Episode 78: Complaints and How to Survive Them Series 1: Preparing to Fail Well with Drs Sarah Coope, Annalene Weston and Sheila Bloomer

A complaint or investigation is one of the most stressful things you can experience as a healthcare professional, and this is true no matter what sort of job you do. However, we can’t live and work in fear of complaints and we should certainly not beat ourselves up when we make a mistake (and we will do). There are better ways to handle these situations.

Drs Sarah Coope, Annalene Weston and Sheila Bloomer join us in this first episode in a new series on ‘Complaints and How to Survive Them’ created in partnership with Medical Protection and Dental Protection to talk about coaching doctors and dentists through complaints made against them. We also talk about the perfectionist mindset and how changing our perspective towards failure can help us and those around us.

If you want to know how to deal better with complaints made against doctors and other professionals in high stress jobs, stay tuned to this episode.

Here are three reasons why you should listen to the full episode:

1. Find out the difference between a fixed and a growth mindset.

2. Know how reframing some of our negative self-talk can help us when we fail.
3. Discover the one phrase we should have learned in our training that might save us from false expectations.

Episode Highlights

[07:47] Why We Deal with Complaints Against Doctors So Badly

• Many practitioners find failure to be very confronting. To do something where a mistake causes harm can be overwhelming.
• A lot of people struggle to find the mental and emotional capacity to deal with having hurt someone else.
• Medical professionals are used to success but not failure.
• Competitiveness and comparison from medical and dental schools perpetuate these incredibly high standards. You need to be successful and seen as successful.

[13:49] Mistakes as Bereavement

• When a doctor receives a complaint, it’s almost like a personal loss or grief.
• Doctors feel guilt and shame. They find it hard to accept that a mistake has happened.
• Shame is a powerful emotion that people feel and often report. They don’t take the learning because they are so ashamed.
• The grief reaction is seen, and there is often a sense of denial and anger.
• Denial is more harmful as it can delay seeking advice.

[15:53] Being Kind to Ourselves as Practitioners

• Medical culture often teaches its trainees and professionals that they come second to patients.
• Practitioners are not as kind to themselves as they need or deserve to be.
• Perfectionism is often how doctors and dentists beat themselves up.
• They don’t ever expect that they might make mistakes.

[17:44] Growth Mindset vs Fixed Mindset

• The fixed mindset makes a person feel that being a success or a failure is their identity. They think they can’t improve.
• The growth mindset takes failure as a learning wherein it teaches one to improve and grow.
• Complaints against doctors and other jobs warrant reflection, growth and change.
• Complaints against doctors can help mould a better practitioner. We can reflect and enhance our medical approach.

[24:23] Having High Expectations and Being Perfect

• We are uncomfortable with making mistakes and have unrealistic expectations.
• It is essential to reassure practitioners that they are not the only ones making mistakes.
• Counselling and having someone to talk to is vital.
• Encourage doctors going through complaints to forgive themselves.
• Be kind to yourself.

[27:45] Having a Mentor

• Having a mentor can be helpful because they can help you understand the ‘why’ of a clinical mistake. They can also help with your confidence.
• Having a mentor makes a practitioner feel better because they know they have a backup.

[30:54] Imposter Syndrome

• You can see imposter syndrome often in dental practice because dentists are proceduralists.
• They don’t want other people to see their work. They’re frightened that they are not as good as others.
• You can see it starting from medical and dental school.

[34:14] Getting Out of the Perfectionist Mindset

• Try to identify the mindset that someone has when they are going through a complaint.
• Spend some time asking them about the thoughts behind their feelings because what we tell ourselves is based on our beliefs.
• Reframe someone’s perspective to step back and start building confidence.
• Find another area of a professional’s life where they are kinder to themselves.
• Recognise how other people can benefit from their experience.

[40:32] Top Tips for People to Prepare to Fail Well

• Accept that mistakes and difficult situations will happen. Face them in an early and timely way.
• Recognise that burying or planting a mistake can have very different outcomes. Be willing for growth to come out of our mistakes.
• None of us is perfect, and we all make mistakes. It is through mistakes that we learn, grow and move forward for ourselves and others.
• Speak to somebody early on.
• Trainees need to accept that they will make mistakes and some of them will be serious, and that is okay.

7 Powerful Quotes

[10:26, Sarah] ‘And I think there’s competitiveness often at medical school, dental school. So I think that competitiveness, and that comparison can really perpetuate that feeling of needing to be successful and being seen to be successful.’

[7:56, Annalene] ‘And many of them find that really hard, because they find the whole concept, they’re going to make a mistake in the first instance, to be very confronting, and then the fact it could be serious and could have serious consequences for the patient.’

[8:22, Annalene] ‘They don’t like it, they find it confronting. They find it makes them feel very uncomfortable. And you can see, some people will go away and reflect on that, or you can see they’re having a moment of self reflection.’

[10:54, Sheila] ‘From my personal experience, I think if a dentist or a doctor or a doctor receives a complaint, it’s almost like a personal loss in some ways, because you invest so much in patient care.’

[12:35, Sarah] ‘But there’s that dread of being in that situation, because people know, it can take years for it to be resolved. They know it can have that dramatic effect. But it’s also the guilt and the shame that can be associated with it.’

[15:53, Sarah] ‘I wonder if it’s true for many of us that there’s almost that unspoken culture, perhaps in medicine that you always come second, patients come first.’

[17:05, Rachel] ‘I think that perfectionism is often one of the ways in which we completely beat ourselves up, when we berate ourselves.’

