I made a mistake. A big mistake. It's the type of mistake that I thought only "bad" pathologists made. I discovered a "cancer mimic" while reviewing a mastectomy of a patient who had already received chemotherapy. The problem was that I was the one who had originally diagnosed this mimic as cancer on a biopsy. The mastectomy specimen appeared to me as what I call "busy breast tissue"; i.e. large amounts of sclerosing adenosis, papillary changes, and hyperplasia. This is why I pulled my original biopsy to look for the cancer. I knew that it would be difficult to diagnose the tumor given how busy the breast tissue looked, so I pulled my original to make a comparison and on that day, months later, I realized it wasn't cancer and that I had made a grievous mistake.
I sought the advice of my colleagues, but they only told me that they never would have pulled the original to compare, and that's where I went wrong. I disagreed. After all, I made the mistake: I changed a patient's life and wanted to be held accountable. To know that my actions could cause such a drastic chain of events changed my life. I couldn’t eat, sleep, or focus at work, but I had to move on to take care of new patients. I had to find a way to make this right.
The problem was that there was no easy way to do it.
I went through a mental checklist that I had cultivated during my training. I knew my original diagnosis was the result of doing everything a new-in-practice pathologist is supposed to do. I even asked for a second opinion and consulted with the most experienced pathologist working that day. He agreed, it was cancer. He signed a form that confirmed my diagnosis, and I put his name as my intradepartmental consultant.
But we were just plain wrong.
To make it right, I called the surgeon and the oncologist the day I became suspicious of my error. The oncologist supported me through several conversations and said that although I had made a mistake, he still believed the patient had cancer—the clinically evident mass had shrunk with chemotherapy. I sought outside consultation from a national breast expert on both of the cases. She agreed it was an error. I asked to meet with the patient, but the oncologist felt my presence might be a violation of the relationship they had built and assured me that he could present this to her compassionately and accurately in my absence. The oncologist even went so far as to tell me that he thought I was a great pathologist, that he valued working with me, and that errors made me human, all of which helped me over the coming months as I came to grips with what had happened.
You become a doctor because you want to help people, and I wanted to do what was right for the patient. I had always assumed that even the best doctors make mistakes, but it’s still difficult to reconcile that message when (not if) it happens to you.
I emphasize to my new hires that they should be aware that they, too, will make mistakes—and that I will help them recover. In doing so, we can learn from our mistakes and work together to do what is best for the patient.