Why It’s So Hard to Admit You’re Wrong

Kristin Wong
The New York Times
Originally published May 22, 2017

Here are two excerpts:

Mistakes can be hard to digest, so sometimes we double down rather than face them. Our confirmation bias kicks in, causing us to seek out evidence to prove what we already believe. The car you cut off has a small dent in its bumper, which obviously means that it is the other driver’s fault.

Psychologists call this cognitive dissonance — the stress we experience when we hold two contradictory thoughts, beliefs, opinions or attitudes.

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“Cognitive dissonance is what we feel when the self-concept — I’m smart, I’m kind, I’m convinced this belief is true — is threatened by evidence that we did something that wasn’t smart, that we did something that hurt another person, that the belief isn’t true,” said Carol Tavris, a co-author of the book “Mistakes Were Made (But Not by Me).”

She added that cognitive dissonance threatened our sense of self.

“To reduce dissonance, we have to modify the self-concept or accept the evidence,” Ms. Tavris said. “Guess which route people prefer?”

Or maybe you cope by justifying your mistake. The psychologist Leon Festinger suggested the theory of cognitive dissonance in the 1950s when he studied a small religious group that believed a flying saucer would rescue its members from an apocalypse on Dec. 20, 1954. Publishing his findings in the book “When Prophecy Fails,” he wrote that the group doubled down on its belief and said God had simply decided to spare the members, coping with their own cognitive dissonance by clinging to a justification.

“Dissonance is uncomfortable and we are motivated to reduce it,” Ms. Tavris said.

When we apologize for being wrong, we have to accept this dissonance, and that is unpleasant. On the other hand, research has shown that it can feel good to stick to our guns.

The article is here.

When Therapists Make Mistakes

Keely Kolmes
drkolmes.com
Originally published August 10, 2009

We don’t often talk about therapeutic blunders, although they happen all the time. There are so many ways for therapists to fail clients. There is probably the most common: a mismatch of styles, or a therapist who is not really helping her client. Then there are those moments when perhaps we fail our clients by not responding in the moment in the way the client might desire. Maybe we sometimes challenge when we should nurture. Or we nurture when we should challenge. Or we may do any number of subtle things, perhaps below the threshold of consciousness, not even fully acknowledged by our clients, but which create distance, disappointment, or detachment. Some examples of this are the stifling of yawns, spacing out for a moment, or failing to remember an important name or detail and the client feels we are not really fully present or engaged with them. This lack of connection may trigger feelings of disappointment, loss, or abandonment. For clients with relational traumas, events such as vacations, emergencies, or even adjustments in session times may also cause feelings of loss and abandonment.

Recently, I was having one of those weeks. The details aren’t important, but I’ll acknowledge that I had taken on a few too many things. Top it off with having a few people needing to meet at different times. Add to that one way I manage client confidentiality: putting client names into my hard calendar (which I do not carry about with me) and then transcribing the sessions later to my iPhone calender simply as “client,” to preserve confidentiality in the event that my phone is lost or stolen.

The result?

The blog post is here.

Medical culture encourages doctors to avoid admitting mistakes

By Lawrence Schlachter
STAT News
Originally published on January 13, 2017

Here are two excerpts:

In reality, the factor that most influences doctors to hide or disclose medical errors should be clear to anyone who has spent much time in the profession: The culture of medicine frowns on admitting mistakes, usually on the pretense of fear of malpractice lawsuits.

But what’s really at risk are doctors’ egos and the preservation of a system that lets physicians avoid accountability by ignoring problems or shifting blame to “the system” or any culprit other than themselves.

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What is a patient to do in this environment? The first thing is to be aware of your own predisposition to take everything your doctor says at face value. Listen closely and you may hear cause for more intense questioning.

You will likely never hear the terms negligence, error, mistake, or injury in a hospital. Instead, these harsh but truthful words and phrases are replaced with softer ones like accident, adverse event, or unfortunate outcome. If you hear any of these euphemisms, ask more questions or seek another opinion from a different doctor, preferably at a different facility.