About the Guests

Dr Sarah Coope is a senior medical educator at Medical Protection. She has a background in general practice and is experienced in coaching and mentoring doctors through difficulty. Contact Sarah here

Dr Annalene Weston is a dentolegal consultant for Dental Protection Australia. She is a practising dentist with a Master’s in Health Law. Annalene does a lot of teaching all about how to recognise and manage burnout in health practitioners. Contact Annalene here.

Dr Sheila Bloomer is a medicolegal consultant at Medical Protection and a General Practitioner. Before she was a GP, she was a solicitor who worked both in the commercial and private sector. She has also been a lecturer in law, and she represents doctors facing lots of issues such as DMCA complaints, criminal proceedings and disciplinary proceedings. Contact Sheila here.

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Episode Transcript

Dr Rachel Morris: Do you live in fear of a complaint? Do you dread making mistakes or getting something wrong? No one goes to work expecting to fail, and no one ever likes to be wrong or receive a complaint. But making mistakes is normal. After all, no one has a 100% success rate, and receiving complaints from patients and clients could be seen to be an occupational hazard. We know this. So why do we find it so hard to cope when it happens? And it will. That’s why we put together a series of You are Not a Frog podcasts on complaints and how to survive them. Going through a complaint or investigation is one of the most stressful things that can happen in your career. And I’ve seen firsthand the anxiety and emotional turmoil it can cause, and I know what it’s like to berate myself when I inevitably fail. But it’s because we care that we find this aspect of our professional practice so difficult. But what if there’s a better way of handling things? What if we could learn to view the whole complaints process as just another part of our professional practice, and learn the skills we need to manage ourselves, our colleagues and our patients in an empathetic and compassionate way throughout?

In this episode, I’m speaking with Dr Sarah Coope, Dr Annalene Weston and Dr Sheila Bloomer, about the mindset shift that’s needed in order for us to prepare to fail well. We talk about the perfectionist tendencies that many of us have had throughout our training, and how complaints in a mistake can impact on our own sense of identity and sell. We discuss how imposter syndrome can contribute to our defensiveness and how we can start talking to ourselves in ways we would never talk to a friend or a loved one. So listen to this episode to find out the difference between a fixed and a growth mindset, how reframing some of our negative self talk can help us when we fail and the one phrase that we should all have learned at medical or dental school that might have saved us from false expectations.

Welcome to You are Not a Frog, life hacks for doctors and other busy professionals who want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP turned coach, speaker and specialist in teaching resilience. And I’m interested in how we can wake up and be excited about going to work no matter what. I’ve had 20 years of experience working in the NHS and I know what it’s like to feel overwhelmed, worried about making a mistake and one crisis away from not coping. Even before the coronavirus crisis, we were facing unprecedented levels of burnout. We have been described as frogs in a pan of slowly boiling water, working harder and longer. And the heat has been turned up so slowly that we hardly noticed the extra long days becoming the norm. And we’ve got used for low grade feelings of stress and exhaustion. Let’s face it, frogs generally only have two options, stay in the pan and be boiled alive, or jump out of the pan and leave. But You are Not a Frog. And that’s where this podcast comes in. You have many more options than you think you do. It is possible to be master of your destiny, and to craft your work and life so that you can thrive even in the most difficult of circumstances. And if you’re happier at work, you will simply do a better job. In this podcast, I’ll be inviting you inside the minds of friends, colleagues and experts, all who have an interesting take on this so that together we can take back control and thrive, not just survive in our work and our lives and love what we do again.

Did you know that for every episode of You are Not a Frog we produce a CPD worksheet, which you can use to reflect on what you’ve learned and claim additional CPD hours. And if you’re a doctor and you want even more resources about how to thrive at work, and to join our Permission to Thrive CPD membership, giving you webinars and CPD coaching workbooks, which will help transform your working life. Links are in the show notes.

Now before we dive into this episode, I’d like to share a word from our partners from this series on complaints. It’s all too easy to feel overwhelmed. And for many healthcare professionals, it’s not only feelings of burnout and stress which can be challenging, there’s also the nagging worry of making a mistake and a patient claim being made against you. It’s enough to give you restless nights and impact your day to day, but you don’t have to go it alone. If you’re a member of Medical Protection or Dental Protection, you can access a range of support from clinical professionals to understand what you face, who are here to help you and not just the legal stuff, but your emotional and mental well-being too. From expert medical and dental legal teams to independent counselling through to webinars and on demand content. You can access it all as part of your membership, so you can focus on loving your job, not fretting about it. Find out more at www.medicalprotection.org and www.dentalprotection.org. And now here’s the episode.

Welcome to our first episode in our podcast series, all about complaints and how to survive them. I’m really thrilled to have with me on the podcast today, three very special guests. The first one is Dr Sarah Coope. Now Sarah is a senior medical educator at NPS. She’s got a background in general practice. And she’s also got a lot of experience in coaching and mentoring doctors in difficulty. So welcome, Sarah. Great to have you here.

Dr Sarah Coope: Thanks very much, Rachel. Great to be here.

Rachel: I’m also really grateful to have with us here Dr Annalene Weston. Annalene is a dentolegal consultant for Dental Protection, working in Brisbane. She’s also a practising dentist, she has a master’s in health law, and does a lot of teaching all about how to recognise and manage burnout in health practitioners. So great to have you here Annalene.

Dr Annalene Weston: Thanks ever so much, Rachel. Great to be here.

Rachel: Also really pleased to have with me Dr Sheila Bloomer. Sheila is a medicolegal consultant, MPs. She’s a GP, before she was a GP, she was a solicitor working both in the commercial and private sector. She’s also been a lecturer in law. And she represents doctors facing lots of issues such as GMC complaints, criminal proceedings, disciplinary proceedings. So lots and lots of experience in that area. So welcome, Sheila, great to have you with us.

