We all make mistakes, but only some of us learn from them


More wallet trauma!

It seems my recent misfortune of having my wallet stolen is the gift that keeps giving for blog content. Having had my wallet stolen and cancelled the cards I awaited the arrival of new ones. I won't name the bank involved, but they managed to cancel my wife's card, the card I still have and not the one that was stolen. They also failed to order any new ones. I only discovered this after my irate wife found her card not to be working and went into the bank. 

After an extended phone-call the bank representative and I decided a mistake had been made and the simplest thing was to cancel everything again and start over. Frustrating though this was it was more of an inconvenience than anything else. It also restricts my wife's shopping for a few days, which is no bad thing for me, but may affect the UK's financial recovery.

There are certain areas of life in which mistakes can have more catastrophic consequences and medicine is one of these. It is impossible to prevent all mistakes, but there are systems to spot them and stop tragic consequences. Also we have systems to report 'near misses' so that people can learn from mistakes. It is generally accepted in medicine that not knowing the answer isn't dangerous it's doctors who think they know everything that are the dangerous ones.

Do we learn from our mistakes?

A study using our old friend functional magnetic resonance imaging has added scientific validity to this observation. A study carried out by Jonathon Downar of the University of Toronto, Canada looked at decision making and response to errors in experienced physicians. They took 35 experienced doctors and presented them with a task in which they had to select treatments and respond dependent on patient response. The failure of a patient to respond to treatment is not necessarily a mistake, but not recognising this and responding to it may well be.

They found the doctors split into two groups:

High Performers: these doctors learned equally from successes and failures.

Low Performers: these doctors seemed  to learn from their successes and ignore failure.

The scan results showed both groups activating their right dorsolateral prefrontal cortex and inferior parietal cortex. These are areas of the brain involved in selecting the importance of something and in associative learning. The difference was the poor performers activated this area in response to success and the high performers activated when the treatment failed.

Interestingly the study also found a trend that the more experienced a doctor the more likely they were to be poor performer in this task.

Don't switch to a younger doctor just yet

We shouldn't come to the paradoxical conclusion that seeing a doctor who knows nothing and has no experience is the best option. This was a task which looked at a specific aspect of decision making. It didn't allow for the use of prior knowledge and research. Experienced doctors are more likely to get things right, but what this study shows is they are more likely to think their right all the time, which is not a good thing. 

Medicine is already responding to this. In our training we are taught to use evidence based medicine which relies on objective measurement of a treatment. The culture of medicine is also changing, we are encouraged to seek colleagues advice, accept we can't know everything and keep an open mind.

I'm not sure how this relates to the bank messing up my cards, but given the banking sectors recent failure to learn from their mistakes it might be worth putting a few bankers in the scanner.

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