Failures can be the pillars of successBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7423.1115 (Published 06 November 2003) Cite this as: BMJ 2003;327:1115
Few doctors can honestly claim that they have gone through their whole career without failing at something. Even the eminent dean of my medical school when I was sitting finals had allegedly failed his final MB examination because of a love affair with rowing.
Although most of the students botched the odd exam at the end of our first hazy term at medical school, I managed to perform consistently for the whole five years—consistently poorly, that is. Many of my peers never failed again, perhaps being genuinely scared into action by their initial blunders. Whatever the reason, it felt like they were freewheeling while I still needed stabilisers. To add to my bewilderment a handful of students were jettisoned at the end of the first year for failing retakes, many of whom had S levels to their name. Failure, much like illness it seemed, could befall anyone at any time.
Experiencing failure has made me more tolerant of colleagues, students, and, most importantly, patients
As time wore on I became sick of retaking exams. I remember a consultant whom I shadowed in Sussex in my final year saying to me, “Exams? Ah, don't worry about failing a few now and again—we've all done it. It hasn't affected my career at all. Breezing exams doesn't necessarily make you a good doctor.” His words offered me only temporary comfort, as I soon went on to “breeze” a fail in the finals, which meant I couldn't take up my post as his house officer. It seemed apocalyptic at the time; in reality it was a chance to take stock.
No one sets out to fail, but in a profession in which some postgraduate examinations have had pass rates as low as 10% to 15% not succeeding is effectively the norm. Last year a friend who had cruised through medical school, gaining distinction in her finals, was unexpectedly trounced by the second part of the MRCP examination—for the third time. Knowing that the odds are stacked against you when you sit this type of exam is of little consolation. If you have never failed an exam before the psychological effects can be immense when you don't make the grade.
Although most doctors' experiences of failure start with exams, the concept of failure extends beyond this. We work in a culture that increasingly calls for accountability and openness. Admitting that we are fallible—that we all make mistakes—is something that has taken years for our profession even to begin to embrace. The concept also applies to meeting our own expectations of ourselves: not getting on a particular rotation, or not getting a paper published in the right journal. It's all relative.
For me, calm reflection and positive thinking have been the key. Getting wound up about failing was depressingly unproductive, especially because deep down I knew why it had happened. (In the early days I had a total lack of aptitude for basic sciences, compared with most students. This resulted in a gross miscalculation in my booze to study ratio, which naturally is different for everyone.)
What I have since found useful is admitting why things went wrong and thinking about what I am going to do to stop it happening again and about whether anything positive can be drawn from it. It's amazing how there are almost always positive outcomes. Cynics would say that I have had to think like this to protect myself from being enveloped by gloom every time I fail. Perhaps there is some truth to this. However, I do know for certain that I would never have spent four extraordinary months abroad, be working in general practice in Buckinghamshire, or have met my wife had I not failed certain exams when I did.
Apart from improving my problem solving skills and my approach to exams (I don't sit them without good reason), deconstructing mishaps has taught me a lot about myself. I understand better my own strengths and limitations. Experiencing failure has also made me more tolerant of others: colleagues, students, and, most importantly, patients. Being aware of my own fallibility makes it easier to accept shortcomings in others.
I think it is particularly difficult for doctors to handle failure, because the outside world considers us to be highly successful people who have all the answers. It can be difficult to soak up this esteem if there are feelings of disappointment within. Failure has hardened me with its knocks but makes my every success all the more satisfying. I probably haven't seen the last of failure (much as I try to keep it at bay), but should our paths cross again I won't be fazed.
Ultimately, failure is an intrinsic part of the medicine game, common to many competitive professional environments. The best thing we can do is to try to learn from each event and capitalise on it.
Those of you who are yet to experience failure are either supreme beings or perhaps a little lucky; maybe both? As for the rest of us—we're only human.