Dr Sheila Bloomer: Thank you for inviting me, I’m looking forward to the session.

Rachel: So, complaints, the reason I wanted to address complaints in a podcast series was, I’ve had a friend and colleague recently who’s gone through a really nasty complaint. And I saw how it so nearly destroyed her, she was really preoccupied with it. It’s sort of ruined the whole of the summer. And even though the complaint is finished, I can see the amount of stress and anxiety it caused. And she’s a really experienced GP. Now she’s not a newbie, it’s not her first one. But it just got me thinking, after all these years of experience, why are we still so frightened of complaints, still so bad at dealing with them? And what I’ve been talking to people about this, people have been saying to me, that actually, as a healthcare professional, particularly as a doctor or dentist, and complaints are just an occupational hazard. Right? Everyone’s nodding at me. So if they’re an occupational hazard, why do we deal with them so badly? And why aren’t we taught better how to deal with them at medical school? Let me ask Annalene, you first, because I know when we talked before, before the podcast, you’ve got a particular line that you say to trainees, which really struck me: ‘I’m going to make mistakes, and some of them are going to be serious.’

Annalene: And that’s absolutely the case. It’s something that I try and get the recent graduate practitioners to repeat in seminars when we’re training them. And many of them find that really hard because they find the whole concept, they’re going to make a mistake in the first instance to be very confronting. And then the fact it could be serious and could have serious consequences for the patient, it’s beyond the pale for many practitioners. I mean, we are health care providers. The clue’s in the name, so to suddenly do something where a mistake which causes harm can just be overwhelming, absolutely overwhelming.

Rachel: And how do they react when you tell them that?

Annalene: They don’t like it. They find it confronting, they find it makes them feel very uncomfortable. And you can see, some people will go away and reflect on that, or you can see they’re having a moment of self reflection. And you can see others will just clam up and say, ‘Nope, never going to be me. Never gonna let that happen to me.’ And they’ll be very rigid in their position, in their body language. Whereas others you can see they go, ‘Okay, this is something I’ve never considered before. I really need to think about that and how that applies to me.’ A lot of people don’t have the mental, emotional capacity to deal with having hurt someone else. I think that that’s what we need to consider, is making mistakes in our line of work often flows on to somebody else being hurt. And I think that that emotionally, I just don’t think we’re well prepared for that. I don’t think anyone would be.

Sarah: Yeah, I think that’s really true that the impact of a mistake has both external effects. So on the patient themselves, perhaps on the organisation, perhaps on our own career externally. But also the internal impact. It’s so hard to come to terms with for many people who perhaps as you said, Annalene, certainly don’t want to face it, they may have been in that position. And I’m reflecting on it. I think that from school before we even get into medical or dental school. If we’re aiming to be a med, a doctor or dentist, we are used to success because that’s how we’ve got to where we have gotten to, so we’re not used to failure. And people around us tell us that, ‘Oh, you’ll be a fantastic doctor, be a fantastic dentist’ perhaps. So this picture that perhaps we have of ourselves as always being successful and we’re not used to failing. And I think therefore for many people, it’s almost like a foreign concept for them to get their heads around that they could acquaint themselves with being anything less than successful. So I think that can be challenging.

Annalene: I think many people haven’t even failed their driving test, let alone an exam. And often the first time they experience failure is at the hands of a failure in patient care.

Sarah: So therefore, it becomes part of their identity. And I think that’s where it can be really challenging. And for people to get their heads around that. And I think there’s a competitiveness often at medical school, dental school. So I think that competitiveness, and that comparison can really perpetuate that feeling of needing to be successful and being seen to be successful. So Sheila, you were nodding there?

Sheila: Yes. I mean, I agree. And I think just from my experiences, when I was working as a GP and I had, I received complaints, as most GPs do in their career. But it’s certainly not unusual, doesn’t mean it’s any less upsetting. From my personal experience, I think if a dentist or a doctor receives a complaint, it’s almost like a personal loss in some ways, because you invest so much in patient care. The last thing is, the last thing you want is either to upset a patient, or to cause harm to a patient. That’s not why we joined the dental and medical professions. And so I mean, from my experience, I was shocked when the patient made a complaint because I’d invested so much time and effort in providing the best care that I could. But I think we have to remember that we are human, and we can only do so much. Even though generally, people like going to dental work and medical work may be perfectionists in some ways. And as Sarah said, from a highly competitive environment. So it’s both a professional and personal shock when you get a complaint. And I think it’s difficult for practitioners to get to grips with that.

Sarah: Also that dread, that people have heard of other people, they’ve either had complaints themselves, which maybe have thankfully been fairly minor and haven’t been great or isn’t significant. But there’s that dread of being in that situation, because people know, it can take years for it to be resolved. They know it can have that dramatic effect.

But it’s also the guilt and the shame that can be associated with it, I think it’s really hard for people to sort of really accept that that mistake has happened. But often because some people, their reaction would be to totally berate themselves and feel extremely ashamed of having made that mistake. And that can really make a situation worse. Annalene, what’s that like in the dental side of things?

