Failing Up and Failing Better

In Physicians as Humans by Sara Gray4 Comments

Do you have a case that haunts you? I do.

The details aren’t relevant, but the case was terrible and stayed with me.
Over the following days and weeks I stopped sleeping.
I stopped going to the gym. I started dreading work.
I swore more. I drank more.
I started falling apart.

Despite my years of studying and training and striving, I felt I wasn’t good enough. My residency, fellowship, and graduate degree hadn’t made me perfect and bulletproof. I felt like a failure. I felt ashamed.
And the worst part?
I kept really really quiet about it. Hiding my dark secret, so that no one would find out.
In medicine, we don’t spend a lot of time talking about our failures. This is the problem. Hiding our shame and our mistakes, only isolates us. It doesn’t allow us to share, to connect, and to learn from each other. It doesn’t let us realize that everyone else has been there too.
So I decided that if it was inevitable that I would fail sometimes, then I better learn how to fail up.

Here are my five steps; perhaps they might work for you too.

Step One: Accepting failure

Step One is to accept that you will fail. Because this makes it much easier to recover. All humans fail sometimes. Don’t start step two until you can handle step one.

Step Two: Breaking the silence

Step two is to learn to talk about your failures. And this one is hard for healthcare workers. In fact, maybe it’s just hard for everyone. We like to hide our mistakes instead. Why do we do this? Because generally, we believe that failing is weak, and one of our guiding rules in medicine is that weakness will not be tolerated. But here’s the thing. Talking about your failures is not weak. Standing up and telling your peers that you made a mistake takes enormous courage. It’s way easier to hide it, than it is to stand up and make yourself vulnerable.

There are different ways to talk these things over, but my personal favorite is to find yourself a failure friend. This is your go-to person you talk to when you’ve screwed up. Choose a person who won’t judge. Choose someone who is capable of empathy. Choose wisely.

This is the person you talk to when you’ve had a bad case, or a bad week or a bad year. You talk to them when you feel like quitting. Or drinking. Or using. Or dropping out.   And here’s the really important detail. You don’t need to have morbidity and mortality rounds with your failure friend. Instead, you talk to your failure friend about HOW YOU FEEL. About feeling ashamed. About feeling like an imposter.

And if you’ve chosen wisely, they will lean in, and tell you that they’ve been there too. And that they understand how you feel. And that you can work through it together.

Now, for some people, developing a failure friend takes a little time, or makes them feel too vulnerable as a first step. A different, and quite reasonable option, is to find yourself a therapist or a counsellor. Many large hospitals or universities have counselling services available. Services are also often available through provincial medical associations, or licensing bodies. Use these resources. If you broke your wrist, you would go to see a specialist to ensure you healed properly. Your brain is just as worthy as your distal radius.

Step Three: Excellent self-care

Step three is taking care of yourself, because excellent self-care makes a huge difference. Figure out what brings you peace of mind, and practice it regularly. It could be exercise, yoga, meditation, or whatever else works for you.

Make time to celebrate, to see your friends, to see your kids. Joy is an excellent antidote to despair. So don’t skip that birthday party.

You should actually book these things in your calendar. Protect time to celebrate, to exercise, to recharge. These are moments worth prioritizing, just as you would prioritize your work. You are worth it.

Good self-care also includes self-compassion. This is the concept of treating yourself kindly. Speaking to yourself in the same language and tone that you would use with your best friend. If you are trying to achieve something difficult, self-compassion is a vital part of that process.

Step Four: Learn and teach about it

Step four is to sit down and learn from the case, from a position of acceptance and self-care. This includes learning the medical lessons involved, but also includes learning to forgive ourselves for having failed in the first place.

Then teach about it, give M&M’s, give rounds. Help others learn from your lessons.

Step Five: Taking care of each other

Step five is to use these skills to look after your friends, loved ones and colleagues who are in crisis. To listen to each others’ stories with compassion rather than judgement. To respond with empathy, rather than shame. Recovering from failure isn’t just about saving yourself; it’s also about helping your friends, your loved ones and your teammates.

Bottom line: No one is perfect. Not you, not me, not your most admired colleague. Accepting that we will all fail is the first step. We need to break our silence around this, because keeping quiet about it can be deadly. Failing better means taking brave steps: to talk about it, and to take active care of ourselves and each other. Don’t let your mistakes drag you down; use them as a springboard towards self-growth and reflection after failure.

Sara Gray

Dr. Sara Gray is an EM physician and Intensivist at St. Michael's Hospital in Toronto, ON. She is also an Associate Professor at the University of Toronto.

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