Honor and shame dominate many cultural interactions here. High-status positions within medicine bring honor and occasionally a sense of entitlement. Correcting anyone in front of other people is felt to be shameful, which makes the back-and-forth of medical education quite difficult. In my residency training, the best teachers were the ones who interrogated my diagnoses and treatment plans until they had found holes in my reasoning, pointed them out for everyone to see, and challenged me about how to think differently about clinical problems. Even changing previously written orders while on rounds together can bring shame to the clinician who wrote the now-abrogated order. (To be fair, my experiences in the American medical system had plenty of hurt feelings over honor and shame!)
Our challenge is to work within the existing culture and recognize its strengths (America is learning what can happen when you keep saying “anyone can be President!”) while encouraging people to take on Christlike humility. It is not easy to be humble in any culture, but it’s particularly challenging in a place where saving face is more important than getting things done and throwing one’s weight around is often the only recourse for maintaining a high standard of care for our patients.
I wasn’t really thinking about this at 4AM on a Sunday morning when poor Graham got roused from sleep to come help me with a surgery, but he was.
I had already been awake for two hours, trying to get the c-section done quickly enough to go back to bed before church. It seemed fairly routine, though I was having trouble controlling the bleeding after I got the baby out and I didn’t know why. I’ve now been doing c-sections on my own routinely, trading off cutting and sewing with some of our clinical officers so that they can grow in experience, too. I hadn’t called for help from one of the more experienced doctors in over a month, but after I had already done all I could do, I felt like I had no other choice but to call for assistance.
One of the great strengths that both expatriate doctors who have both been here for years share is their sense of calm in life-and-death situations. (Read more about Jeff here and Graham here.) It was no different this early Sunday morning as I held pressure and Graham ambled into the operating theatre, putting on a mask and leaning over to look into my surgical field as I threw my hands up in exasperated fear that I had done something wrong.
In a manner meant as much for the staff gathered in the room as for me, he mentioned a time when he had made a mistake at the step in the operation I was stuck at. After a few minutes of looking around, I realized that I had followed in Graham’s footsteps and made exactly the same mistake!
This was my first time that I’d had to cut my own sutures in the middle of an operation. It was not a pleasant experience to undo my very thorough (and very wrong) work, then keep the rest of the surgical team up for an extra half hour while I fixed my mistake. The patient and her baby did fine, but I was of course ashamed and discouraged because I’d made such an ugly mistake.
When I got home, Graham had already written me an email. It was a perfect example, he suggested, of how peers correct each other and accept correction while maintaining mutual respect. While I would personally like to have opportunities to be a light and a witness in ways other than “models humility when wrong”, I was really thankful that we were able to have that interaction as an demonstrate something that the long-term workers have been talking about for years.
Every medical team, no matter where they are practicing, will make mistakes. And no matter where you are, the people involved will feel the urge to save face and resist correction instead of being honest and working together to find a solution. We need good systems and protocols in place to catch mistake before they cause harm, but we also need humble-hearted clinicians to take responsibility and change course, even if it might mean admitting you were wrong in a culture where doing so brings shame. I don’t know when my next opportunity to learn something the hard way will come (hopefully at a more reasonable time of day), but I’ll certainly look at it as an opportunity to teach, too.