Annalene: I absolutely agree. But shame is a really powerful emotion that people feel and often report. And I think many times, practitioners, as you said, are already measuring themselves up against others. So they see themselves as being less than their peers, less abled or less good for want of a better word, and it really pummels their self-esteem when they’re already trying to deal with the patient issues. And then of course, I find that when I’m dealing with practitioners who are experiencing compliance and going through compliance, you have some who cannot look and they’ll go, ‘No, everything I did was right.’ And they’ll be quite rigid and like, ‘No, no, no, the patient’s wrong.’ And then, and that’s how they cope. And then other people can cope by saying, ‘Everything I did was wrong.’ Do you see what I mean? So they don’t necessarily take the learning. They’re so ashamed, they’re so distressed, that they will, it will become everything, they did everything wrong, when in fact, often that’s not the case. Would you agree, Sheila?

Sheila: I definitely would agree with that. Both my own experience of having a complaint against me, as a GP, but also then working closely with doctors over the last several years who’ve had complaints or claims against them. And it’s almost like a bereavement because you have this confidence that you’re giving the best care that you possibly can for patients. You’re working very hard, often very long hours. You’re putting your home life or social life to the side, often to ensure patient care. Then if you get a complaint, you think, ‘Well, I’ve done everything I possibly can, why has this happened to me?’ And I think the reaction that I experienced, but also I see day to day from doctors, is almost like a grief reaction. And as you said Annalene, at first, it’s often a sense of denial, that this just isn’t justified. Why has it happened to me? And also anger as well. ‘I’ve done the best I possibly can. Why has this patient turned on me? I couldn’t have done any more.’ So it’s I think it’s almost like a grief reaction.

And I think if doctors and dentists could think of those lines when they receive a complaint, then perhaps it could be kinder to themselves and understand that this is a process that anybody who receives a complaint can go through. And it can take several months to go through the process, just as it does in the process of bereavement. I’ve experienced that with a number of doctors. And in fact, denial is probably more harmful because it can delay a doctor speaking to a trusted colleague, for example, about complaint. Seeking advice and help from their medical defence organisation, for example. And then it can just mount and mount and compound and get worse and worse. So, if a doctor or a dentist receives a complaint, I just like to reassure them that it’s not unusual. And the best thing is to speak to somebody they trust, and possibly to contact their medical defence organisation, or maybe their more senior colleague for, just to talk it through in the first instance. It’s like a burden shared is a burden halved is a really good saying in these kind of situations.

Annalene: Do you think we’re kind to ourselves anyway, as practitioners do you think? What do you think, Sarah?

Sarah: I wonder if it’s true for many of us that there’s almost that unspoken culture, perhaps in medicine that you always come second; patients come first. And therefore, I think it’s true for many of us that we’re not as kind to ourselves when we’re practising as we need to be, or deserve to be. And we all talk about, we’ve got to put your own oxygen mask on first in order to help others and you can’t pour from an empty cup. And we know there’s sayings but yet, it’s so hard to do that perhaps because, as Sheila said, we often put, made a lot of sacrifices, put home life and social life to one side, perhaps put your own well-being to one side in order to focus on your career and to be there for patients. And therefore haven’t prioritised this in the way that we need to.

And I’ve certainly seen that a lot in the doctors that I’ve worked with on a coaching and mentoring perspective, that they’re maybe not kind to themselves in a physical way, as much as they should be. They’re looking after their everyday, their exercise, eating all those sorts of daily needs, but also kind to ourselves internally. So when I talk to her about guilt and shame, often that’s a way of being unkind to ourselves, isn’t it? And we wouldn’t probably respond to a colleague who had a complaint, but making them feel guilty making them feel ashamed. But yet, we will do that to ourselves.

Rachel: And I think that perfectionism is often one of the ways in which we completely beat ourselves up and we berate ourselves. So that internal dialogue that, ‘I must be perfect. I must never make a mistake. Making mistake means I’m a bad person, like I’m a bad doctor.’ I think when we finish medical school, or dental school, or nursing training or any training, I think we sometimes expect that we are the full package. We’re the full package, and yes, we’ve got to go through the training to learn the extra skills we need to do to be a good surgeon or that, this and that. But we don’t ever expect that we’re going to be making mistakes along the way. And that’s where this whole growth mindset comes in. I know Carol Dweck has talked about this fantastic TED talk by Carol Dweck, about the difference between a growth mindset and a fixed mindset. a fixed mindset says that ‘If I make a mistake, that means I’m a bad person, that I can’t improve, that my skills and my knowledge are innate, they are part of me as a person. Therefore, if I fail, that reflects on me as a person.’ Whereas growth mindset is actually, ‘everybody’s learning and failure is actually quite good because it teaches me what I don’t know. And then I can develop and grow.’ But actually, there’d be no healthcare professional on this earth, I think that would say failure is great.

Sheila: That’s very personal. And my experience of doctors who are facing complaints which go to the General Medical Council, the GMC, for example. The GMC, they welcome and actually encourage doctors to reflect upon something that’s gone wrong. And the GMC is more concerned when a doctor doesn’t reflect on what’s gone wrong, doesn’t learn from it, and then improve their practice as a consequence. So that’s exactly, I agree with what you’re saying, Rachel. And actually, the GMC encouraged that. An unwary doctor is entrenched in their view, for example, that what they did was right, and they would do it again. That’s more concerning, because they’re not learning from, even if it wasn’t a mistake, and the complaints are justified. There’s usually something in the complaint that is, that does warrant reflection for growth and change. And I think we can become better doctors, better dentists after complaints because we can reflect and improve our approach, either in terms of communication with patients, or in terms of our clinical practice, or in terms of our own personal care, which gets in the way of us performing as well as we can when we’re providing care for patients.