Most doctors would never tell a flagrant lie. But in my experience as a neurosurgeon and as an attorney, too many of them resort to half-truths and glaring omissions when it comes to errors. Beware of passive language like “the patient experienced bleeding” rather than “I made a bad cut”; attributing an error to random chance or a nameless, faceless system; or trivialization of the consequences of the error by claiming something was “a blessing in disguise.”

The article is here.

Why Is It So Hard for Us to Admit Our Mistakes?

Karen Firestone
Harvard Business Review
Originally posted March 28, 2016

Advice for how to gracefully handle mistakes often emphasizes 1) taking responsibility for the error, 2) presenting a plan for the remedy, and then 3) fixing what was wrong. Although these directions sound simple, they can be extremely difficult to execute in real life. No one finds it easy to own up to a mistake — particularly a costly one.

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Many people are afraid of appearing incompetent in front of our colleagues and bosses. But what we sometimes don’t realize is that it is worse to be viewed as a coward incapable of owning up to mistakes or accepting criticism. Rather than saying, “The plate dropped,” it is good practice to say, “I dropped the plate” — especially if that is exactly what happened. The best executives and investors “drop plates” all the time; without doing so, they would lack experience and a healthy understanding of risk.

The article is here.

Is It Safe For Medical Residents To Work 30-Hour Shifts?

By Rob Stein
NPR
Originally published December 7, 2015

Since 2003, strict rules have limited how long medical residents can work without a break. The rules are supposed to minimize the risk that these doctors-in-training will make mistakes that threaten patients' safety because of fatigue.

But are these rules really the best for new doctors and their patients? There's been intense debate over that and some say little data to resolve the question.

So a group of researchers decided to follow thousands of medical residents at dozens of hospitals around the country.

The study compares the current rules, which limit first-year residents to working no more than 16 hours without a break, with a more flexible schedule that could allow the young doctors to work up to 30 hours.

Researchers will examine whether more mistakes happen on one schedule or the other and whether the residents learn more one way or the other. The year-long study started in July.

The entire article is here.

Haunts or Helps from the Past: Understanding the Effect of Recall on Current Self-Control

Hristina Nikolova, Cait Lamberton, and Kelly L. Haws
Journal of Consumer Psychology
Available online 30 June 2015

Scientific Abstract

Conventional wisdom suggests that remembering our past, and particularly, the mistakes we have made, will help us make better decisions in the present. But how successful is this practice in the domain of self-control? Our work examines how the content of consumers' recollections (past self-control successes versus failures) and the subjective difficulty with which this content comes to mind (easily or with difficulty) jointly shape consumers' self-control decisions. When successes are easy to recall, we find that people display more self-control than when they have difficulty recalling successes.  However, recalling failures prompts indulgence regardless of its difficulty. We suggest that these differences in behavior may exist because recalling failures has substantially different affective and cognitive consequences than does recalling successes. Consistent with this theory, we demonstrate that self-certainty moderates the effects of recall on self-control. Taken together, this work enhances our understanding of self-control, self-perceptions, and metacognition.

Layperson interpretation can be found here.

Professional article can be found here.

So much for Hippocrates: Why docs won’t reveal each other’s mistakes

Research suggests physicians are concerned about becoming known as a tattler and losing referrals

By Marshall Allen
Propublica
Originally published November 12, 2013

Patients don’t always know when their doctor has made a medical error. But other doctors do.

A few years ago I called a Las Vegas surgeon because I had hospital data showing which of his peers had high rates of surgical injuries – things like removing a healthy kidney, accidentally puncturing a young girl’s aorta during an appendectomy and mistakenly removing part of a woman’s pancreas.

I wanted to see if he could help me investigate what happened. But the surgeon surprised me.

Before I could get a question out, he started rattling off the names of surgeons he considered the worst in town. He and his partners often had to correct their mistakes — “cleanup” surgeries, he said. He didn’t need a database to tell him which surgeons made the most mistakes.

The entire story is here.

Thanks to Gary Schoener for this article.

