For years I have believed that you can learn more from your mistakes than from your successes. It is a dictum that I have quoted many times on rounds with residents and students. I tell them that I still remember the mistakes made as an intern, but the success stories have faded from my brain. I still worry about one probable mistake that occurred one night while I was an intern on call in the Coronary Care Unit (CCU).
Two days earlier, we had admitted an 80+-year-old woman with a non-ST-elevation myocardial infarction. We were treating her with the standard protocol at that time, and she was stable without chest pain or shortness of breath. In the middle of night of day 2 after her admission, I had a call from one of my colleagues in the Emergency Department saying that he had an urgent admission for the CCU. All the beds in the CCU were full at that point in time. My colleague said, “Please send your least sick patient to the floor to make room for my patient here in the Emergency Department.” My 80+-year-old lady had been stable for 2 days, and I decided that she was the person to be transferred to a floor bed. When I told her that she was going to be transferred, she said to me, “Don’t transfer me; something bad will happen if you send me out of the CCU. I need to stay another day in here.” I spent some time explaining that we would still be caring for her on the floor and tried to reassure her. She was subsequently transferred and died suddenly in the hospital 2 days later.
Perhaps this might have happened even if I had not transferred her, but to this day I still feel that I made a mistake in transferring her against her strong desire to remain for another day in the CCU. During the many subsequent years of my career, I have tried hard not to force patient transfers when the patient tells me they feel strongly that this would be to their detriment. I tell this story as an example of a probable mistake that I made that has haunted me for many years, a history that proves that one can learn from perceived mistakes. However, one of my colleagues recently told me that neurologic research had disproven the adage that one learns more from recognized mistakes.
To delve a bit deeper into the question of which kind of experience, success versus failure, was the best instructor, I consulted the medical literature in PubMed. I discovered that my colleague was correct: success led to more brain activation seen on functional magnetic resonance imaging than did failure.1, 2, 3 A Google search on this same topic found mixed messages. Some quoted the scientific experiments cited earlier as proof that success was more powerful than failure in activating brain circuitry. However, I also found an excellent essay by a psychologist, Lisabeth Saunders Medlock, PhD, pointing out that failing was indeed an excellent method of instruction.4
Dr. Medlock suggested 9 potential lessons that an individual could take away from their failures. First, she pointed out that perceived mistakes can help us understand what path we want to follow in our lives. Second, recognized mistakes teach us that we are not perfect and yet we can still be a valued person and a contributor to society. Third, acknowledging our mistakes enables us to accept our fallibility, face our fears, and go forward with our lives. Fourth, perceived mistakes help us to live with our imperfections and continue telling the truth. Fifth, recognized mistakes teach us what works and what does not work when approaching a particular problem or issue. Sixth, accepting our mistakes helps us learn to take responsibility for erroneous ideas or actions. Seventh, perceived mistakes can strengthen integrity in our character. Eighth, recognizing our mistakes enables us to engage in our lives and to live to the fullest extent possible. And finally, when we acknowledge our mistakes openly, this inspires others to do likewise.
So, what did I learn after studying and thinking about whether a successful or a failed event was the best instructor? Putting the scientific information together with my own personal experiences, I believe that both success and failure can provide important lessons. The important thing is to recognize why and how something succeeded or failed, to repeat the success and avoid a subsequent failure. In fact, we already have a venue in medicine for openly recognizing errors that occur in daily practice: the morbidity and mortality conference. In our department of medicine at the University of Arizona, we hold these peer-protected and confidential conferences every quarter in an attempt to discover what went wrong and how we might prevent such an occurrence in the future.
As always, I look forward to hearing from the readers of The American Journal of Medicine about this editorial or any other.
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-Joseph S. Alpert, MD
This article originally appeared in the April issue of The American Journal of Medicine.