Annalene: I agree with everything. And I like to think I’ve got as growth mindset as a dentist can have, I can think of an adverse outcome that happened 12 years ago in my practice. And I know it was 12 years ago because I was heavily pregnant at the time. And even though what happened was assessed by a specialist, even though I put the patient right, I will actually never forgive myself for hurting him. Even though it was unavoidable, and the specialist has assured me, he’s actually someone I’ve become quite good friends with. And this comes up in conversation a lot. Because 12 years on, I actually still can’t forgive myself for hurting that patient. And what’s funny is, I still think of him sometimes first thing in the morning, and last thing at night, and I bet you, he’s not thinking of me. Not anymore. I’m sure he did at the time, but he would have forgotten I even exist. But to me, he stands out as a blazing point, and I will never forgive myself for having hurt him. So I think there’s that too. We were talking about guilt and shame of those things, too. But we are people too. And all the reasons that we’ve said, with not one of us gets up in the morning with the intention to cause harm.

Rachel: It’s that concept of the second victim, isn’t it? When a complaint or a failure, when a mistake happens, you get your first victim, but you’ve got then the second victim of the people around or the person that’s made the mistake. And I’m really sorry to hear, Annalene, that you’re still— it’s still troubling you.

Annalene: It’s a bit of a worry, isn’t it? But I think it’s funny because we were discussing how we all are involved in either teaching or counselling, or helping people through these. And yet, perhaps one of the reasons that we’re so well able to do it is because we know exactly how it feels. And we know exactly how they feel, how the members feel, Sheila, when they ring us up, because we felt all those emotions ourselves.

Rachel: So Annalene, I’m just thinking that looking back on that thing that happened, is there anything that you know now about this whole perfectionism growth mindset thing that you didn’t know then, that you wish you’d known when you were going through that?

Annalene: I really, truly wish I’d been kinder to myself, because as I say, I was heavily pregnant at the time, and I was so sickened that this patient had been hurt. And it was, as I say, it was an adverse outcome. So it was not something that could have been foreseen, it’s not, and that doesn’t make it any better. I just want to be. So it’s not like I could go back and apply some learning. If only I’d done the procedure this way rather than that way, there was no clinical skill learning to be had there. The only learning really was how I coped with it. And obviously, as I said, I put the patient right, I made sure the patient got to the specialist, and he’s fine. And he was fine very quickly. But I was horrible to myself, I made myself sick. I didn’t sleep, I didn’t eat. And it dominated my life for a really long time, up until I had a baby. And that dominated my life from that point. Distraction.

But still now when I teach about adverse outcomes and things like that, I often share my story with dental practitioners where it’s meaningful to them what actually went wrong because it really was that just once in a lifetime moment in time. But I think it’s important because you can actually see people go through the feelings that I felt, because I imagine how it would feel for them. And so I think there’s learning there, so I’m more than happy to talk about it and share it with people. I just wish I’d been kinder to myself. I just couldn’t get past, I must have done something wrong. And I couldn’t get past the fact that he was hurt. I just couldn’t move past those things. Because he’s hurt, I must be wrong. I must be bad. I must be terrible. I must be, I’m a terrible person. And I just couldn’t. So I guess. Yeah, I just couldn’t move past that.

Rachel: I think that’s really insightful. Because the problem with all of this, right, is that I remember getting a complaint and looking through the night thinking, ‘Was it my fault? Was it my fault? Did I do anything? Did I do anything? Was it my fault?’ The problem is, why is it not okay for it to be my fault, right? Because every human being makes mistakes. If you wash up enough plates, you’re gonna drop one. And we are very uncomfortable with being a normal human being. It’s almost like we’re, as healthcare professionals, trying to deny the laws of gravity. The machines will sometimes make an error or get things wrong or something will happen. And we expect ourselves not to do that. And of course, we work in such a high stakes environment. It’s I guess, in a way, it’s good to have those expectations, but then it’s really unhealthy as well. What do you think about that, Sarah?

Sarah: Yeah, I agree with all of that, that I think we have those unrealistic expectations often of ourselves. So I guess I was wondering, I mean, what would you say to a dentist who rang, who’d had a similar adverse outcome occur to them where they hadn’t made a mistake as such, but this has still happened. And they were saying, ‘I must have done something wrong. I just can’t kind of get over that.’ What advice would you give another dentist?

Annalene: Well, I think it goes back, Sarah, to ‘I will make mistakes and some of them will be serious.’ So let’s start there. And I think I would reassure them that they’re not alone. I think I felt so alone. I felt like I was the only person in the world who had ever done this, and I didn’t even know what I’d done, it was so rare, I didn’t even understand what had happened. And then I felt very stupid for not understanding what had happened. So I would encourage the practitioner who called to do what I did and reach out to the specialist, get the patient fixed. Because obviously that’s, the patient has to be the priority. And I’m not saying the practitioner is not a priority. I’m saying that we have to take care of our patients. It’s just, we have to stay on that journey. But also, then to start looking, once we’ve got the patient moving in the right direction, to then start looking at how we feel. I would encourage anybody who went through what I went through to have counselling. Obviously, we do have access to a confidential counselling service. And I think it would have been very healthy for me to talk to somebody at the time about why I was feeling the way I was, and to try and get some closure from that. And yeah, I just think I’d just say to them, ‘You’re not alone.’ And just encourage them to forgive themselves. But I don’t think you can on the first day. I think on the first day, you’ve got to go through, Sheila, you were saying the stages of grief, isn’t it? Denial, fear, anger. You’ve got to go through it, haven’t you?

