Episode 31: Why We Err

Welcome to wisdom from the aerial view, the podcast for those who wish to learn how to crush their anxiety and find meaning and purpose in their lives. Good morning, good afternoon, good evening, I guess good evening to Dr. Klein, how are you Mark?

Good, Enid, how are you?

I am very good. Life is very good. And anytime you can wake up, put your legs on the floor when you get out of that bed, it's not a bad day. But you know, sometimes in life we make mistakes. So why don't we talk about mistakes today? I want to start by talking about a woman whose name is Charlotte Foltz Jones. She wrote a book entitled Mistakes That Work. It's about 40 different stories highlighting how seemingly flawed beginnings led to successful outcomes. For example, she discusses how it was a mistake that led to potato chips, silly putty, Velcro, and popsicles. But the real intent of the book was to subtly encourage deeper reflection on the nature of discovery, significance, and self-awareness. Now you have a chapter in your book entitled Why We Air. And you, being you, talk about the second law of thermodynamics, or as you call it, the law of unavoidable failure. You say, and I quote, perfection is an impossible goal. So today, let's talk about mistakes.

You

Are you implying I did something wrong?

But yeah, mean, thermodynamics, you know, I love it. So let's talk about it. Why this chat? Why the whole chapter on why we make mistakes.

Well, I'll tell you why. You one of the things we spend a lot of time doing in this, in our society, is placing blame on people. Who's responsible? Who knew what when? Blah, blah, blah, blah, blah, right? Okay. Well, you know, and I watch these people on TV accusing people of this, that, or the other thing, and he made a mistake, she made a mistake, blah, blah. Okay. Well, guess what? So did you. So does everybody. It's impossible. The law of unavoidable failure is, I just termed it that because it's so clear, right, that there is this law of unavoidable failure in our world. The world in which we live, People, you're going to make mistakes. You're going to make a lot of them, actually. You're not going to make just one. You're going to make a lot of them. You're going to make them at every age. You're going to make them in every venue of your life. It's going to happen. And why we err is a really interesting question. Why aren't we perfect? People go, well, it's just the way the world is. And as we've discussed previously in this podcast, that's a cop out because the world This world we live in is probably one of many, many worlds. I don't mean many planets, I mean many universes. That gets back to that quantum physics stuff we talked about. But the point is our world is very peculiar. It has certain characteristics. Not just the fact that there's 21 % oxygen in the air or gravity is just perfect for all the metabolic processes in our body to function. If we lived on Jupiter, none of this would work. not only the oxygen part, but the gravity would be so strong, your body wouldn't function, you couldn't do anything, there'd be no life, no human life as we know it. But our world is just kind of fine-tuned for human life, it's quite perfect. But it comes with a few other rules, right? And one of those rules is the law of unabordable failure. In the universe in which we live, in the world in which we live, everybody is going to make mistakes, 100 % of people. I just read an article, yes ma'am.

I want to stop you for one quick question. I just wrote myself a note. Is mistake versus failure? You say is a mistake a failure always or is it just a mistake? Why is it interchangeable?

No, think they're different things. What do you think? Yeah. I think failure, first of all, we should talk about that in another episode because failure is really a very interesting phenomenon too. we see these people rise from the ashes all the time. It's fantastic. It's these great, fantastic stories. We love them. Let's get.

I think they're different.

Right. But you call it unavoidable failure. It's a chapter on erring, which is erring is to make a mistake. So I gotcha. Okay, I'm just saying that because you know.

All right, you got me. It should be the law of unavoidable mistakes. How's that? Well, you're right, as always. I'm getting sick of the fact that you're always right. But but you are right. You are right. Except when you're wrong, because you too err. Everybody errs. OK, well, let's change it. Let's change it to law of unavoidable mistakes. OK, because I I want to get you off the. Too late.

I'm not, kind of liking this. I err, but I didn't fail. And there's that big difference. Okay. Let's rewrite the book here. Okay.