Talking with Patients about Other Clinicians' Errors

By Thomas H. Gallagher, Michelle M. Mello, and others
The New England Journal of Medicine
Originally published November 6, 2013

Here is an excerpt:

The rationales for disclosing harmful errors to patients are compelling and well described. Nonetheless, multiple barriers, including embarrassment, lack of confidence in one's disclosure skills, and mixed messages from institutions and malpractice insurers, make talking with patients about errors challenging. Several distinctive aspects of disclosing harmful errors involving colleagues intensify the difficulties.

One challenge is determining what happened when a clinician was not directly involved in the event in question. He or she may have little firsthand knowledge about the event, and relevant information in the medical record may be lacking. Beyond this, potential errors exist on a broad spectrum ranging from clinical decisions that are “not what I would have done” but are within the standard of care to blatant errors that might even suggest a problem of professional competence or proficiency.

The entire article is here.

Thanks to Gary Schoener for this information.

The ethics of admitting you messed up

By Janet D. Stemwedel | October 14, 2013
The Scientific American Blog
@docfreeride

Here is an excerpt:

Ethically speaking, mistakes are a problem because they cause harm, or because they result from a lapse in an obligation we ought to be honoring, or both. Thus, an ethical response to messing up ought to involving addressing that harm and/or getting back on track with the obligation we fell down on. What does this look like?

1. Acknowledge the harm. This needs to be the very first thing you do. To admit you messed up, you have to recognize the mess, with no qualifications. There it is.

2. Acknowledge the experiential report of the people you have harmed. If you’re serious about sharing a world (which is what ethics is all about), you need to take seriously what the people with whom your sharing that world tell you about how they feel. They have privileged access to their own lived experiences; you need to rely on their testimony of those lived experiences.

The entire article is here.

Owning Our Mistakes

By Nate Kreuter
Inside Higher Ed - Career Advice
Originally published May 15, 2013

Some of the columns that I write here at Inside Higher Ed arise from a really basic formula. It goes something like this: I make a mistake at work. I realize my error, or am compelled by another party to realize it, and I take corrective action. Then I write a column addressing the mistake in general terms, in hopes of perhaps removing a little of the trial and error from this whole higher education gig for a reader or two. Somewhat less frequently I simply observe the mistake of another and then write a column. I probably couldn’t keep up with this column without the steady stream of mistakes I make myself. Maybe my mistakes are job security of a strange sort.

I probably could even use this venue to make a public promise regarding my mistakes to my colleagues in my department, college, university, and across my discipline. Here goes: I promise you all that I’ll screw up again one day. I don’t know exactly how and I don’t know exactly when, but I promise to bungle something. Maybe just in a small way. Maybe in a big way. Who knows?

But here’s what I also promise: I promise to own up to whatever mistakes I make as soon as I recognize them, to do everything in my power to correct them, and to do my damnedest not to repeat them. This is, I think and I hope, what it means to be a good colleague. I certainly would not ask a colleague for more, but I also expect no less.

If to err is human, then 'fessing up is humane. Humane for ourselves and humane for our fellows.

The entire post is here.

Leading Psychiatri​st Apologizes for Study Supporting Gay 'Cure'

By Benedict Carey
The New York Times
Originally published on May 18, 2012

Dr. Spitzer

The simple fact was that he had done something wrong, and at the end of a long and revolutionary career it didn’t matter how often he’d been right, how powerful he once was, or what it would mean for his legacy.

Dr. Robert L. Spitzer, considered by some to be the father of modern psychiatry, lay awake at 4 o’clock on a recent morning knowing he had to do the one thing that comes least naturally to him.      

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Now here he was at his computer, ready to recant a study he had done himself, a poorly conceived 2003 investigation that supported the use of so-called reparative therapy to “cure” homosexuality for people strongly motivated to change.

What to say? The issue of gay marriage was rocking national politics yet again. The California State Legislature was debating a bill to ban the therapy outright as being dangerous. A magazine writer who had been through the therapy as a teenager recently visited his house, to explain how miserably disorienting the experience was.

And he would later learn that a World Health Organization report, released on Thursday, calls the therapy “a serious threat to the health and well-being — even the lives — of affected people.”

The entire story is here.

