The art of fixing breaks
- amyhluu
- May 22, 2023
- 3 min read
I don’t know if I’ve been a very good doctor this week.
Sometimes, when things go wrong in medicine, they can go very wrong. It may not even be an error in clinical decision making. It may be related to a delay in medicine administration time. It may be related to an emotionally charged patient interaction that led to an aggravated clinician. It may be the snowball effect of what is said during heightened situations that impacts everyone throughout the course of their day. And sometimes, it can be difficult to pinpoint the exact moment where things went wrong.
We work in a complex system. Failure is inevitable in such a complex system. Part of the issue in understanding and accepting the failures that occur, is that medicine is made up of highly performing individuals who are raised to value hyper competence. This hyper competence is equated to insanely long working hours, an intense and complex patient load and efficiency despite your attention being pulled in ten different directions. But this value and striving for hyper competence comes at a cost. The cost is that when systemic failures do occur, they can become adopted as personal failures.
In recent months, I’ve spent a great deal of time thinking about fractures.
Fracture:
Noun – the cracking or breaking of a hard object or material
Verb – break or cause to break
Most of the time, fractures in children have an expected trajectory. There is a break in the bone and then there is an intervention to try and fix the break. The healing comes. The child grows up healthily and hopefully happily. They fearlessly go back on the monkeybars and play football and jump on the trampoline. I mean, I suppose somebody has to keep us in business. One of the main life lessons I lived by in the preceding months was scrawled on an A4 piece of paper (in a surgeon’s half legible handwritten scrawl) stuck on the wall of an office with peeling off bluetack.

I lived by the idealism that breaks could be fixed. Breaks in the system, however, are much more difficult to fix. Fractured teams are much more difficult to fix. I don’t think I was a very good doctor this week because I haven’t quite yet learned how to fail gracefully within a complex and fraught system. And in doing so, I wonder if, at times, I didn’t keep the best interests of a complex and sick patient at the forefront of my reactions and decision-making. I was faced with the humbling reality that hyper competence in medicine may well be a myth, and the absurd expectations we can place on ourselves can lead to the most spectacular failures.
But like any break that has just occurred, the first step is reduction. The original meaning of the word is to ‘bring back, or restore.’ I think we need to restore the original principle of why we’re all doing this in the first place, whatever reason that may be for you. It is easy to get caught up in the annoyance of the daily ins and outs of the job. The weird smells. The shitty IT. The rejected referrals. The constant beeping. We can never be fully cognisant of all the parts and pieces and people that make up this complex system. But we can choose to be a slightly more decent part of it all. Warmth and patience and grace goes a long way. Distance, distraction and deflection are all well-known tricks of the trade (believe me, I have been living amongst the surgeons), but they are not the tools you want when patients are sick and dying and families are struggling to let go. So perhaps the starting point for an approach to failure is to recognise that hyper competence is a dangerous ideal to strive for, and instead it is more about reliability than performance. Showing up every day, not just for your patients, but for your people. So, I think I’ll persevere, despite all of the breaks and my many flaws.
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