So yes, let's talk about it. Just talk about errors. Let's leave failure out of it. I probably shouldn't have called it that, but I did. But the point being that you're going to get it wrong. Everybody's going to get it wrong sometimes. So I read an article, I think two days ago, one of the medical. journals, now they're all online. This was a, what we used to call in medicine throwaway journals, meaning that they weren't like the New England Journal of Medicine or the Journal of Medical Association, which are peer reviewed. authors write articles that get reviewed by other experts and then they finally get published. throwaway journals were referred to as when they were paper, is that you could write an article about something medical that other doctors would receive and read, but they weren't necessarily peer-reviewed research papers. So now there's a whole bunch from online, nobody uses paper anymore. And I get these in my inbox like five times a day. I mean, I got a whole lot of them. And this one caught my eye because I'm a radiologist and this was about medical malpractice. among doctors and it was they coined this syndrome it was called medical malpractice stress syndrome i think it was maybe mmss they called it i think it's close to that it's a made-up word it doesn't don't worry about it don't commit it to memory because somebody made it up but the point being is like post-traumatic stress syndrome right or ptsd right this occurs in doctors who get sued for malpractice

Sure, sure.

Yes.

So what percent, here's a good question, what percent of doctors, let's just take radiologists, I only know that one, but what percent of radiologists, these are people who read CT scans, MRI scans, ultrasounds, x-rays, PET scans, all these things, what percent of radiologists will get sued in their career?

Probably way too many.

pick a number.

39%. No.

90. 90 % of radiologists will get sued in their career. I remember when I was years ago here in the Washington DC area where we live, 100 % of neurosurgeons had gotten sued. Now think about that. Are we saying that 100 % of neurosurgeons are incompetent? Are we saying that 90 % of radiologists are incompetent? Come on. I mean, look at the numbers. So that means that, and why is that? I can just talk about radiology.

Goodness. Enid (07:15.3) But how many lose? You get sued, but how many of them actually lose in court?

Doesn't matter whether you win or lose, I'll tell you why. Because MMSS, it's Medical Man Practices Stress Syndrome, takes effect whether you win or lose. Doesn't matter. So you're a big sports person and you know that, like if you ask Tom Brady about his Super Bowls, the first two he's going to talk about are the ones he lost to the New York Giants.

Yeah, that's true. No question, right?

you know, all professional athletes from the Michael Jordan's on, the things they remember are not so much the victories, but the defeats. They remember the failures. They remember the near misses. So as a doctor, because I'm like every other doctor and I've made mistakes. I remember every one of them. Now, the fact that I can remember them is a good sign. means I didn't make that many. But I remember them. I remember from the day I was a resident up until the latter part of my career. I remember the mistakes because you get so mad at yourself. But of course, you forget the rule of unavoidable, the law of unavoidable failure. You're going to make mistakes. I don't care who you are. So we talk about AI replacing doctors, or let's say radiologists. That was a big thing. Will AR replace radiologists? No, maybe, certainly not for a long time, but maybe not ever. But I think it's fantastic because it will help you make fewer errors because you're a human being, you get distracted, you miss things and you usually miss things because you're focusing on one area. Let's give an example. Let's say a patient comes in and have pain in their left side, high up under their ribs. So you're going to focus on that area like crazy. But there could be something in the right hip bone that's at the very bottom of the image that is indicative of something else. And you don't see it because you're so focused on trying to figure out why does this patient have pain on the upper side. This happens all the time. this, when you, when, when you make a mistake, especially as radiologists, it's in black and white forever. Images don't go away. We don't delete them. You're not allowed to. So a malpractice lawyer can, I can give you a better one. So let's talk about mammography. He brought that up not too long ago, breast cancer. So about 80 % of breast cancers can be seen retroactively on an earlier mammogram.

That means if you have a breast cancer diagnosed today, a good chance that there was some hint of it on a previous mammogram. But mammograms are like, where's Waldo? Good luck, right? They're very, very difficult to interpret. So the fact that if you go back and you say, oh, that's where it started, doesn't mean that a year or two ago you could have seen it and picked it up and recognized it as a problem. Right. So the retrospectoscope, which is a term we use in medicine, retrospectoscope, meaning looking back, hindsight is 20, 20. Right. You say, oh, God, it was there. Look at it right there. Now if you're a malpractice attorney, know, what we used to call ambulance chasers, you just have to hang out inside a breast cancer clinic and when a woman comes out, just ask every one of them, they diagnose breast cancer? And if one of them says yeah, there's an eight out of 10 chance they could see it on the previous mammogram, boom, you see the radiologist. So that's what life is like for a radiologist. It was the worst part of my career.

this.

