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A Piece of My Mind
June 12, 2018

The Art of Constructive Worrying

Author Affiliations
  • 1Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis
JAMA. 2018;319(22):2273-2274. doi:10.1001/jama.2018.6670

Some nights I lie awake and think about patients from the past. Mistakes play back like a movie reel in my mind. Some details are now lost to me, as many of these mistakes hark back to when I was a resident. But the sick sensation of realizing an error comes back as vividly as if it were happening now. Why didn’t I immediately transfer the patient with a suspected gastrointestinal bleed to the intensive care unit? Shouldn’t I have made a diagnosis of sepsis earlier in the patient who had low blood pressure but no fever? Why did I question the need for a bronchoscopy in the patient who had a solid organ transplant a year earlier and ended up having pneumocystis pneumonia? The mistakes haunt me, as they should any conscientious physician. We carry deep within us the cardinal rule of medicine: first, do no harm. And yet all of us will make errors, and therefore do harm.