“Is your dad, Glenn Waterkotte?” she said as I paid for my snow cone on a hot Phoenix evening at the little league field.  In response to my confirmation, she further explained, “He took care of both of my boys in the Neonatal ICU and now my oldest is a freshman in college!”.  She beamed with gratitude and I nodded with the appreciation that I had become so accustomed to hearing in our community. With that comment, I dove into reflecting on his 40 years of practice in a specialty filled with morbidity and mortality.  I remembered how he told me that in his 3 month sabbatical prior to retirement, the most notable thing was that he didn’t worry about his patients.  In the moment, the losses or near misses get all of our attention but we must celebrate the difference that we are making with our work.

Diagnostic heuristics are part of our daily work in healthcare.  These learned patterns based on study and experience create shortcuts that allow us to care for many patients every day.  They also are vulnerable and a component of errors.  Errors are events that we didn’t intend-  mistakes of missed diagnoses or improper treatments that have devastating effects on the caregivers who committed them.

Other losses that impact caregivers are the include inevitable physical decline related to our patients’ humanity, the inevitability of their deaths and the continued progression of incurable diseases despite the most sophisticated, state of the art treatments.

When you combine the sense of ownership and responsibility that those in healthcare possesses as a part of our professionalism with patient vulnerabilities and the limitations related to cognitive errors, caregivers continuously face loss that they feel personally responsible for.

This is hard and becomes the focus of our memories and attention.  Such attention can lead to us learning more through case discussion in morbidity and mortality conference, sharing with colleagues, publication of cases and further research.  However, it also can lead to silent suffering and a fear of not being “enough”.

Let’s also reflect on the more common and numerous successes.  These successes can range from listening, being compassionate for others, a diagnosis that comes from thoughtful review of the history and exam, confident reassurance in a worried patient or finding new efficiencies or capacity to accommodate a patient in our schedule.  How might our hearts change if we heard all of the voices of praise (like at the snow cone stand!) louder than our self doubt?

Reflection: Think of 3 things that you did well today in your work?   What stories might your patients or their families have said about you?