bad.

For instance, take the spinal MR I was dealing with this morning. When I took the CD out of its envelope, I smirked a little as I saw that someone had, with a green marker worthy of a grade school art class, labeled it to be a study of the “Lumber Spine.” My smirk faded as I saw the actual images on the CD were also annotated as being Lumber, and I kid you not, the actual report from the imaging-center also proclaimed the spine to be of the Lumber variety. In its text, and in its heading. I wonder if they successfully got reimbursed for it.

I won’t go into the other unflattering aspects of that particular facility’s work (which left something to be desired), but let’s say the actual imaging study was technically amazing, and its interpretation even more so. What’s the chance that there would be any potential referrers left to impress after the first, ah, wooden impression had been made?

Such things put me in mind of one of my old bosses, when I was out of fellowship and in my first “real” job as a rad. I’d be lying if he’d impressed me as a radiological wizard to begin with, but hey, the guy was in charge of his own group in a competitive environment, so surely he knew a thing or two, right? Then I started seeing his reports. Not yet having any real evidence whether he was a capable diagnostician or not, a big part of my mind was made up about his skills when I saw how he made frequent reference to “shabby” lymph nodes.

The first time, I was sure it must have been a typo or transcription error; surely, he’d meant “shotty” nodes, which of course I’d heard about more than a few times in my preceding years of education and training. But there it was again. And again! What did he think this word meant? How had he gotten in the habit of using it that way? More importantly, how was he still using it, decades into his practice as a rad?

It also reminds me of an internship-interview I’d gone on once upon a time. A sleepy little community hospital, it surely would have treated me more gently than the County facility I ultimately prowled for a year.

During the part of the interview-visit where I shadowed the Program Director and her residents, a bit of confusion arose over a handwritten note about a diabetic patient’s leg-wound. The housestaff, having puzzled at the scrawl, concluded that the wound was being described as a “shoe-bite.” The PD ultimately concluded the same.

Being an interviewee who wanted to impress but not overstep, I humbly suggested that, maybe, the writing said “shark-bite.” First, because it made more sense, and second, because I vaguely remembered someone once describing particularly big, nasty wounds as being the sort a shark might inflict. You can imagine my appraisal of the situation when I tell you that not a single one of their eyes lit up with comprehension, or even consideration of the new idea.

In the grand scheme of things, these are flyspeck-sized errors. Nobody’s healthcare (hopefully) is going to be harmed by them, and there are plenty of more important things on which to focus if you’re wanting to up your game.

The problem is that other people will notice them, and it will seriously color their impressions of you-perhaps incorrectly, if every other aspect of your work is superb. But maybe correctly: If you don’t notice these pointless little errors-or worse, you don’t care enough to fix them-how is anyone else supposed to have faith in anything else you’re doing?

Related article: How to Apologize for a Medical Error

If, for instance, you’re calling nodes things like “shabby” in your reports, maybe clinicians are going to start wondering if you can be trusted in your actual nodal evaluation. Are you carefully measuring them? Comparing them against prior studies? Aware of what constitutes “normal” versus what does not? Calling them by their proper names, versus describing an unrelated location?

Errors, of course, are going to be made. Even painfully embarrassing ones-and that pain is kind of a good thing. If you care about the work you’re doing and how it looks to colleagues, patients, and their families, that can be a driving force to pay attention to what you’re saying, writing, and doing (and that includes proofreading your dictated reports!). Keep a critical eye on yourself, always looking for ways to improve. The alternative, whether you recognize it or not, is embracing a slow but steady decline for the remainder of your career.