Not getting suit park because that didn't happen very often. It was the fact that I was worried about it 24-7. Everyone is. We live in total panic fear from the moment we show up in our office to the time we leave. It never goes away. Right? And that's true for neurosurgeons. It's true for internal medicine doctors. I joke with my internal medicine doctor friends. I say, look, if you make a mistake, which you do, and the patient doesn't die, nobody knows about it. Right? But if I make a mistake,

Yeah.

and the patient doesn't die, doesn't matter because that film is still in black and white, it's digitized, it's available forever. So every doctor is making mistakes all day long. Nobody wants to hear that. The better doctors probably make fewer. I had a phone call. Years ago, when I was researching medical malpractice among doctors, was concerned that doctors were just freaking out and quitting. A very good friend of mine, who was a fantastic doctor, got sued about what we call a bad baby. The baby was born, this is many, many years ago, born with some serious medical issues. They sued the gynecologist because the gynecologist didn't deliver the baby earlier. But I can tell you from this case, if they had delivered the baby earlier, the same thing would have happened. They would have sued the gynecologist for delivering the baby too early. This is a no-win situation. But this doctor got so upset, and he was a fantastic doctor, he stopped delivering babies. Right then and there, boom, no more, I'm not doing it anymore. Well. The world just lost a really great obstetrician. This guy was terrific. Everybody loves him. And he's very technically skilled, but he couldn't handle it. And he is not alone. This is what happens to doctors all over the country. This idea of burnout you hear among doctors, one of the major reasons for burnout is people are afraid of getting sued. You go into the emergency room and you complain about abdominal pain, you're going to get a CT scan. or you go into the emergency room and you complain and get a headache, you're going to get a CT scan or MRI scan. Why?

1000 people are going to have a brain tumor or a headache. that emergence from doctor doesn't want to be the one to miss it and get sued. So he or she orders that extra study. So the cost of medical care goes up because we're ordering tons of unnecessary tests because people don't want to get sued. the side about we're talking is the stress it puts on the doctor to know every minute of every day, every patient you meet could be the one who's going to sue you because you're going to make mistakes. mistakes. First of all, you often get mis-suited for things you didn't get wrong, but you know you're going to make mistakes. It's 100 % guaranteed that you are going to make a mistake. If you work five days a week, that week you made a mistake. Guaranteed, absolute. Hopefully you only made one. You could have made 10. Who knows? But you're going to make mistakes. That's the law of unverbal failure. We don't really care about it in a plumber. If the plumber makes a mistake in the pipe, they come, I'll you, you know, well, it's not a great example. Let's talk about The plumber comes, fixes a leak, and then the next day you notice it's still leaking. You go, oh, gone. So you call the plumber back, go, hey, by the way, it didn't work. Oh, I'm really sorry, I'll come back and fix it. They come back, they fix it. No harm, no foul, a little puddle of water on the floor, that's it. If your doctor makes a mistake, well. The repercussions could be much greater. If a pilot makes a mistake, uh-oh, that could really be bad. So everybody's making mistakes, just the relative significance of the mistake changes based on what it is, right? So we don't really give the plumber too hard a time, because we know they're not going to get them all right. But if the doctor gets it wrong, if the pilot gets it wrong, this is a really big deal, right? So this law of unavoidable failure is ingrained in our universe. You cannot remove it. So then the question is, okay, what do we do to minimize it? So we do things to minimize them, but you're never gonna get rid of them.

Never ever ever. So in the MMS syndrome, the medical malpractice stress syndrome, this is a real problem. We're short on doctors as it is. We're just chasing doctors out of the field. We're making them retire early because they're freaked out, they're burned out. This is a big part of it.

The name of the chapter, of course, is why we err. So why do we make mistakes? Okay, you see? Right.