Providers to Test Power of Apology in Malpractice Claims

By Robert Lowes

Medscape Medical News

Originally published April 27, 2012

The Massachusetts Medical Society (MMS) wants to prove that clinicians and hospitals can keep medical malpractice out of the courtroom by owning up to their mistakes with apologies — and sometimes cash as well.

The result, says the MMS, will be not only fewer lawsuits but also improved patient safety, less defensive medicine, and lower costs.

Earlier this month, the MMS and 5 other state healthcare organizations announced the start of a pilot program to promote a process called Disclosure, Apology, and Offer, or DA&O. It's a kinder and gentler approach to medical liability reform compared with measures such as caps on noneconomic (pain and suffering) and punitive damages, which are viewed in some quarters as abridging the legal rights of patients.

Like most of organized medicine, MMS supports these traditional liability reforms, but it also sees merit in avoiding the courts.

"The current liability system impedes open communication," says Alan Woodward, MD, a past MMS president and chair of its professional liability committee. "It creates a culture of blame, finger-pointing, and secrecy. We're trying to turn that around into an advocacy system that supports both patients and providers."

The entire article is here.

Thanks to Gary Schoener for this lead.

danger + opportunity ≠ crisis

How a misunderstanding about Chinese characters has led many astray

by Victor H. Mair

There is a widespread public misperception, particularly among the New Age sector, that the Chinese word for “crisis” is composed of elements that signify “danger” and “opportunity.” I first encountered this curious specimen of alleged oriental wisdom about ten years ago at an altitude of 35,000 feet sitting next to an American executive. He was intently studying a bound volume that had adopted this notorious formulation as the basic premise of its method for making increased profits even when the market is falling. At that moment, I didn't have the heart to disappoint my gullible neighbor who was blissfully imbibing what he assumed were the gems of Far Eastern sagacity enshrined within the pages of his workbook. Now, however, the damage from this kind of pseudo-profundity has reached such gross proportions that I feel obliged, as a responsible Sinologist, to take counteraction.

A whole industry of pundits and therapists has grown up around this one grossly inaccurate statement. A casual search of the Web turns up more than a million references to this spurious proverb. It appears, often complete with Chinese characters, on the covers of books, on advertisements for seminars, on expensive courses for “thinking outside of the box,” and practically everywhere one turns in the world of quick-buck business, pop psychology, and orientalist hocus-pocus. This catchy expression (Crisis = Danger + Opportunity) has rapidly become nearly as ubiquitous as The Tao of Pooh and Sun Zi's Art of War for the Board / Bed / Bath / Whichever Room.

The explication of the Chinese word for crisis as made up of two components signifying danger and opportunity is due partly to wishful thinking, but mainly to a fundamental misunderstanding about how terms are formed in Mandarin and other Sinitic languages. For example, one of the most popular websites centered on this mistaken notion about the Chinese word for crisis explains: “The top part of the Chinese Ideogram for 'Crisis' is the symbol for 'Danger': The bottom symbol represents 'Opportunity'.” Among the most egregious of the radical errors in this statement is the use of the exotic term “Ideogram” to refer to Chinese characters. Linguists and writing theorists avoid “ideogram” as a descriptive referent for hanzi (Mandarin) / kanji (Japanese) / hanja (Korean) because only an exceedingly small proportion of them actually convey ideas directly through their shapes. (For similar reasons, the same caveat holds for another frequently encountered label, pictogram.) It is far better to refer to the hanzi / kanji / hanja as logographs, sinographs, hanograms, tetragraphs (from their square shapes [i.e., as fangkuaizi]), morphosyllabographs, etc., or — since most of those renditions may strike the average reader as unduly arcane or clunky — simply as characters.

The second misconception in this formulation is that the author seems to take the Chinese word for crisis as a single graph, referring to it as “the Chinese Ideogram for 'crisis'.” Like most Mandarin words, that for “crisis” (wēijī) consists of two syllables that are written with two separate characters, wēi (危) and jī (機/机).

The third, and fatal, misapprehension is the author's definition of jī as “opportunity.” While it is true that wēijī does indeed mean “crisis” and that the wēi syllable of wēijī does convey the notion of “danger,” the jī syllable of wēijī most definitely does not signify “opportunity.” Webster's Ninth New Collegiate Dictionary defines “opportunity” as:

1. a favorable juncture of circumstances;
2. a good chance for advancement or progress.

