A fool such as I
http://www.100md.com
《英国医生杂志》
1 UnitedHealth Europe, London SW1P 1SB richardswsmith@yahoo.co.uk
Making mistakes is an essential part of being human. Ralph Waldo Emerson said: "All life is an experiment. The more experiments you make, the better." He might have written: "All life is mistakes. The more mistakes you make, the better." Mistakes are great teachers, but they also allow us to get through the day. Try to spend a day without making a mistake, and you'll do nothing. So I find it hard as I survey 52 years of mistakes to pick my biggest. I'm spoilt for choice.
But since this is a medical journal I think back more than a quarter of a century to a man in his 50s who was admitted to the ward on which I worked. He was a true cretin with congenital hypothyroidism. He had pneumonia and was in respiratory failure. Should we treat him? All we knew about him was that he lived with his elderly mother. After much debate—a debate, in retrospect, that was wholly uninformed by ethical analysis—we decided that we wouldn't. He was tucked up in bed, and I went home.
Credit: topfoto.co.uk
When I arrived the next morning he was sitting up in bed, reading a comic, and surrounded by visitors. He was, I discovered, the most popular person in his village. His mother was devoted to him, and I soon came to like him. After a few days he went home.
This was a mistake that had wholly positive outcomes. The patient did well—and might not have done if we'd tried some heroic treatment. I learnt about the severe limitations of medicine and that I was a fool. Only unthinking fools could have decided to leave a man to die without learning more about him and talking directly to his relatives. I couldn't claim now not to be a fool, but that mistake made me a wiser fool.
Competing interests: None declared.
True confessions
In October Minerva asked readers to submit their tales of clinical, career, or other mistakes, for publication in this issue. First to respond were Dave Sackett and Richard Smith, followed by others, some of whose confessions are printed below. You can see all the responses and add your own contribution on bmj.com (http://bmj.bmjjournals.com/cgi/content/full/329/7474/DC3)(Richard Smith, chief exec)
Making mistakes is an essential part of being human. Ralph Waldo Emerson said: "All life is an experiment. The more experiments you make, the better." He might have written: "All life is mistakes. The more mistakes you make, the better." Mistakes are great teachers, but they also allow us to get through the day. Try to spend a day without making a mistake, and you'll do nothing. So I find it hard as I survey 52 years of mistakes to pick my biggest. I'm spoilt for choice.
But since this is a medical journal I think back more than a quarter of a century to a man in his 50s who was admitted to the ward on which I worked. He was a true cretin with congenital hypothyroidism. He had pneumonia and was in respiratory failure. Should we treat him? All we knew about him was that he lived with his elderly mother. After much debate—a debate, in retrospect, that was wholly uninformed by ethical analysis—we decided that we wouldn't. He was tucked up in bed, and I went home.
Credit: topfoto.co.uk
When I arrived the next morning he was sitting up in bed, reading a comic, and surrounded by visitors. He was, I discovered, the most popular person in his village. His mother was devoted to him, and I soon came to like him. After a few days he went home.
This was a mistake that had wholly positive outcomes. The patient did well—and might not have done if we'd tried some heroic treatment. I learnt about the severe limitations of medicine and that I was a fool. Only unthinking fools could have decided to leave a man to die without learning more about him and talking directly to his relatives. I couldn't claim now not to be a fool, but that mistake made me a wiser fool.
Competing interests: None declared.
True confessions
In October Minerva asked readers to submit their tales of clinical, career, or other mistakes, for publication in this issue. First to respond were Dave Sackett and Richard Smith, followed by others, some of whose confessions are printed below. You can see all the responses and add your own contribution on bmj.com (http://bmj.bmjjournals.com/cgi/content/full/329/7474/DC3)(Richard Smith, chief exec)