I was hoping we'd get to that. First we set the groundwork that everybody's gonna make mistakes, and now why? So we talked about the fact that the gravity on our planet is just perfect and that 21 % of oxygen in the air is just perfect. A lot of things are just perfect for human life or life in general. And we've also talked about the fact that many, many, many physicists from the best universities and places in the world believe that we live in one of an infinite or near infinite number of universes. And the laws of physics in our universe aren't necessarily replicated in those other universes. So gravity could be different. Oxygen in the air, we know in different planets, is different. But just the rules of physics could be different. So when you understand that, you have to look at our world with a little bit of a more of a close view and say, hmm, why is it this way? Why? So we could be born, we talked about this, with cells that never die. Our DNA could be written that no cell ever died and therefore no organism ever died. You know, we take for granted that we age, but that doesn't have to be that way. That's just because the software that runs us, our DNA, is written that way. So we could also live in a universe where nobody made a mistake, where everybody was perfect. where we might, the words to say, to err as human might not make any sense at all because there are no errors. We could live in a world with no errors. Why don't we? What is it, why? Then you think, okay, so why do we err? Why are we built this way? And then we get back to the topic we've discussed many, many times and that's the mission we're on, right? We are continually striving to make that evolution from selfish to selfless, from inward focus to outward focus. Making mistakes is part of it. This is how we learn. This is how we progress. This is how we become better than we were 10 minutes ago.

When you realize that you are fallible, that you can make a mistake, a couple of things happen. One, okay, I better try and pay more attention. But even more than that, understand that you are on this conveyor belt of life and your job is to continually improve, especially in how you treat other people. So there's a reason why it's part of the nature of our universe. It's required.

so we can learn from our mistakes as well.

Of course, yes, that's the point, to learn from your mistakes.

So let's talk, if we can for a minute, you're always talking about our mission, our mission. If our mission is prescribed for us, does the mission ever change? Does that evolve? After we make a mistake, does the mission change?

Hello? Is that you, Enid? Enid (17:46.5) my god, it's the President of the United States. Hold on. See, my mission is to put that phone on mute. Does the mission ever change?

No, the mission doesn't change, but part of the mission is to understand that we are here for a reason, that errors are another symptom, they're another example of what we're supposed to do. If there were no errors, we'd never have to learn anything. If we were perfect, if we lived in one of those universes where there is perfection and there would mistakes, there'd be nothing to learn, there'd be nothing to evolve from too. We'd be perfect. What else there is to do? Game over, born, done, die. There's no reason to be here, right?

Yeah. Yeah.

But there is, but it's not like that. We do err. We do have to overcome obstacles. We do have to learn from our mistakes. You mentioned failure. We do have to fail so that we can learn from those mistakes, those failures, so we can succeed the next time. It's part of the deal. So we started out talking about blame. And I mentioned that we tend to blame people, everybody for everything. But we have to have mistakes. They're a required part of humanity. We would have no humanity as we know it without mistakes. without the ability to educate, to learn, to progress, to improve. Without errors, this would never happen. You would see no progress in the world. Nothing new would ever occur. There'd be no new inventions. There'd be no new discoveries. There'd be no new writing. There'd be no new anything. If we were all perfect from the beginning, none of these things would exist.

You know, you said to err as human, you're right. But the second part of that is to forgive is divine.

it is.

So talk about that. Talk about after you've erred, talk about forgiveness.

So when I watch the news and I watch one politician after another politician blaming one side, they're always blaming each other. Have you noticed, very rarely do you hear a politician go, my bad, I failed. You hear athletes say that. You see somebody come back from a huddle, a football game, and it points to himself, that's...

Yep, no, no.

Right. And they'll write me right. That's right.

My bad, right? The quarterback will do it, the receiver will do it, the lineman, they'll all do it. You don't see a really successful football team or any sports team, the really successful ones, you don't see them fingers at each other. If they're pointing at themselves, if they're pointing at each other, they're not a winning team. But if they're pointing at each other, they realize, have a responsibility to this team. And we each have a responsibility in this world. That's it, to learn, to progress, to evolve. That's our job, right?

Right, not at each other, but at themselves. Correct.

