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Everything’s My Fault: How A Surgeon Says I’m Sorry

Wed, 11/13/2013 - 8:58am
Lara Devgan, M.D., M.P.H.

When I started my surgical internship, my chief resident told me some magic words: Whenever something bad happens, stay calm and say “I assume full responsibility. It won’t happen again.”

As a young surgeon at the bottom of the totem pole, those words were my mantra for the times when someone’s head was going to roll. In those nascent days of my surgical career, I was just trying to st ay in everyone’s good graces. Surgery is a traditional, hierarchical field, and acting defensive or blaming someone else — whether it is justified or not — is a rookie mistake.

In the beginning, I used the “responsibility mantra” mainly to put out fires. Late one night, a transplant surgeon pulled me into the supply room to scold me. A kidney transplant patient’s blood tests were missing, he barked. Where were they? I thought about telling him the full story: I ordered the blood tests, the phlebotomist drew the blood and sent it to the lab, and somehow the test tube went missing. I thought about saying I was sorry.

Instead, I took a deep breath and said “I assume full responsiblity. It won’t happen again.” His anger was temporarily extinguished. Then I drew the patient’s blood myself, hand-delivered the test tube to the lab, and waited for the results to get printed before I ventured back to the wards.

This same scenario repeated itself over and over in my first few months as a junior surgeon. A patient would accidentally eat a snack before getting wheeled to the operating room, and the case would get cancelled. A chest x-ray I ordered wouldn’t get done. The results of a wound culture wouldn’t show up in the computer records. The hospital is an imperfect place, and there are holes in the system. Over and over again, I would assume full responsibility for things that on some level had nothing to do with me. I didn’t want to incur the fiery wrath of the senior surgeons.

Over time, though, a funny thing happened. After repeating the responsibility mantra so many times, I internalized it. I really believed it. When something went wrong with one of my patients — whether it was his fault, my fault, or someone else’s — it was always my responsibility. When a person trusts you with his life, the buck stops with you.

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