Sheila: Yeah, really. I mean, it definitely is like the stages of grief. And I think it might be helpful if doctors and dentists who do, who have been involved in an adverse incident or complaint, to think about it in that way. Because it helps them realise that things are not going to get better straight away. And not to put pressure on themselves. I think, well, I have sorted out the patient now. So everything’s fine. They need to know that their feelings can take months to resolve. And as you suggested, only counselling can be of assistance just as it is when just as it can be if you have a bereavement. I mean, and interestingly, when you look at the symptoms of grief and bereavement, they include things like having physical symptoms, such as headaches, insomnia, loss of appetite, perhaps drinking too much alcohol. Also emotional symptoms such as crying, feeling down, having personal difficulties in our relationships, fatigue, anger, and aches and pains and other physical ailments and illnesses that they may need to see their own doctor about. So when I speak to doctors, I try to say, ‘Look, be kind to yourself. We all make mistakes. And it may take some time for you to get through what you’re feeling at the moment. But don’t rush it. Don’t feel that feel like, well, next week, everything should be okay. Because we don’t work that way. We are human beings. We’re not machines, we’re not computers.’

Annalene: I do wonder how many of those symptoms for my pregnancy or passed off as my pregnancy. But I certainly had those emotions. I’ve mentioned a couple of times when we were talking about this my relationship with the specialists, and I’ve mentioned that we’ve actually become quite good friends. And I also do think that having a mentor, or somebody you can talk to, particularly for younger practitioners, but not just for younger practitioners for any practitioner can be super helpful too. Because not only does it help you understand the why, particularly if it is a clinical mistake, and particularly if it’s one that occurs commonly. So this has happened to me and why and the steps we can take to avoid it. But they can help you with your confidence then, because oftentimes we see practitioners who become fearful to do, because obviously, dental practitioners are fundamentally proceduralists. I mean, we do procedures to patients every day. We’re diagnosticians and those things too, but essentially, we’re proceduralists. So we’ll have a situation where perhaps a practitioner will have an issue extracting a tooth, and then you’ll find the next time they go to extract a tooth, they almost get the wobbles because they fear it’s going to happen again. It becomes that deja vu moment where they start reliving it in their head. And actually having a mentor in place to give them the confidence and to help them with the planning. And if that person can be on-site all the more better, because you know you’ve got backup. I think that that’s a really powerful thing as well. I think having a mentor. So because I’ve mentioned my specialist colleague. In many ways, that’s what he’s become to me, as well as a friend.

Sarah: Yeah, and I really agree, Annalene, with that. I think having somebody there alongside that you can speak to that you can be really open and honest with is really important, just as you would want that that support it in a bereavement. I think a lot of the work that I was doing before joining Medical Protection around coaching and mentoring doctors who had had a complaint who’d been referred back to the area team, or the GMC, was really to give them confidence because the incident happens. If they were willing to reflect it often made people really over reflect or generalise that ‘Oh, because I made the mistake in that area. I must be in danger of making a mistake in another situation.’ I think that vigilance is sometimes good. However, the danger is that then people’s confidence really, really sinks.

And a lot of my work I think was spent on validating people and pointing out the things that they were doing that showed what a good doctor they were. These could be people who were very junior, who had ever had a complaint before. And were really stunned by the fact that this had happened so early on. But often, the people who had been very experienced practitioners who had wonderful careers, and the complaint was the first time that happened to them. And I think just the fact that that had come at this stage in their careers was really difficult for them to get their heads around. Some people do find it difficult to reflect and you mentioned often that denial. We’ve also talked about growth mindsets, and for some people, they may have more of a fixed mindset in approach to themselves and how they see failure. And I think it can be quite challenging for people who struggle to reflect, who struggle to accept that this has happened to them, take the learning from that. We talked before in the previous conversation only, we talked about imposter syndrome. And I wonder if this comes in here a little bit.

Annalene: Imposter syndrome is rife, I think, across all clinical practices, but we particularly see it in dental practice because we’re proceduralists. And not just that, the majority of our patients will come for planned care. So they don’t tend to come for emergency treatments, they’ll have pre-scheduled appointments for planned care. And they’ll have their practitioner of choice. And some of our patients will see for 20, 30 years, we’ll see for a lifetime and see their children and their children’s children. But what that means is that we never see each other’s work. So you go through the whole of your dental career, only seeing the work that others put yours, and then the work that other people put on Instagram. Now bear in mind, they’re only putting their best work on Instagram, right? So you’re only seeing beautiful fillings, other people’s beautiful fillings. And yours will be functional, but they don’t look like that. And we try and explain to the young practitioners, ‘They know that work’s good, that’s why it’s on Instagram.’

But you find that people tend to think ‘I’m bad, I’m bad.’ And we find that in the work superheroes don’t take sick leave when they were talking about why practitioners won’t take time away because they’re worried about being away from their team and letting their team down. A lot of dental practitioners report a fear of taking sick leave because they’re worried if another practitioner sees their patients, they’re going to realise just how terrible they are. They don’t want other people to see their work because they’re frightened they’re not as good as others. And it doesn’t just start in practice. We actually see it starting all the way back in medical and dental school where imposter syndrome is rife. And of course, there’s been an amount of research about this, hasn’t it, across all clinical.

And going back to the point that Sarah made earlier about how we’ve never failed, and we’re used to being the highest achiever, we often see in problems in the dental schools in Australia, and I’m sure that this isn’t an Australian thing only, whereby people are so used to being top, and then all of a sudden, they’re not. We try and say to them, ‘Look around you. There’s nothing wrong with being average in excellence.’ And yet they can’t. ‘I’m always top, I’m always top, that’s how I define myself. That’s what makes me me.’ There are numerous cases of medical and dental students who’ve taken their lives when things hadn’t gone as they’d hoped. And I think when you hear that, that’s when we really decided we need to get into these dental schools and start teaching them some of these skills or just bringing to their attention, ‘I will make mistakes, and some of them will be serious.’