Assessing blame is so foolish because if you're going to blame somebody for mistake then you are blind to the fact or willfully ignoring the fact that you have made mistakes and will continue to make mistakes. How in the world can you point your finger at somebody and say it's your fault when you're knowing 10 minutes ago it was your fault and 10 minutes from now it will be your fault again? So why are we pointing fingers at each other? Instead, we should give each other grace to forgive as divine. Yes, because the main reason is, hello, I'm gonna tell you another story.

Right.

Yes.

I know you hate these medical error stories, but I'm... Well, it's just the way it is, you know, but don't remember, just remember, don't worry about it. You don't have to worry about those things. That's what the aerial view tells us. You don't have to fret about these things. It's not, it's not, that's not what you have to worry about. Life is finite. You have a certain number of days. Death is inevitable. So just, you're here for a purpose, right? Don't worry about those things. But let me...

Well, no, it scare me to death, but other than that, hey, yeah.

So, but then why is there medical whatever syndrome? I mean, on the one hand you say don't worry, on the other hand you say every day that you're a doctor, every day you worry about the fact that somebody's gonna sue you. So how on the one hand you say don't worry, on the other hand you say, do I worry?

Okay, so that's an excellent question. So many years ago, I had to decide what I wanted to be. Am I gonna be the guy who worries all day long about making a mistake and ordering extra tests? I'll give you an example. When a radiologist reads a report, reads a case, we give what's called a differential diagnosis. I found this and these are the five things that can cause it. It could be an infection, could be a tumor, could be trauma. could be congenital, we give a differential diagnosis of the things that can cause it. A lot of radiologists will say, we'll give a differential like a lawyer. You ever try and get a lawyer to give you an answer? Well, it could be this, it could be this, it could be this, Well, so doctors can do the same thing and many do. So I know radiologists who write a report and say, it could be this, it could be this, and give a list of 12 things, right? And therefore you need to do five other tests. And I wouldn't do that.

Yeah.

I would say I think it's one of these three or four things. I think there is one of the tests I would do, that's it. Or I don't think it's worth doing another test right now. Let's wait and see because... I felt my responsibility was always to the patient. If I sent a patient for five more tests when I know they probably don't need it, what kind of doctor am I? I'm not helping anybody. I'm running up the cost and I'm running up the anxiety, right? The cost is one thing, but the anxiety is even worse. What do you mean it could be this? What do you mean it could be this? What do you mean I have to this test? You know, so I think it's responsibility to not increase the anxiety and not increase the cost and sit, you know, okay, you're out on a limb.

Right, yes.

You're gonna be out on a limb. I spent a lot of time out on limbs. Luckily, most of the time the limb didn't crash. Rarely it did, but it did, because I'm a human being. But at least I was doing what I thought was right for the patient. So I had to decide I'm not gonna be paralyzed. I'm not gonna let this paralyze me. So when I got that idea in my head and I started to get nervous, I would say, okay, no, no, no, no. You have it for a reason. You have a job to do. you know, the chips will fall with MA, you can't be paralyzed by this fear. So I never had MMSS, I never had medical mind practice stress syndrome, because I wouldn't let it happen to me. But I was well aware that I was like a millimeter away from it all the time. It took active effort not to let it get me. And occasionally it did, but most of the time it didn't. I didn't want to practice that way. I didn't want to be in constant fear. But I'll tell you a funny story, another one. I was talking to one of my colleagues the other day. And whenever I would get a phone call from the front desk, say, there's somebody here to see you, the first thing I would think about was, God, it's somebody presenting me with a, what do call it, not a summons, but a notification of being sued. You know, what do they call that when they come to serve you? I was being served papers for a malpractice suit. Every time my front desk would call me, for years, they'd say, somebody's here to see you. It was usually a patient or a friend or another doctor. It wasn't anything, but the first thing I thought of was that. The other day I was talking to one of my colleagues who I've worked with for many, many years. And I said, I'm gonna ask you a question. When they would call you from the front desk and say, Dr. So-and-so, there's somebody here to see you. What was your first thought? He said, oh, that I was being served with malpractice papers. Right? Crazy, right? That's how we lived. But, but.

