Penitentes, (summit of Kilimanjaro. Photo H. Colt)

The name “penitente” is defined as both a noun (a person who repents their wrongdoings and seeks forgiveness) and an adjective (a feeling or showing of sorrow and regret for having done wrong). The origin is Spanish, and the description in the mountains arose because a field of penitentes looks like a procession of monks in white robes.  These snow and ice formations range from one to six meters high, occurring at high altitude on glaciers and snow fields, requiring sunlight, and cold dry weather for their formation.

Everyone makes mistakes, including doctors, but not everyone feels bad about it afterwards. Or perhaps such a blanket statement is untrue about medical professionals? These thoughts were on my mind as I was climbing Kilimanjaro and some of the higher African peaks a couple months ago. Among other things, I tried to recall the names of patients and the circumstances during which my performance could have been better; where mistakes could have been avoided, and where results from therapeutic curative or palliative procedures might have been improved.

Most medical practices and teaching institutions do not readily offer counseling or guidance in case of medical error. Focus is almost entirely on the potential or real legal aspects of an incident. Some departments do stress quality control and rapid remedial response in case of sentinel incidents. Repeated procedural practice using simulators and models is not widespread, however, and nonjudgmental professionally-led forums for repentant health care providers are not actively promoted for trainees, faculty, or physicians-in-practice.

Think about it. When was the last time you initiated serious conversation with a colleague or sought consultation with a medical professional to discuss one of your medical errors? Did you discuss the facts, procedural outcomes, and technical solutions? Did the conversation mostly involve that part of your cognitive brain, or were you also able to honestly and openly discuss your feelings (guilt, remorse, anger, or regret). If you are a teacher or mentor, how often do you include a query about feelings, thoughts and emotions when you discuss accident prevention, complications, or medical procedural errors? How often do you make such discussions part of a regularly scheduled debriefing session?

And if the answer is not often, pray tell, why not?