While that may be what our Pollyanaish advocates of “crisis” as “danger” plus “opportunity” desire jī to signify, it means something altogether different.

The jī of wēijī, in fact, means something like “incipient moment; crucial point (when something begins or changes).” Thus, a wēijī is indeed a genuine crisis, a dangerous moment, a time when things start to go awry. A wēijī indicates a perilous situation when one should be especially wary. It is not a juncture when one goes looking for advantages and benefits. In a crisis, one wants above all to save one's skin and neck! Any would-be guru who advocates opportunism in the face of crisis should be run out of town on a rail, for his / her advice will only compound the danger of the crisis.

For those who have staked their hopes and careers on the CRISIS = DANGER + OPPORTUNITY formula and are loath to abandon their fervent belief in jī as signifying “opportunity,” it is essential to list some of the primary meanings of the graph in question. Aside from the notion of “incipient moment” or “crucial point” discussed above, the graph for jī by itself indicates “quick-witted(ness); resourceful(ness)” and “machine; device.” In combination with other graphs, however, jī can acquire hundreds of secondary meanings. It is absolutely crucial to observe that jī possesses these secondary meanings only in the multisyllabic terms into which it enters. To be specific in the matter under investigation, jī added to huì (“occasion”) creates the Mandarin word for “opportunity” (jīhuì), but by itself jī does not mean “opportunity.”

The rest can be read at Pinyin.info

When Colleagues Make Mistakes

By Stephen A. Ragusea, PsyD, ABPP

Guest Blogger

At least once a month, I receive a telephone call from a Florida psychologist who tells me that he or she knows that a colleague -- or a practitioner of a different profession -- is guilty of committing an ethical violation.  The psychologist then typically asks if I agree with their appraisal of the situation and expresses frustration regarding the problem.  Finally, they ask what they should do, often expecting that the Florida Psychological Associaton (FPA) will handle the problem.  They often express surprise when I remind them that, according to our Ethical Principles, their first responsibility is to have a little talk with the alleged offender. 

The American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (2002) suggests that our first obligation in these situations is to first seek an “informal” solution through professional consultation.  Specifically, Principle 1.04 states:

1.04 Informal Resolution of Ethical Violations

When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual, if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved. (See also Standards 1.02, Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority, and 1.03, Conflicts Between Ethics and Organizational Demands.)

But what happens if the offender isn’t willing to change or just pretends to seriously address the problem?  Or what happens if they insist the problem doesn’t exist?  I then explain that it may be necessary for them to report the matter to the appropriate professional board.  At that point, we consider Principle 1.05.  If the alleged offender is a psychologist, then the problem would be reported to the Florida Board of Psychology at 850- 488-0595, or referred to the APA Ethics Committee.   If, however, the practitioner is a member of a different profession, then the appropriate professional board must be contacted.  However, one must always remember that the ethical standards of the individual’s profession are those that apply, not those of the American Psychological Association.  Psychology’s ethical standards only apply to psychologists.  Of course, if the individual isn’t a member of any recognized profession, ethical considerations are unenforceable and little can be done as long as the person is functioning within the law.

1.05 Reporting Ethical Violations

If an apparent ethical violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution under Standard 1.04, Informal Resolution of Ethical Violations, or is not resolved properly in that fashion, psychologists take further action appropriate to the situation.  Such action might include referral to state or national committees on professional ethics, to state licensing boards, or to the appropriate institutional authorities. This standard does not apply when an intervention would violate confidentiality rights or when psychologists have been retained to review the work of another psychologist whose professional conduct is in question.  (See also Standard 1.02, Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority.)

For a variety of reasons, psychologists are often unwilling to confront these problems in either way outlined above.  For example, sometimes psychologists are afraid of insulting the other professional or sometimes they fear some form of retribution.  However, we must all have a little courage and remember that it part of our own ethical duty to address these matters in a productive, professional, and effective manner.  We’re all in this together and we’re all trying to serve humanity well.  Don't be afraid to make a constructive intervention; we can all do better!