Yeah, yeah, yeah.

Once you realize that you don't want to live that way, it's a very unhealthy way to live. It's not good for you and it's certainly not good for your patients. So I'll tell you, these are the kind of things that happen to every doctor. So I got a phone call years ago from one of my colleagues. said, hey, I want you to look at a case. You read this case two years ago. This is a very elderly gentleman, I think he was 90, came back for some other problem. And he said, at his kidney. And looked and sure enough, was a little, probably a little tumor growing in his kidney at that time. And now it had gotten much bigger. That's not what his medical problem was. He had other problems as well. But I look back, crap, I should have seen that, right? It was very subtle. I should have seen it. Fine. And I felt badly, but it didn't change the patient's outcome. wasn't going to shorten this patient's lifespan. The patient was 90, but also he had many other problems. He was just showing me this for interest, right? Not because it made any difference to the patient. A week later, I'm reading a case, a follow-up that he read a patient six months earlier, and the patient had a pancreatic cancer. And I looked back, and sure enough, it was there, and he missed it. Right? So this is the life of a radiologist, right? Now you can live, and it happens to everybody, the very, very, very, very best of the best of the best. 100%. Go to Harvard, find the best doctors in each department and ask them, have you ever made a mistake? And they'll all start laughing. Right? Well, of course I've made a mistake, right? That's just the way it is. So I decided that I wasn't going to be paralyzed by this because otherwise I'd have to quit.

Sure, sure.

I'd have to quit or be a terrible doctor and order 5,000 tests on every patient. That was the choice. Neither one of were acceptable to me. So I lived with the, tried to suppress the anxiety as much as I could. It was always there in the background, but I had to make a decision. You know, what was it going to be? I've, I've gone to medical school. did a residency and fellowship. I'm well trained. I'm here to serve the public. I can't panic. I can't freak out. I can't order 9 million tests on every patient.

Good.

just buck, you know, as my wife would say, just buck up, you man up, don't be a weenie. And that's what I did, but it took effort and I'm not complaining, it's just the way it is.

Yeah, yeah.

So we won't make mistakes. And again, I look at the clock and we're just a bit out of time. So let me end.

I don't think we're out of time. I think you're sick of talking to me.

No, I'm just scared to death and I'm never going to a doctor the rest of my life. I to end, as I usually do, with your own words from the chapter of Why We Erad. You say the law of unavoidable failure is another in the long list of clues we have assembled that points to a specific purpose for our lives. It is no accident that our world is as it is. We are supposed to get it wrong sometimes. Errors are prerequisites for personal growth. They are painful, but that is how we progress. A world without mistakes is a world without education, a world without change, a world without advancement. If we lived in a universe where we were blessed with wisdom right from the start, we would have nothing significant to learn. Every decision would work out. there would be no swings and misses. In this world, we are instead born ignorant and helpless, selfish and inward-focused. All our experiences, especially our blunders, are intended to incrementally reverse that as we progress through life. Mistakes are not a curse. Our inevitable missteps serve as additional confirmation that life is preparation. Those are good words. Those are wise words. But in many respects, they're scary words, but it reflects on where we are, who we are, our mission, and where we go from here. Final words?

But from the aerial view, they're not scary at all. From the aerial view, you get your purpose. You understand why you're here. You understand what the world is about. That's why each one of us repeats essentially the same acts as those who came before. We feel the same emotions. There's no emotion that you feel that nobody else has felt. We each have to experience life. Life is experiential. You have to go through this. You have to make the mistakes. You have to blunder. You have to fail because otherwise you won't be able to make the evolution. We're here for a reason. That's what's crystal clear from the aerial view.

Thank you. Appreciate that. I have a friend, a good friend of mine who's actually listening to this podcast and said to me just two days ago, you know, I think that this whole notion of the aerial view is something that I'm really getting into and it's changing my life. So Dr. Klein, again, let me hawk the book here. Wisdom from the Aerial View, the superpower that can change your life in this world by Mark E. Klein, MD. Good show, doc. Appreciate it. Love you.

Love you too, Enid. Thanks a million. Bye everybody. Thanks for listening.

See you next time, peace.