Rachel: This thing about, ‘I will make mistakes, some of them will be serious.’ Getting people to get out of that perfectionist mindset and into the growth mindset, but also escape from their whole imposter syndrome, whether you get perfectionism and imposter syndrome, both at the same time, which is this deadly. It’s a conglomeration of mindset things. And I’m just wondering, and Sarah, I’m interested in your thoughts on this as a coach, it’s much better for us to get into this growth mindset before we have a mistake. So we can then cope with it better then at the time and have to relearn our ways of thinking. What advice would you be giving someone as a coach to try and get themselves out of the perfectionist way of thinking out of that way of beating themselves up? And that awful self talk we have to ourselves?

Sarah: Yeah, that’s a really good question. I think prevention is better than cure. But as I said, I don’t think it’s often something that is really talked about at medical school, dental school and in terms of preparing yourself to make mistakes, I think as a coach alongside or mentor alongside someone who has, who’s going through a complaint or an adverse outcome has occurred is firstly to identify their mindset. So many of us don’t really tune into our thoughts in terms of what am I telling myself at the moment. So I would spend some time asking someone to really write out their thoughts. So I would talk about, ‘When you’re feeling like this, if you’re feeling angry, if you’re feeling really upset, or the feelings that you can identify, what’s behind that? What’s the thought that you’re telling yourself that’s perpetuating that feeling?’ So using that approach, I suppose from CBT, from cognitive behavioural therapy, your thoughts affect your feelings, which then affects your behaviour.

So if you want to change how we feel, and what we do, our behaviour, we need to go back to what am I telling myself. Because that’s what’s at the basis of the mindset. So either I’m telling myself, ‘I’m a terrible doctor, I’m the worst dentist.’ We’re telling ourselves things like that, which people might not consciously be aware that that’s what they’re saying. So a lot of coaching will be to pull that out. Make them aware of it, bring it out into the light, which often loses its power, and then often challenge those thoughts. ‘Where did that come from? Who says that that’s true? Could that be another perspective?’ So a lot of it will be reframing, let’s look. And often people find it really hard to see a different picture of themselves if that’s the decision that they’ve made. And so it would be a lot of stepping back and just looking at, and I think that’s where the confidence building comes in often as well. It’s interesting that people often have a fixed mindset around one aspect of their identity or their personality, but might have a growth mindset around something else. So often, I would try and find another area of their lives where they are perhaps kinder to themselves, and then say, ‘Okay, so you’re in your parenting, you practice very forgiving of mistakes that you make, or in another situation in your life.’ But what stops you, I often use the question, ‘what’s the difference that makes the difference in this area? So why is it different and okay to learn from your mistakes in your parenting, but it’s not okay to learn from your mistakes when you’re a health professional? ‘

Rachel: Hmm, that’s really good advice, isn’t it? Apply it to something else. Is there something else that you’re learning that you’re quite happy to fail out or make mistakes that we’ve talked in the podcast before? Yeah, I’m learning to ice skate. I make mistakes all the time. Because that’s what happens when you’re learning. You literally cannot learn to ice skate without falling over and making mistakes. Why can’t I then apply that to everything else that I’m doing in life and my work and stuff?

Sarah: And get back to coaching and mentoring doctors on the things I would often look at was gently challenging people that that mindset that they’ve got of applying to themselves? And what is the impact of that? And how’s that working out for you? And I suppose just thinking, is there another way of, I suppose, trying to pull the benefits or the good things? And you can’t look at it in the moment because it’s too painful to look at what’s the learning, I think, right in the heat of the moment. But later on, like Annalene said, she uses her example to help share that learning with other other dentists. And I think, how can you recognise that there’s learning in that not just for you, but also that dissemination of learning for others. We often think about in theatres with the connection for oxygen and nitrous oxide, the connectors were the same. And sometimes inadvertently, when cleaners were in the theatre would plug them back to where we ran, and that could have disastrous consequences. But how, because that was recognised, and people were open about the mistake that happened, how that probably saved lives on a much wider scale, because the connections are then changed to make it much clearer. And that mistake didn’t happen, it wouldn’t happen again. And I think one of the things that can help doctors and dentists is recognising how other people can benefit from their experience, and how that’s so powerful. And I think that can often be a hard thing. Not I say in the early stages, but later on how that can be useful.

Annalene: It doesn’t even have to be the big thing, though does it? I mean, I had a young recent graduate come to speak to me at the end of a conference to ask me how I, she was just found out she was pregnant. And she asked me, ‘How am I going to be a clinician with a baby? How am I going to make this work?’ And I said to her, ‘You know, you’re gonna have good days and bad days.’ And I also said to her, ‘One of the most important things to remember whatever you’re dealing with is there are people all over the world dealing with exactly what you’re dealing with right now.’ And I saw her years later and she said, ‘I have to thank you,’ and she gave me this whole story about how her baby, they’ve been driving, she’d been on the-way to work, just take the little one today, care the baby have been violently sick, projectile vomited everywhere, everyone was covered. And she said she was stood at the side of the road like mopping and both off with baby wipes crying going, ‘There are people all over the world going through this right now.’ She said, not only did she find it really helpful, but it actually made her laugh. And I think that it’s not just the big things, I guess. If we can compound that advice to our colleagues, sometimes you’d be surprised where people can find that help if we do share our experiences, good and bad. But particularly bad.

Sarah: Yes. I’ve certainly heard the saying normalise the abnormal, and I think that can be really helpful concept, those sorts of situations where you’re not alone. Other people have gone through this. And I think that is a really important message to take away.

