Failure: the great teacherBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7198.0 (Published 12 June 1999) Cite this as: BMJ 1999;318:0
Once in a gloomy moment, to console myself, I wrote: “One learns nothing from success, only from failure.” Somebody must have thought the same before, and it is probably more true than untrue. Failure obliges change. Success breeds complacency and fear of change. Hence success contains the seeds of failure. In a fast changing world stagnation means eventual failure. The first will be last. (We can perhaps see this now in the world of medical journals.)
Failure is, however, a greater taboo than sex or money, argues Carl Gray (Career Focus, classified supplement; classified.bmj.com/careerfocus). Doctors, all of whom have known the success of getting into and graduating from medical school, have great difficulties with failure. But, writes Gray: “Few doctors pass all their examinations first time, take their first choice of jobs at each stage, marry the perfect partner for them, and have 12 perfect children. None will continuously deliver high quality care to universally grateful patients before dying of joy after receiving the Monarch's congratulations on his or her 100th birthday.” Failure is all around us in medicine: the patients who cannot be saved; the errors that occur with a frequency far higher than in most other industries. There is a sense, suggests Gray, in which the whole medical profession is currently failing the public.
Medicine and doctors must embrace failure, not deny it. Otherwise, we destroy ourselves. Ironically, we aspire to a world without failure and yet must fail to reach such an unachievable state. Gray offers excellent advice, but some of the best comes from those two stalwarts of the (now failed) British Empire: Winston Churchill and Rudyard Kipling. Churchill regarded success as “the ability to go from failure to failure without losing your enthusiasm.” Kipling, in the poem voted the nation's favourite in Britain, wrote: “If you can meet with Triumph and Disaster and treat those two imposters just the same.”
Most doctors cannot follow this advice, shows a qualitative study of how general practitioners reacted to patients' complaints (p 1596). Most found the experience wholly negative. They responded by becoming more defensive in their practice and offering a less appropriate service. Only a very few managed to learn from the experience. This is a chilling study because it seems likely that in the future most doctors will have complaints made against them. If so, then as Richard Baker says in his editorial, it will be necessary to do more than simply intimidate those general practitioners who make mistakes (p 1567). Doctors are being toppled from their pedestals. The old world of omniscience, perfection, and success is dead. Long live the world of ignorance, weakness, and failure. It might be better.
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