Rachel: Yeah, totally. So we’re nearly out of time. In a second, I’m going to ask you for your three top tips that you would have for people so that they can prepare to fail well. And I think about it sort of myself, I would sort of just go back to this mindset thing, and what’s the self talk that you’ve got in your head? And what are the underlying beliefs about yourself? Because if you’re sort of, if something goes wrong, that hits on the fact that actually I’m not a very good doctor, then you’re going to have that dreadful self talk. Actually, you can change those stories you tell yourself quite well into, ‘I’m a good doctor. I’m doing my best. Mistakes will happen. But that doesn’t mean I don’t care.’ Things like that, that is going to sort of stand you in pretty good stead. So who’s got three to kick off with.

Sarah: So everything I’ve just said, normalise the abnormal in a way. Small things or big things, mistakes will happen, or complaints will be made, and difficult situations will occur. So accepting that that is going to happen. And then when it does, facing up to it in an early and a timely way in order to have the ability to be open. I think looking at something bad that happens, either we bury it and try and pretend it hasn’t happened and sort of never really push it down. Or we still plant it in the soil in terms of, we don’t want to always be carrying it around with us. But we are willing to wait for growth to come out of that. And as we’ve said, along this podcast, that it takes time for that to happen, but looking at it, and that when something grows, other people can also benefit from that. So I think just recognising either burying or planting a failure or a mistake can have very different outcomes.

Rachel: Thank you. So plants your failures. Sheila, what about you?

Sheila: I think the first thing I would say is, none of us are perfect. Even though at medical school, dental school, we believe that we have to be perfect to be successful, caring doctors or dentists. That’s the first thing, we’re not perfect. Second thing is we all make mistakes. No matter how careful we are, no matter how much time and training we put in, no matter how much we put patients first, we will all make mistakes. No matter how we try not to but something will be in the way.

And this is the most important thing I hope that listeners will take away from this, that, really, a mistake is a way to learn and grow and move forward. Not just for ourselves, but as I think Sarah, Rachel and Annalene have been saying, it’s a way of helping others as well. Because unless you’ve been in the shoes of someone who’s made a mistake, it’s difficult to give them guidance about how to get through it. So it’s not just a growth exercise for us. But it can help other people as well in the future. So, they’re my three tips, please come, if you do have a complaint, don’t feel ashamed or embarrassed to speak to somebody early on. Whether it’s a mentor, a close colleague at work or medical defence organisations, it’s best to share it early on. And that’s less of a burden in the future.

Rachel: Annalene.

Annalene: I suppose I’ll just say that not every piece of work you do will be an Instagrammable moment. It’s okay to do functional dentistry, speaking to my dental colleagues. It doesn’t have to be Instagram-worthy to be good. I don’t know if I’ve got three. But one thing I would say is that I’ve actually grown and learned from this conversation from something that Sarah said when we were talking about my adverse outcome, when she commented, what would you say to somebody if they rang up and had the conversation with you? And just reflecting on that, maybe that’s how I would say that we can prepare for failure. Not only by being kind to our colleagues and encouraging people to talk about their failure, so you don’t feel so isolated. You know, it can happen to anyone, it was just your turn, it was just your day. But also if you’re feeling really low, maybe that’s how we need to flip it. Maybe if I had sought Annalene, what would you say if Sarah was sharing this experience with you? Maybe my own self-talk could have been a little bit kinder. So that’s something for me to reflect on. Thank you, Sarah.

Sarah: Be kind to colleagues. Be kind to yourself. And I just think that every medical student, every trainee should have that phrase, ‘I am going to make mistakes and some of them will be serious. And that is okay. It doesn’t mean that I am a bad doctor, dentist, person, human being.’ Should have that sort of tattooed on where I can view the screens or something like that. It’s for me, it’s looking out for the self-talk. What are we telling ourselves? And when you catch yourself, berating yourself, telling yourself it’s shameful, feeling dreadful about it. Think, ‘Is this what I would say to my best mate? Is this how I would treat a loved one?’ And treat yourself the way that you would treat your best mate or a loved one.

Rachel: So thank you so much, everyone. We could talk about this for hours, I think but I think that’s been a really helpful conversation. I encourage people to just check out the resources around perfectionism, growth mindset. We’ll put some of the resources in the show notes. So if people wanted to get in touch with you guys, I guess it’d be through the Dental Protection or Medical Protection websites. There’s going to be more episodes in the surviving complaints series. So I hope this has been helpful to you. We would love listeners to share their comments or questions with us. I’ll also put my email address in the show notes as well, because we just love to hear your experiences, what your thoughts are. And if you are going through something at the moment that is difficult, please don’t keep it to yourself, please get the help that you need. And then we’ll put some more resources in the show notes about that as well. So thank you so much, everybody. It’s been a real pleasure speaking to you.

Sarah: Thanks very much, Rachel.

Rachel: Thanks for listening. If you’ve enjoyed this episode, then please share it with your friends and colleagues. Please subscribe to my You are Not a Frog email list and subscribe to the podcast. And if you have enjoyed it, then please leave me a rating wherever you listen to your podcasts. So keep well everyone. You’re doing a great job. You got this.

Podcast links

Join our Permission to Thrive CPD membership for doctors.

The Power of Believing You Can Improve, a TED talk by Carol Dweck

Connect with Sarah: Medical Protection Society

Connect with Annalene: Dental Protection Australia

Contact Sheila by sending your queries here.

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Twitter: @DrRachelMorris

Email: rachel@wildmonday.co.uk

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